Inspection on 26/09/08 for Westbury Grange

This inspection was carried out on 26th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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: Paganell Grange Westbury Lane Newport Pagnell Buckinghamshire MK16 8JA     The quality rating for this care home is:   one star adequate 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: Barbara Mulligan     Date: 2 9 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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 31 Information about the care home Name of care home: Address: Paganell Grange Westbury Lane Newport Pagnell Buckinghamshire MK16 8JA 01908210322 01908615282 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Linda Stubbs Type of registration: Number of places registered: Methodist Homes for the Aged 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 category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Paganell Grange is a nursing home providing personal care and accommodation for thirty older people. The home is situated in Newport Pagnel on the same site as its sister home. The home is located close to the town centre of Newport Pagnell, which offers a variety of shops, restaurants pubs and other amenities. The home is divided into three house groups called the Cedars,Portsfield and Lovat. Each of these house groups has a small kitchen,lounge and dining area. These are well maintained and 0 Over 65 0 Care Homes for Older People Page 4 of 31 Brief description of the care home nicely decorated, bright and cheerful. All bedrooms have ensuite facilities and can be personalised by the occupant. Fees range from £550 per week to £667 per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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: This unannounced key inspection was conducted over the course of two days and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account. The Commission received five CSCI surveys from people who use the service. The inspection officer was Barbara Mulligan. The registered manager is Linda Stubbs. The inspection consisted of discussion with the registered manager and other staff, opportunities to meet with some people who use the service, examination of some of Care Homes for Older People Page 6 of 31 the home’s required records, observation of practice and a tour of the premises. The home has recently had a new provider, Methodist Homes and they had been managing Paganell Grange for six months. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? What they could do better: The home must make sure that a record is completed of all medicines administered and all hand written entries on medicine charts are signed and dated by two staff. The home must make sure that guidelines are in place for the administration of medicines prescribed to be given only when required. The home must make sure that people living in the home, and especially being nursed in bed are given opportunities for stimulation through leisure and recreational activities which suit their needs, preferences and capacities. The organisation must contact the Environmental Health Department to view the lunchtime process and to act upon any advice issued. Adequate numbers of competent and experienced staff must be available to support Care Homes for Older People Page 8 of 31 service users during meal times and ensure their needs can be met. The organisation need to review and improve upon the present regime for meal times so that service users receive a varied and nutritious diet, taken in a congenial setting and at flexible times. The gardens need to be maintained and kept tidy. The organisation must carry out a review of the needs of people who use the service, and staffing must be provided in line with these needs. The fire risk assessment needs to be updated and this must be carried out annually. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience 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 assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. Evidence: The home has a new provider so the Statement of Purpose and Service Users Guide were looked at as part of the inspection. Both documents are very detailed and informative. Some areas are in pictorial form to make it more user friendly. Four completed needs assessments were examined, including those most newly admitted to the home. The home are using a new organisational assessment tool. This was seen in the files for people new to the service. This tool is comprehensive and completed assessments were detailed and informative. The assessment tool covers health promotion, tissue viability, nutrition, spirituality and religious practice, personal care, mobility, emotional well-being,maintaining a safe working environment, Care Homes for Older People Page 11 of 31 Evidence: communication, resting and sleeping, expressing sexuality and change, loss and adaption. This information is readily available to staff who are expected to refer to the documentation to meet service users care needs. It is noted that the service users have been asked their preferred name which is indicated throughout any further documentation seen, this is noted as good practice. The assessment demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. The home does not admit service users for intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people using the service are well met, with personal care delivered in a way that promotes respect and dignity. However, improvements need to be made to the recording of medicines administered, to ensure people are protected by the homes medication practices. Evidence: Four care plans were examined during this inspection, including those most newly admitted to the home. The home has changed the care planning documentation to a new format as a result of having a new provider. These are very detailed and informative and reflect the changing needs of the individual. Care needs are identified with a very detailed action plan setting out guidelines detailing how staff will meet those needs. All care plans observed are of a high standard. There was evidence that care plans are reviewed monthly and it is noted that this is a thorough process and not just no change written. Daily notes are detailed and informative and record the personal care received and activities that the individual has undertaken through out the day. Care Homes for Older People Page 13 of 31 Evidence: Service users are registered with two local GP Practices. The registered manager said they can register with their own GP if this is practical and agreeable to both parties. All have access to local NHS Services. Tissue viability assessments are in place for service users and these were seen to be reviewed on a monthly basis and pressure relieving equipment is in place for individuals who need it. A domiciliary optical service visits the home on an annual basis and referrals for a hearing test go through the service users G.P. Nutritional risk assessments are completed for each person and weight monitoring is undertaken on a monthly basis and recorded. This was evident in the four files examined. Chiropody services visit the home on a six weekly basis. At the time of the inspection there were no service users who were able to selfadminister their medication. Medication is stored in three mobile lockable trolleys and these are kept in a locked treatment room. The home uses a monitored dosage system and all medicines are administered by qualified nurses. There were no out of date medications held in the service users home with a returns procedure in place. There are systems in place to ensure that controlled drugs are handled in line with the Misuse of Drugs Regulations 1973. The Medication Administration Records (MAR) were examined for two house groups. Photographs of service users, on medication charts, are used for identification.There were several omissions noted in each and this needs to be addressed. Several handwritten entries were evident on MAR charts which were not signed or dated. When medicines are prescribed to be given when required there were some protocols available in records for staff to follow which detail why and when these should be given. However, these need to be in place for all when required medicines. A requirement has been issued to address these areas of the medication practices in the home. Preferred terms of address are identified at the initial assessment and the inspector saw evidence of this in care plans. The homes induction programme includes training regarding privacy and dignity. Staff are also given a code of conduct and there is a care policy available for staff regarding privacy and dignity. The Statement of Purpose and Service Users Guide include information about maintaining the privacy of service user’s. Residents of the home can have a key to their rooms if they wish to use this facility and it is felt to be safe. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems need to be improved in the home so that service users are given more opportunities to engage in appropriate leisure activities which meet their social, leisure and spiritual needs. The present meal time regime needs to be improved to ensure service users receive a varied and balanced diet, in a congenial setting, which is unrushed and suited to the needs of the people living in the home, not the organisation. Evidence: The routines in the home are flexible and service users spoken to said they have a choice as to when they get up and when they go to bed. They are able to have meals in their room if they wish. Relatives and friends are welcome at any time and visiting relatives spoken to on the day were able to confirm this. The home employs a volunteer coordinator and her role is to find volunteers to provide activities for residents of the home. The inspector was informed that the home is not provided with a budget for activities. Money is raised by the volunteers coordinator who recently completed a sponsored sky dive and the home has a league of friends who also raise funds. There are organised activities available and some of these include hand massage, table games, cream teas, beetle drive and sing-a-long. During the two day Care Homes for Older People Page 15 of 31 Evidence: inspection it was noted that a high number of service users were being nursed in bed. These individuals are unable to attend the organised activities and are at risk of becoming socially isolated. The inspector was able to talk to a visitor on the day whose relative was being nursed in bed. She said mum is lucky because she has visitors every day. I feel sorry for people in bed who dont have many visitors because staff dont have the time to sit with them as they are so busy. Staff spoken to over the course of the two day inspection confirmed that they have very little time to sit with people being nursed in bed. Some staff also expressed concerns that if an individual was receiving palliative care, staff would be unable to attend to their needs appropriately. A recent audit/assessment of the home, undertaken by the organisation,identified that there is a lack of stimulation for residents who do not wish to take part in the one organised activity daily. The home must ensure that where service users are being nursed in bed they are still given opportunities for stimulation through leisure and recreation activities which suit their needs, preferences and capacities. It is questionable how long the home can maintain a varied and full time table of activities when having to rely on volunteers and fund raising to do so. A requirement is issued for improvement in this area. Examples of involvement in the home by local community groups and individuals are visits by mobile hairdressers, various visiting entertainers and a chaplain who visits the home twice weekly. Service users are able to receive visitors in the privacy of their own rooms and are able to choose whom they see and do not see. There are no restrictions on visiting, and this is documented in the Service Users Guide. Family and friends are invited to participate in some of the social event organised. Service users and/or their families are encouraged to look after their own financial affairs whenever possible. If this is not practicable a chosen solicitor will be responsible for an individuals financial dealings. An invitation to bring in personal items of furniture and other belongings is included in the service users guide and this was evident during a tour of the premises. On the day of the visit the inspector was informed that the kitchen had been closed due to poor practices and meals were now being cooked at the sister home on the same site. However, the report for the kitchen does not demonstrate why the kitchen needs to be closed permanently and the shortfalls identified can be easily rectified. With the closure of the kitchen it is questionable if the premises is suitable for the purpose of achieving the aims and objectives set out in the statement of purpose. The organisation are required to contact the Environmental Health Department for advice and to act upon any recommendations they may issue. Two staff are required to collect the meals from the neighbouring home and to Care Homes for Older People Page 16 of 31 Evidence: distribute these to the three house groups within Pagnell Grange. The inspector accompanied staff for this process. We set off at 12:20pm to collect the food from the sister home. The meals had been cooked and were sitting in a heated trolley. The meals were then transferred into an insulated trolley. Not all of the food would fit into the trolley so the maintenance man carried some trays over. Some dishes and jugs of custard were balanced on the top of the trolley. Many areas of the grounds are uneven and the carer pushing it said it can be difficult to maneuver in certain places. Another carer told the inspector she had hurt her back pushing the trolley.The trolley is then taken into the kitchen which has been closed to dish up the meals for the different house groups and put into smaller heated trolleys. The staff have to liquidise the soft diets at this point which can be time consuming. A member of administration staff regularly helps with the distribution of the meals to the house groups. Heated trolleys are then taken to the different house groups. Once the food arrives at the house groups the food is put onto individual plates and the temperature of the food is taken. The inspector observed numerous meals having to be re-heated in the micro wave. The inspector observed the meal time for house group 3. There are two staff for each house group. In house group 3 there are a minimum of six service users that need assistance with feeding and these people tend to take their meals in their room. Staff regularly work twelve hour shifts as part of the rota system and if a member of staff is working a twelve hour shift, they are required to take their lunch break during this period. This leaves one care worker to attend to the entire house group.However,a member of the administration staff regularly helps out with supporting service users to eat their meals. Two staff are required to collect and distribute the meals during the present regime which takes them away for the task of supporting service users to eat their meals. The inspector was informed that this is usually a carer and a nurse. It has been observed how rushed and difficult the lunchtime period is.Staffing at mealtines is already at a minimum and this lack of necessary support makes the outcomes for service users unacceptable. A requirement is made for adequate numbers of competent and experienced staff to be available to support service users during meal times and ensure their needs can be met. There were four service users seated at the dining table in house group 3. The last person to receive their lunch did so at 13:25pm. This individual was complaining that she had been seated at the table for over an hour until she received her lunch. The lunch time meal was rushed and Inpersonal. Service users were not offered salt and pepper or sauces by any care staff. Two different care workers were observed at different times to assist a service user with their meal. They stood beside him and did not speak to him. They gave him a fork-full of food then walked away. The administration staff member was the only person observed to offer condiments and who spoke to the individual in an appropriate manner and who responded to their needs. Staff spoken to during the lunchtime period said that the new regime does not allow a choice of meals for service users and Care Homes for Older People Page 17 of 31 Evidence: they are no longer able to have a cooked breakfast. The organisation are required to review the present regime to ensure a wholesome and service users receive a varied and nutritious diet taken in a congenial setting and at flexible times. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience 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 able to effectively manage complaints and safeguard service users ensuring service users are listened to and kept safe from harm and abuse. Evidence: The home has a complaints procedure, which is accessible to service users and their representatives. This is dated 2003 and still refers to the National Care Standards Commission. It is strongly recommended that this is updated to include present information about the Commission for Social Care Inspection. A record of all complaints is maintained, and this was viewed. The home has received one complaint since the previous inspection and this is well recorded and responded to within timescales. A summary of the complaints procedure is included in the Statement of Purpose and Service Users Guide. No complaints or concerns have been received by CSCI. Procedures are in place for the protection of vulnerable adults and staff have access to a whistle blowing policy. The home has a copy of the local authority SOVA policy. Training records demonstrate that staff have undertaken training in adult protection. There has been one safeguarding issues which has been referred to the appropriate authorities and has been concluded satisfactorily. Care Homes for Older People Page 19 of 31 Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within the home is good, providing people who use the service with an attractive and homely place to live. Evidence: Paganell Grange is a nursing home providing personal care and accommodation for thirty older people. The home is situated in Newport Pagnell on the same site as its sister home. The home is located close to the town centre of Newport Pagnell, which offers a variety of shops, restaurants pubs and other amenities. The home is divided into three house groups called the Cedars,Portsfield and Lovat. Each of these house groups has a small kitchen,lounge and dining area. These are well maintained and nicely decorated, bright and cheerful. There are personal touches around the home such as flowers, pictures, books and mirrors. The main kitchen has been closed and meals are prepared in the sister home on the same site. A requirement has been issued for the registered provider to contact the Environmental Health Department to view the lunchtime process and to act upon any advice issued. The gardens have not been well maintained and are scruffy and untidy. During a recent audit of the home the findings identify the exterior of the home and the gardens are very unkempt It is a requirement of the reoport that this is adressed. Care Homes for Older People Page 21 of 31 Evidence: There are accessible toilets available for service users throughout the home and several are close to the lounges and dining area. There is a system in place to address day-to-day maintenance issues, so that the safety of service users and staff is safeguarded. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The laundry floor finishes are impermeable and these and the wall finishes are readily cleanable. The home has an infection control policy and eighteen staff members have attended infection control training, including laundry and housekeeping staff. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a staff team who are adequately trained to support the residents with personal care. However, staffing numbers are not adequate at all tomes of the day and need to be reviewed to ensure the needs of service users can be met. The home has a robust recruitment procedure that ensures the safety and protection of residents in the home. Evidence: The homes staff rota demonstrates that there are generally adequate numbers of staff on duty. However, because of the present situation at mealtimes there are not enough staff to satisfactorily meet the needs of service users at this time. The registered provider is required to ensure that a review is undertaken of service users needs and the staffing levels are viewed in line with service users needs. Staff spoken to on the of the inspection said that I go home exhausted. I like to do activities with the residents like giving some one a manicure but I never get the time. I go home thinking I didnt do everything I wanted to do today. Another staff member said, whenever I sit with the residents to talk or carry out an activity I get called away. A further comment made by staff felt that the organisation have not been supportive to staff during the transition. Information given to us has been poor and always late. Staff morale has been very low. Care Homes for Older People Page 23 of 31 Evidence: The home continues to support staff on NVQ training and at the time of this inspection all care staff had completed NVQ training. This is to be commended. The recruitment files for the two most recently appointed staff and a further two files for staff recruited several years ago were examined. All files looked at contain the necessary documentation as detailed in schedule 2. There is evidence that all staff CRB checks had been obtained. Several CRB checks are dated 2003 and 2004 and it is recommended that these are renewed. The registered manager said that staff attend the Milton Keynes Council five day induction course. This ensures that new staff members are familiarised with their roles and responsibilities and provides the staff member with a personal development portfolio. This includes fire safety, moving and handling techniques and core skills training. Training records reflect that staff have received mandatory training and this appears to be up to date for all staff. There is specialist training available for staff, an example of this is care of the dying, the principles of care and dementia awareness training. Staff confirmed that there are regular staff meetings. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a consistent service to people using the service and there are systems in place to protect the health and safety of service users. The home must ensure that the fire risk assessment is updated annually. Evidence: The manager has been in post for four years. Prior to this she was assistant manager for two years. The registered manager is a registered nurse and has completed the Registered Managers Award. She said that she regularly undertakes training to update her knowledge and skills.Training undertaken in the previous twelve months includes care of the dying, supervision and appraisals and principles of care. Staff meetings take place regularly and staff spoken to confirmed this and copies of minutes of the meetings are held on file. The manager said that staff receive one to one supervision meetings which have only recently been introduced and the inspector saw the dates recorded for these meetings. Care Homes for Older People Page 25 of 31 Evidence: The home has been purchased by Methodist homes and this took place approximately six months ago. The registered manager requested that the organisation complete its own standards and values assessment so the home can identify the areas that need further development in line with the new organisation. This covers values, person centred care, social needs, diversity, the environment, catering, house keeping, security and safety, medication, training and staffing. Accident and pressure sores and complaints are monitored on a regular basis. There is a folder containing compliments and thank you letters, mainly from the relatives of service users. It was noted that one of the organisation’s senior managers visits the home monthly to carry out regulation 26 visits. The manager does not undertake the role of appointee for any service users. Most families look after their relative’s money and only a small number of individuals require the home to look after personal money. Relatives will bring in small amounts of personal money and written records are maintained of all transactions. Secure facilities are available for the safekeeping of valuables if required. Records were seen for fire safety. These cover the homes fire procedures, practice fire drills, fire prevention, fire alarm testing and emergency lighting testing. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment and it was noticed that this needs to be updated. A requirement is issued for improvement in this area. Evidence of mandatory health and safety training demonstrates that staff are up to date with this training. Service reports are in place for the maintenance of hoists and the lift. There are service certificates for the gas appliances dated 07/08/08, PAT testing January 2008, electrical installation 14/12/2007 and legionella 10/09/08. There are systems in place for water chlorination and kitchen hygiene. COSHH sheets are up to date and accurate. The inspector looked at Infection Control guidelines that are available for all staff. Care Homes for Older People Page 26 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person is required to ensure that guidelines are in place for the administration of medicines prescribed to be given only when required. To ensure that service users receive the medicines they require as prescribed. The registered person is required to ensure that a record is completed of all medicines administered and all hand written entires are signed and dated by two staff. To ensure that service users are protected by the systems in place. 30/11/2008 2 9 13 30/11/2008 3 12 16 The registered person is 30/12/2008 required to ensure that service users, including those people being nursed in bed, are given opportunities for stimulation through leisure and recreational Care Homes for Older People Page 28 of 31 activities which suit their needs, preferences and capacities. To ensure that the home can meet the social, cultural, religious and recreational interests and needs of people who use the service. 4 15 12 The registered person is required to review the present regime to ensure service users receive a varied and nutritious diet, taken in a congenial setting and at flexible times. To ensure service users receive a wholesome, appealing diet, in pleasing surroundings at times convenient to them. 5 15 18 The registered person is 30/11/2008 required to ensure that adequate numbers of competent and experienced staff are available to support service users during meal times and ensure their needs can be met. To ensure service users are offered assistance in eating, discreetly and sensitively. 6 15 23 The registered person is 30/11/2008 required to contact the Environmental Health Department to view the lunchtime process and to act upon any advice issued. 30/11/2008 Care Homes for Older People Page 29 of 31 To ensure that meals are provided safely for people using the service. 7 19 23 The registered person is required to ensure the gardens are appropriately maintained. To ensure the grounds are kept tidy, safe, attractive and accessible to service users. 8 27 18 The registered person is required to ensure that a review of service users needs is completed and staffing levels are adjusted in line with this. To ensure the needs of service users can be met. 9 38 23 The registered person is required to ensure that the fire risk assessment is updated. To ensure the safety of service users and staff in the home. 30/10/2008 15/11/2008 30/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 16 It is recommended that the organisations complaints procedure is updated to include present information about the Commission for Social Care Inspection, and must include an upto date address. It is recommended that all CRB checks dated 2003 and 2004 are renewed. 2 29 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. 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