Inspection on 28/10/08 for Park Hall Resource Centre

This inspection was carried out on 28th October 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Park Hall Resource Centre 03/10/06

Park Hall Resource Centre 15/11/05

Park Hall Resource Centre 14/06/05

Park Hall Resource Centre 22/11/04

Park Hall Resource Centre 22/01/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Park Hall 1 Park Hall Reigate Surrey RH2 9LH     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: Jane Jewell     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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Park Hall 1 Park Hall Reigate Surrey RH2 9LH 01737224420 01737223755 Rachel.Darcy@Surreycc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Rachel Darcy Type of registration: Number of places registered: South West Surrey Adults & Community Care Services care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 50 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 : Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Park Hall is located in a quiet residential area on the outskirts of Reigate. The home is registered to provided personal care and accommodation for up to fifty older people, some of whom have dementia. The home is owned and operated by Surrey County Council, who also operate a further six registered care establishments in the Surrey area. . The premises are purpose built and of modern design. Accommodation is Care Homes for Older People Page 4 of 31 Over 65 0 50 50 0 Brief description of the care home arranged across five units all of which are at ground floor level. Each unit has its own placement arrangements and aims and objectives. Two units are mainly used to accommodate elderly frail residents on respite care, one unit for the Promotion of Independence Programme (PIP) and two units are for people who have various levels of dementia care needs. Each unit has its own bathroom and toilet facilities and a communal lounge and dining area. All bedrooms are for single occupancy and have a wash hand basin. There is also a large day centre which is accessed by the local community as well as the residents at the home. The home provides a range of placement arrangements including Intermediate care, respite care and long term placements. The homes literature states that it aims to provide a range of residential and day care services for vulnerable frail older people who meet the county council eligibility criteria. 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: The information contained in this report has been comprised from an unannounced inspection undertaken over six hours and information gathered about the home before and after the inspection. The person appointed by the provider to oversee the running of the home had completed an Annual Quality Assurance Assessment form prior to the inspection and the information contained in this document has been used to inform the inspection. Feedback comment cards were sent to the home in advance of the inspection for the home to distribute and fourteen were returned. Ten were from residents three from relatives and two from a health care professional. A summary of their feedback is contained in this report. There were thirty six residents at the home at the time of the inspection. Care Homes for Older People Page 6 of 31 A senior carer who was the person in charge, facilitated the inspection which consisted of a tour of the premises, examination of the homes documentation and in-depth discussion with ten residents and ten staff. Five relatives were also consulted about their experiences at the home. The inspector spent time observing residents on two units during lunch time period and in their daily routines and in their interactions with staff. This was in order to assess the well-being of residents who are not able to verbally share their experiences of the home. There were thirty six residents at the home on the day of the inspection. What the care home does well: What has improved since the last inspection? All of the shortfalls noted at the previous inspection have now been addressed or are in the process of being addressed. This has improved the environment in which residents live through minor redecoration and better management of odours. Residents safety Care Homes for Older People Page 8 of 31 has improved by a more robust recruitment process which helps to ensure only those people who are suitable are employed. The home has been without a registered manager for some time, consistent feedback was received that the person appointed by the provider to oversee the running of the home has made significant positive changes to the running of the home and its practices. This is with particular reference to staffing, environment and food. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Older People Page 9 of 31 240 7535. Care Homes for Older People Page 10 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 11 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. The home provides both prospective and existing residents, with a range of information about what services are provided and what to expect when living at the home, with minor additions needed to these documents to ensure that they include the range of additional fees. Residents only move into the home following an assessment of their needs. The home demonstrates that it can meet most needs of residents with further work needed in staffing competence and training to ensure that the needs of people who have dementia can be fully met. Evidence: There is a range of information about the home and the services it provides, this includes a statement of purpose and service user guide which are displayed at the Care Homes for Older People Page 12 of 31 Evidence: home and given to prospective residents, representatives and other interested parties. Copies of previous inspection reports are also easily assessable. A resident said that their relative had been given all of the information she needed about the home. Residents are provided with a written contract of terms and conditions of residency with the home. This can be used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. A signed copy of the contract is usually retained in residents files. Minor additions are needed to this contract to include the range of additional charges. This is to ensure that prospective residents are aware of the full range of charges at the home. The home ensures that prospective residents are accommodated following an assessment of their needs by the person appointed to run the home or by Social Services. Advice is sought during the assessment process from health care professionals and others who know and understand the needs of the prospective resident. In the case of emergency admissions the home gathers as much information as is possible in advance of any admissions. Needs assessment are used to form the basis of a care plan. This helps ensure that staff are aware of the recorded needs of new residents prior to them moving into the home. There is a wide range of residents needs accommodated, this includes residents who are receiving intermediate care and who require minimum support and residents who have complex dementia and physical needs. The home generally balances well the range of residents needs, through the home having specialised units where residents of similar level of needs are accommodated. Further work is however needed in the dementia care units, in order for the home to be able to meet most needs of residents who have dementia. This is discussed further in this report. A sample of comments received from residents and relatives about their overall experiences at the home included, very satisfied with the home happy staying here on respite we think park hall should be congratulated on all they do. They do their best to look after us in every way very nice place to come and stay of all the places we visited this was the best and still is and Welcoming and very friendly. Residents and their representatives consulted with spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Most residents consulted said that it was their families that looked around the home on their behalf. For long term placements the first six weeks of occupancy is looked upon as trail occupancy. Where social services are the placement authority it is usual practice that Care Homes for Older People Page 13 of 31 Evidence: within this period a review be undertaken to determine whether the residents wishes to stay permanently or not. The home works closely with the Intermediate care team to ensure that residents referred for PIP/intermediate care receive the support they need, in order that they complete the rehabilitation programme view to them returning to independent living. Staff showed a clear understanding of the aims and objectives of PIP and spoke of the training they receive and the equipment provided to be able to provide the appropriate support to residents. Care Homes for Older People Page 14 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. Care plans need to accurately reflect the range of residents needs, in order to ensure that staff have the guidance necessary to meet their needs and provided consistent care. Medication procedures and practices are generally good, however further work is needed on ensuring residents safety in the administration of as required medication Residents receive good health care intervention they need from a range of health care professional. Personal support is offered in ways, which generally promotes and protect residents privacy and dignity. Evidence: Five plans of care were examined from across the various units at the home. Some good examples were noted in care plans which provided clear guidance for staff on the Care Homes for Older People Page 15 of 31 Evidence: needs of residents and how their needs are to be met. A health care professional feedback that Parkhall operates a good individual care service. However the care plans for people who have dementia did not include the range of residents needs observed at the inspection. This lead in one instance of inconsistent care practices being observed by the inspector that resulted in some anxiety and confusion for a resident. The home maintains a daily record for each resident on events and occurrences. The tone of language used was respectful however examples were noted whereby the notes were largely repetitive and were not linked to residents care plans and their goals. For example where individual goals and care needs had been identified there was little reference to how these were being met in the daily notes in order to provide the accumulative evidence needed when reviewing care plans. The standardised care planning documentation used did not take into account the various placements arrangements ie PIP, short term care and long term dementia care, or take into account each placement types different aims and objectives. This meant that the care plans were often restricted in being able to provide the range of guidance for staff on the needs of residents. This was particularly noticeable in dementia care where a more specialised person centred care planning process is needed. The risks faced and posed by residents are assessed and any actions needed to reduce or manage risks are recorded in the care plans. Records of medical intervention showed that the home works closely with health care professionals including GP, Occupational therapist District and specialist nurses, chiropodists, opticians and dentists to ensure residents receive a range of health care intervention. Residents consulted said that when they have asked to see a Doctor then this has been sought promptly. A health care professional feedback that Staff are always receptive to any information passed either way from the PIP team to them good inter service relations. The medicine administration practice observed showed that systems have been established to ensure staff are trained and records are accurate and provide a history of what was given by who and when. However an example was noted whereby the staff member administering medication did not know the prescribed instruction for an as required medication. This was of particular concern as it was a life effecting medication which would have needed to be administered promptly. Records did show however that this medication was not regularly being used, but a more robust system must be in place to promote their safely. It has therefore been required that additional Care Homes for Older People Page 16 of 31 Evidence: instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. In order to fully eliminate the associated risk when copying prescribed instructions onto medication administration records, it is recommended that these records should be checked and countersigned for accuracy by a second member of staff. Staff consulted with showed an understanding of practices in preserving residents rights to privacy and dignity and gave examples of how they promote these rights in their every day care practices. A relative spoke of how staff went out of their way to ensure that their relative dignity remained in tack despite some resistance from their relative. The use of incontinence bed sheets on the seats of lounge chairs was noted as a practice that did not promote the dignity of residents and it is recommended that this practice be reviewed. Staff spoke of the support they had received in the past from Health Care professionals during the care of residents who are receiving end of life care. Staff also spoke sensitively about the care and support provided to residents and their families when residents have become terminally ill. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are helped to exercise some choice and control over their lives with flexible routines being a part of daily practice at the home. Links with families and friends are valued and supported by the home. Residents lives need to be further enriched by the home providing appropriate opportunities for occupation and leisure. The meals are good offering both choice and variety. Evidence: It was evident, during the inspection that the routines of daily living are flexible to suit residents individual needs e.g. rising going to bed, taking meals in their private rooms and entertaining visitors. A resident commented I choose when I want to go to bed and just let the girls know and they fit me in whenever they can. For a few people living at the home, being able to exercising their choice was difficult due to their level of needs. Staff were seen in some instances to use their acquired knowledge of the person to help them make choices with regard to food and drink. Care Homes for Older People Page 18 of 31 Evidence: Variable feedback was received on the opportunities for occupation and stimulation. A sample of comments included No stimulation down on the dementia unit, TV is left on they sit there all day long sometimes there are activities that you can take part in not all activities are suitable and not everyone can do them I am asked if I want to go to the day centre but its not really what I enjoy and I am very happy with occupying myself. There is an onsite day/resource centre which is accessed by the community along with any residents who wishes to attend. On the day of the inspection three residents were attending. Feedback was received in the lack of encouragement in the way staff sometimes asked residents if they want to attend the day centre which did not motivate residents. Each unit has access to a range of equipment suitable for in house entertainment, including craft and audio equipment. However a staff member spoke of not always having the time to use this equipment. Staff did not always demonstrate an understanding of activities, occupations suitable for people who have dementia. A relative and staff member when asked what the home could improve upon both said increasing the opportunities for residents to go out. In order to further enrich residents lives it has been required that residents social needs and preferences are identified and recorded on individual care plans and opportunities for social engagement and meaningful activities be provided based on these identified needs. Visitors commented upon how welcomed they are made to feel during their stay, this included being offered beverages or meals and staff being friendly and approachable. Relatives commented No restrictions can visit whenever we want and make a cup of tea ourselves whenever you want and there is good communication between the home and us. Lunch time was observed with staff offering discrete assistance and encouragement to those residents who needed support to eat. Staff showed an understanding of the importance of positive environmental factors during meal times for residents who have complex dementia in order to help maintain their focus. The meals are good offering both choice and variety and catering for special dietary needs. Although residents choose their meal preferences the day before, good practices were observed in meals being individually served onto plates from serving dishes based on each unit. This enables the staff to adapt the meal in accordance with individual preferences and provided residents with the opportunity to change their minds. A sample of comments made about the food included: very good you get a choice food wonderful they get you something else if you don’t like whats on offer and the food pretty good. Care Homes for Older People Page 19 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. There is a complaints system with evidence that all residents and the majority of relatives consulted with felt that they are able to raise any concerns which would be acted upon promptly. Staff have the guidance necessary to show them what to do if abuse is suspected. Evidence: There is an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. All residents consulted with said that they felt able to share any concerns they had with staff and that where they have done so their concerns have been addressed promptly and satisfactorily. The majority of relatives consulted with also felt confident to raise concerns, however one relative felt that issues they have raised regarding the lack of stimulus for some residents had not been addressed or their views listened to. The home has written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. The majority of staff have received formal training in safeguarding adults and prevention of abuse. The staff consulted with showed some understanding of their roles and responsibilities under safeguarding adults guidelines. Care Homes for Older People Page 20 of 31 Care Homes for Older People Page 21 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. Residents live in a clean and homely environment, with minor redecoration needed to ensure that it remains well decorated throughout. The layout of one lounge area did not always promote social interaction. The home ensures that residents private accommodation is equipped to provide comfort and privacy and to meet the assessed needs of those people residing in the room. Evidence: Park Hall is located in a residential road on the outskirts of Reigate. Local facilities are a short journey away. The premises are split into five distinct units each with their own dining lounge areas and kitchen. Communal space is spacious and includes the day centre, small quiet areas throughout, hairdressing room and gardens which surround the home. The garden consists of small patio areas with seating. Although winter at the time of inspection a resident was enjoying sitting in the garden. They had been provided with suitable seating and blankets to ensure their comfort and staff were attentive to them. Much effort had been made to create a homely environment, however parts of the home are in need of minor redecoration in order to ensure a consistency good Care Homes for Older People Page 22 of 31 Evidence: environment throughout. The home has been required to develop a plan of redecoration and repair in order to address this. The currently layout of the lounge area in the dementia unit did not always enable a range of social activities to take place or social interaction. A relative commented very small TV which is not able to be seen due to lay out of the room. The inspector also observed a residents anxiety, which in part, related to not being able to see and get a response from staff due to the position of their lounge chair. This was feedback to the staff on duty who agreed to review the layout of the room and said that they are currently awaiting a larger TV. All residents consulted with said that their private space provided everything they needed. Residents bedrooms were observed to have been individualised, where possible, to reflect their individual lifestyle and preferences. There was a range of individual aids and adaptations to assist residents mobility and independence, including raised toilet seats, walking aids, hoist ramps and grab rails. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. Residents who said that they have used it all said that staff responded quickly to calls for assistance, including at night. All areas inspected were observed to be cleaned to a high standard. Residents commented No horrid smells always looks clean and Nice bedroom always kept clean. A relative feedback that it was often cold as windows are left open. This was the case on one unit during the inspection as the domestic staff said that this helped in drying shampooed carpets. Staff on duty agreed to monitor this to ensure that this procedure does not make it too cold for residents. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally residents benefit from a staff team who are motivated and who are trained to work with them safely and who have access to a range of specialist training. However not all staff working on the dementia units demonstrate an understanding of good practices in the care of people who have dementia. Staff are robustly recruited to help ensure residents safety. Evidence: Many letters of compliment and praise were seen, which in particular mentioned the kindness of staff. Staff were observed being courteous towards residents and visitors. Many positive interactions were noted between staff and residents which often involved humour. A resident who was receiving PIP support spoke of how well staff encouraged her to remain independent. Residents who were not able to verbally share their experiences showed signs of recognising staff and feeling comfortable in their company, who in return showed affection and sensitivity. Consistent feedback was received from staff and relatives regarding the sometimes insufficient staffing levels on the dementia care units. Two relatives commented Always seem to be short staffed however the staff seem very nice good attitude most of them do their best seem understaffed and staff seam to disappear for 15 minutes Care Homes for Older People Page 24 of 31 Evidence: at a time to go and help on the other unit. Some of the staff dont always seem motivated to work in the best interest of residents and Some of the staff it can be difficult to understand their English sometimes. Staff feedback that when there is not enough staff on duty at peak times meant that they do not always have to time to meet the emotional needs of residents. A staff member commented Dont always have the time to sit and talk with residents and trying to meet some residents needs can be quite difficult at times. Not all key staff assigned to the dementia units had undergone the comprehensive dementia care training made accessible to staff at the home. An incident was observed by the inspector which demonstrated a lack of understanding in the care of people who have dementia. This was feedback immediately to the person in charge who rectified the situation. It has been required that at all times there are suitable qualified staff on duty in such numbers as is suitable to meet the needs of residents. The home has been proactive in ensuring that the majority of staff have completed a National Vocational Qualification in care. All of the staff consulted with spoke of having completed or are in the process of completing all of the mandatory areas of training needed for them to be able to work safety with residents. Staff also spoke of undertaking a wide range of specialist training with a staff member commenting Training is excellent here, Surrey do offer a really good range of training. A staff member spoke of the training they had undergone to be able to work with residents who are receiving PIP and how this enabled them to have the skills to follow the programme of rehabilitation designed by occupational therapists. Several staff spoke of currently undertaking a comprehensive dementia care course. It was discussed with the person appointed to manage the home their plans to enable this training to positively influence care practices within the dementia care units and to enable all staff assigned to these units to undergo appropriate training in dementia care. The personal files of the three staff were inspected and these showed that a robust recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau checks and written references prior to employment commencing. Care Homes for Older People Page 25 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. Residents benefit from an effective management team which has a strong sense of leadership and direction. The systems for resident consultation are good with a variety of evidence that indicates that residents views are both sought and acted upon. Staff are generally being supervised, however closer supervision of staff within the dementia care units is currently needed in order to promote good care practices A range of regular health and safety checks and good practices helps to promote the health and safety of residents and staff. Evidence: The person appointed to manage the home has been in post since July 2007 and are currently in the process of applying to the Commission to become the registered Care Homes for Older People Page 26 of 31 Evidence: manager. They demonstrated a clear understanding of the daily running of a service for older people and of their role and responsibilities. All persons spoke positively about them with particular reference to how supportive they are and the improvements they have made to the service. A sample of their comments included Manager extremely supportive Manager like her always friendly Rachel best manager the home has had here in a long time, listens to you Rachel very good I trust her and Its a nice place to work and it is getting better under the new manager. The manager is supported by an established senior care team who collectively have considerable experience, skills and knowledge. In line with the previous requirement improvements have been made to the way in which the home monitors whether it is achieving its aims and objectives. This includes sending out twice yearly surveys to residents and stakeholders involved in their care in order to ascertain feedback on the quality of the services and facilities. Changes to menus and staffing have occurred as a result of feedback from residents. Residents meetings are held where residents are encouraged to air any views. Regular internal audits are undertaken on elements of the homes practices in order to identify any areas for future service developments. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or other responsible persons external to the home. Staff spoke of receiving formal supervision with their line manager and all felt well supported to undertake their roles. Closer supervision of care practices on the dementia care units is needed to promote improvements and ensure residents social and emotional needs are being assessed and met. Records submitted by the home prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems were in place to support fire safety, which included regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that they had undertaken a fire risk assessment, which recorded significant findings and the actions taken to ensure adequate fire safety precautions in the home. Care Homes for Older People Page 27 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 28 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 7 15 That care plans provide clear 23/02/2009 guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs. To ensure that staff know how to support residents in order to be able to meet thier needs. 2 9 13 That additional instructions 23/01/2009 are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. To ensure that staff know when to administer these medicines. 3 12 16 That service users social needs and preferences are identified and recorded on individual care plans and 23/02/2009 Care Homes for Older People Page 29 of 31 opportunities for social engagement and meaningful activities be provided based on these identified needs. In order to further enrich residents lives. 4 19 23 That a plan of re-decoration 23/03/2009 and repair be developed, which addresses the areas of redecoration and repair identified at inspection and includes timescales for their completion. To ensure that the home is in a good state of redecoration thorought 5 27 18 That at all times there are sufficient numbers of staff who are appropriately qualified, experienced and trained to ensure the health and welfare of service users and to meet the assessed care needs of service users To ensure that residents needs can be met and that staff have the skills to be able to 23/02/2009 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 9 That hand written Medication Administration Records (MAR) are checked and countersigned by a second member of staff for accuracy. That the use of incontinence bed sheets on lounge chairs be reviewed in order to promote residents dignity. 2 10 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 © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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