Inspection on 22/12/08 for Philips Court

This inspection was carried out on 22nd December 2008.

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

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

Other inspections for this house

Philips Court 16/11/09

Philips Court 19/02/08

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Philips Court Bluebell Close Sheriff Hill Gateshead Tyne & Wear NE9 6RL     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: Irene Bowater     Date: 2 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 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 33 Information about the care home Name of care home: Address: Philips Court Bluebell Close Sheriff Hill Gateshead Tyne & Wear NE9 6RL 01914910429 01914913428 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross BC OpCo Ltd Name of registered manager (if applicable) Cynthia Dove Guy Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 75 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Dementia Code DE, maximum number of places 75 Mental Disorder, excluding learning disability or dementia, Code MD, maximum number of places 75 Date of last inspection Brief description of the care home Philips Court Nursing Home is a 75 place facility.It has a 15 place unit,which provides personal care and two 30 place units which provide nursing care for predominantly people with dementia. The two nursing units are located at one side of the home, with the personal care unit being at the other side of the home. The reception area, a large Care Homes for Older People Page 4 of 33 care home 75 Over 65 0 0 75 75 Brief description of the care home communal room and office are located at the centre of the home. Each unit contains dining rooms, lounges, bathrooms, toilets and bedrooms. Philips Court is a purpose built home that stands in its own grounds. The home is near to the Queen Elizabeth Hospital and located within a recently built residential area. It is within close proximity to a range of local amenities and facilities such as shops and churches.There are bus stops nearby which link with the main regional centre of Gateshead. The fees payable range from: Local Authority 400 pounds for social and personal care , Private social and personal care 447.50 pounds. Nursing care 410 pounds plus the free nursing care element. Private nursing 596 pounds minus the free nursing care. There is an additional top up fee of 15 pounds for all rooms. Not included in the fee rates are personal items,clothing,newspapers and some outings. 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: 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: Before the visit we looked at information we have received since the last visit on the 25 March and 11 September 2008. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service,their relatives,staff and other professionals. We checked the cost for people living in the home.And the fee rates vary from 400 pounds from social and personal care to 596 pounds for nursing care. Items such as toiletries,clothing,newspapers and hairdressing are extra. We have reviewed our practice when making requirements,to improve national Care Homes for Older People Page 6 of 33 consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm. In future,if a requirement is repeated,it is likely that enforcement action will be taken. The Visit. An unannounced visit was made on the 22 December 2008.This visit was carried out by two inspectors and took ten hours to complete. The pharmacy inspector completed out a full inspection of medicines on the same day. During the visit we: Talked with people who use the service,staff,relatives and the manager. Looked at information about the people who use the service and how well their needs are met. Looked at other records,which must be kept. Checked that staff have the knowledge,skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean,safe and comfortable. We told the registered manager and operational manager what we found. What the care home does well: What has improved since the last inspection? Work has started on improving the care plans and social historys and they are up to date. Staff make sure peoples nutritional status is met. Activities are being developed so that people are given opportunities to lead an active life style as far as they are able. The home makes sure there are sufficient staff on duty. Concerns and complaints are being listened to and actions and outcomes recorded. Staff have received safeguarding training so that they can recognise any sign of abuse. There has been a vast improvement in the environment making it a comfortable,pleasant and safe place to live. Care Homes for Older People Page 8 of 33 Health and safety systems are in place so that risks are minimised. There is now a registered manager who is showing guidance and leadership the the staff team. 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. People receive clear information about the service and a good assessment of need before admission.This makes sure that they make the right decision about moving in and they can be sure their needs will be met. Evidence: Southern Cross Corporate Statement of Purpose and Service User Guide is readily available and a copy is given to each person living in the home. Assessments are carried out by the home ,care managers and nurse assessors. There is also a tick box assessment with room for comments and supplements ,these were all dated and signed by the person completing the assessment. A body map also records any injury on admission including pressure ulcers,bruising and scratches.Weights are also recorded. Care Homes for Older People Page 11 of 33 Evidence: Risk assessments are in place and include falls,(MUST) , which is a Malutrition Screening Tool,Braden scoring for pressure ulcers,continence and behaviours,likes ,dislikes and information about cultural and religious beliefs. Care plans also record six week reviews with the person,relative,senior home staff and care manager. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Access to health care is satisfactory but care planning is not fully developed or person centred.And staff do not always make sure people receive their medication properly.This could affect their well being. Evidence: Each person has a care plan which is based on the admission assessment.Risk assessments for nutrition, using the Malnutrition Universal Screening Tool (MUST) pressure ulcer prevention (Braden tool),moving and assisting,falls prevention,continence,mental health and dependency levels are completed then updated on a monthly basis. The care plan model of Roper, Logan and Tierney is not particularly person centred and doesnt encourage staff to think in that vein. Although the information is fairly comprehensive the person centred aspect could be further developed. The care plans for those with diabetes show that the language and directions for care Care Homes for Older People Page 13 of 33 Evidence: suggest that the person writing the plan has not had updated training about more contemporary methods of diabetic care. For example needs in the care plan are identified as requires a diabetic diet and sugar controlled fluids and makes reference to no sugar rather than healthy eating options and involvement from dietitian. It refers to hypo and hyperglygaemic symptoms but doesnt say what they are and how this person presents with this as an individual so that staff can be aware and recognise symptoms early and provide preventative action. Another example makes reference to challenging behaviour but doesnt give a description of how this is presented which might help to guide staff to recognise when this person is becoming becoming distressed or agitated or feed into any strategies to prevent the situation. Steps in the care plan are reasonably clear and identify things like the gender of the staff to undertake personal care tasks, or approach a person from the front to reduce fear and potential to hit out . Evaluation of care plans takes place regularly and the information is of a reasonably level but tends to list what has happened rather than provide an evaluation of the persons progress ,response to treatment, deterioration or change to the care plan to accommodate changes. Another care plan shows that staff are concerned about how they manage behaviours that challenge.There is evidence of referral to the psychiatrist and the multi disciplinary team to prevent safeguarding issues and harm to the person and others. Some of the terms used are not easy for everyone to understand and the although a behaviour monitoring chart is being used the information is not used to analyse trends such as threats to that person or others. Two care plans show that staff are now looking at peoples previous lifestyles and history.Information is available about likes ,dislikes and family contacts.For example on person goes out regularly with family and another gives staff information about going to bed early to read and offer drinks and snacks if awake during the night. Although there is information about some sexual disinhabition the care plans to not detail what the triggers are or what the management strategies are to prevent escalation or possible harm. Care Homes for Older People Page 14 of 33 Evidence: Care plans are in place about all aspects of peoples health care including weight loss.Information includes weekly weights,providing fortified drinks such as milk shakes and high calorie foods. Fluid balance and food charts are being used but the standard of recording varies.Charts are sometimes incomplete,only record half a plate of food given and some fluid charts show that staff are not making sure people receive plenty of fluids during a twenty four period. People at risk of pressure damage have care plans in place to show what staff have to do to improve or prevent problems.There are plenty of pressure relieving devices and the staff have access to tissue viability specialists. Medicine administration was observed on the residential unit and was generally seen to be in accordance with best practice guidance. At the end of the morning round we noticed two unlabelled medicine pots containing a variety of medicines. We were informed by the senior carer that the medicines were intended for two people who were with the hairdresser at the time of the administration round and would receive the medication later. Medicine storage facilities within the home were generally secure and tidy. The treatment rooms where medicines are stored were warm and the temperature records showed that the rooms regularly reach 25 or 26 degrees centigrade, which is the limit for the maximum recommended temperature for the storage of non refrigerated medicines. On the first floor medication storage facilities consist of a small warm cupboard area just large enough to house the medicines trolley. Additional medicines stock and medicines requiring refrigeration for this unit are located on the ground floor which results in staff frequently having to move between floors to ensure that they have all medication at hand at the time of the administration round. On arrival at the home, the two medicine fridges in one of the treatment rooms on the ground floor were not locked and the keys were in the lock. One fridge was in need of defrosting and the temperature record chart confirmed that the internal temperature of this fridge was regularly outside the accepted storage range of 2 to 8 degrees centigrade. A vial of insulin with no dispensing label attached was found in the medicines cupboard on the residential unit next to an unlabelled syringe containing fluid. We were informed Care Homes for Older People Page 15 of 33 Evidence: by the senior carer that a district nurse attends the home to administer insulin and was responsible for preparing the medication. We discussed this later with the manager and highlighted that this was not safe practice. The controlled drug cupboard appears to meet safe custody regulations and there were no discrepancies between controlled drugs held in the home and the relevant entries in the controlled drug register and on the medication administration record (MAR) charts. We noted that some temazepam tablets had been returned to the supplying pharmacy for disposal rather than being processed for disposal in the home in line with legal requirements. The manager informed us that this practice has stopped and all medicines, including controlled drugs, are now disposed of appropriately via a waste contractor. The current MAR charts on both floors were looked at. There were no significant discrepancies between the quantities of medicines received, the number of doses recorded and the quantity of medicines remaining. This indicates that people are getting their medicines as prescribed. One person was prescribed fentanyl patches to be replaced every three days. On one occasion the replacement patch had not been replaced on the prescribed date of 21 December 2008, but on the following day. We also noted that the administration of one dose of warfarin, an anticoagulant, had not been recorded on one day but on checking the remaining stock and talking to the nurse we confirmed that it had been given as prescribed. A further omission involved a weekly dose of risedronate that was due for administration the day prior to the inspection. The senior carer informed us that she had administered the dose as prescribed but had forgotten to sign the MAR sheet at the time of administration. Some handwritten entries on the MAR charts were incomplete and did not always include the quantity of medication carried over from one month to the next or a witness signature to confirm their accuracy. Some creams and ointments prescribed for people on the residential unit were not regularly and consistently recorded on the MAR charts although this medication was located in the medicines trolley and appeared to be in use. One person was prescribed warfarin as per INR but there was no supporting dosage Care Homes for Older People Page 16 of 33 Evidence: information with the MAR chart to assist the nurse in selecting the correct dose to administer. On one MAR chart a daily dose of frusemide and isosorbide had not been recorded and a hand written entry stated awaiting prescription.A supply of medication was obtained in time for administration the following day. We noted that some MAR sheets listed medicines that were no longer being prescribed. We were informed that these were incorrectly printed by the pharmacy and discussions were underway with the pharmacist to resolve this. Medicines with limited use once opened were labelled with the date of first opening although one bottle of timolol eye drops in use on the residential use had not date of opening. We were informed that monthly prescriptions come to the home first for checking prior to being sent to the pharmacy for dispensing. Records of prescriptions ordered and received are not consistently being fully documented in all units and consequently the prescription audit trail is not complete. The medicines policy is comprehensive and is supplemented with written guidance in the treatment rooms and senior staff in the home regularly undertake comprehensive audits of the medication system. Staff were sensitive to the needs of the people.They spoke calmly and gently,asked them what they wanted and provided easy to understand explanations when they were helping them. One member of staff has a very gentle approach with people, constantly interacting throughout the day and when undertaking tasks or just passing by. They used touch to engage and got down to peoples level to ensure they could see and hear her. Relatives said: The staff are lovely and always keep me informed about X Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to take part in leisure and social activities are improving and people are supported to maintain a balanced and varied diet although mealtimes are not always organised and an enjoyable experience.This means people do not have the opportunity to lead active lifestyles. Evidence: Since the last visit to the home there ha been a vast improvement in how people are supported in their daily lives and activities.There is now a tea room where people can take their relatives for coffee and tea and there are regular tea dances. One lounge upstairs is now a music room with a good range of musical instruments available for people to use. Items are displayed on the walls for people to touch and provide interest and there are rummage boxes and hat stands with various items for people to become interested in. There are lots of sitting areas dotted around the units where people can stop and sit or spent some quiet time on their own. Care Homes for Older People Page 18 of 33 Evidence: A new activities coordinator has been employed since the last visit. She is very enthusiastic and has started to develop social profiles for each person.The information is toCelebrate the Life of and gain information from the person and the families. Photographs are to be added at important points in peoples lives such as weddings and birth of children. There is now a monthly newsletter to let people and any relative or other visitor know what is happening and a copy is given to those who can still read to keep abreast of current events.A copy is also available in the reception for anyone to read. Lots of information was available regarding Christmas activities and events.Staff also organise pamper days,crafts,painting,baking,reading and activities on a one to one basis. Neither coordinator has had any training in dementia care which would help provide better insight into how to develop the right activities and they have not had any specific activities training. This was discussed with the manager to encourage both to attend meetings with other activities coordinators to generate ideas and share practice. Although all of this work is going on many of the people living in the home have complex general and mental health care needs and are unable to join in most group events. This visit started early morning as there has been concerns that people are not given choices about times they get up in the morning.On arrival a the home and a tour of the building found that most people were still in bed asleep.Those that were up were nicely dressed,clean with their hair combed and they were offered and given tea and biscuits . There are dining rooms on each unit and each have a facility for making hot and cold drinks and light snacks.Tables were appropriately set on each unit although menus are not available in large print or picture style. The breakfast meal was served at nine am on both nursing units.There were choices of Weetabix,Corn flakes and Porridge followed by scrambled eggs,sausages bread,toast butter and preserves.And a choice of fresh fruit juices and hot drinks. This was quite a long drawn out affair finishing at about eleven am as staff were busy getting people up, medications were being carried out by the nurse and others were in Care Homes for Older People Page 19 of 33 Evidence: two dining rooms waiting for breakfast. Some people did have breakfast in their bedroom. Staff were helpful and considerate with people but organisation of mealtimes at this time of day could improve to prevent people waiting as long. All but a couple of people needed some kind of prompt or physical assistance to eat their breakfast. One person only takes fluids and wont eat anything solid. Care staff were able to say what this person needed to have and made sure there were plenty high calories supplement drinks,fruit juices and milk and kept checking throughout the meal. Breakfast on the fifteen bedded unit was also long and drawn out affair and did not start until ten am despite the fact that people were up sitting waiting for their meal.Although many of the people would be able to self serve some of the meal this option was not available or even considered by the staff. Lunch time was better co-ordinated and people did not wait as long. It started at one pm. Choices included chicken and ham pasties or shepherds pie with potatoes,green beans and carrots and staff gave reminders about options. One member of staff gave one person a running commentary about what they were giving them i.e. identifying what was on each spoonful or what drink was being offered so the person knew what was coming. Staff were responsive and observant throughout the mealtime and quick to offer help. Comments about the food included: Food is always good I really enjoy my food Care Homes for Older People Page 20 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. Good complaints and safeguarding procedures are in place so that people are protected from harm. Evidence: Southern Cross have detailed complaints policies and procedures.These are readily available in the reception area of the home and are given to people on admission. The procedures are not available in large print or picture style. Given the level of memory loss people would have little insight into daily lives and would have difficulty expressing concerns. There is evidence that incidents are recorded and referred to appropriate agencies In some instances safeguarding alerts have been addressed through care review and further assessment either in the home or in hospital. Since the last visit CSCI have received two complaints.One resulted in a late visit to the home and a Random Inspection and the other included an early morning visit for this Key inspection visit. The home have received three complaints and these have been dealt with by the provider. Care Homes for Older People Page 21 of 33 Evidence: Staff have completed Safeguarding training and said they would know what to do should there be any incident of suspected abuse. Any incident is reported although not all are referred via Safeguarding but are referred to the appropriate agencies so that people have reviews and further assessments either in the home or in hospital. Care Homes for Older People Page 22 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. The home is a pleasant,clean and comfortable place to live. Evidence: This a very large purpose built care home with nursing that provides care for people with various types of dementia and complex general mental health care needs. There are three units two provide nursing care and one provides care for those who have a dementia who have social and personal care needs. Each unit has its own facilities including communal areas,bedrooms bathrooms,showers and toilets. All of the bedrooms have an en suite facility. Since that last visit there has been a vast improvement so that the home provides a more appropriate environment for people with dementia and helps them find their way around the home. Corridors have been themed and have interesting scenes of local history and scenes such as the Tyne Bridge,Saltwell Park in the original state and postcards of the long gone mining community. There are also pictures of the Royal family at various points in history,pictures of film stars from various time periods and tactile materials. Care Homes for Older People Page 23 of 33 Evidence: Chairs are dotted about the corridors to let people have somewhere to sit should they want some quiet time or are tired of walking about. The large room in reception has been divided with one part changed into a tea room where people can entertain their visitors and enjoy regular events. There is also a music room and reminiscence room which also improves the lives for those living in the home. Bedrooms are nicely furnished and people have been encouraged to bring small items with them making rooms individualised and homely. One relative spoken with complained that he has to remind staff to change bedding when it has marks on it and that furniture is often sticky or dirty. This was discussed with the manager who said this was the night shift responsibility but any spillage ,dirt or stickiness should be cleaned straight away and is everyones responsibility as well as a general task for night staff. On the day of the visit the home was nicely decorated for Christmas,warm and fresh smelling. Care Homes for Older People Page 24 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. Staffing levels and systems around recruitment,selection and training of staff are good and meet the range of needs of the people using the service and protect them from harm. Evidence: Since the last visit to the home the shift system has changed and staff now work from eight am to eight pm and overnight from eight pm to eight am.There are two nursing units,each are staffed by qualified mental health nurses and care staff. Although the current staffing levels are sufficient deployment at mealtimes should be reviewed to ensure best use of staff at times of peak activity. There is a handover at each change of shift but the detail varies as there was a lot of no problems,settled and one person with chest infection prescribed antibiotics.There was no mention of what type or whether to watch out for side effects and report back to the person in charge. Also two units are able to have a report in private where as on one unit the report was given close to where people were sitting which could compromise confidentiality. Care Homes for Older People Page 25 of 33 Evidence: In addition there are sufficient ancillary staff including administrator,domestics,laundry cook,kitchen assistants,activity organisers and the manager is supernumerary. The records for recruitment are good.There was evidence of Criminal Record Bureau checks,two written references,proof of identity and professional identity numbers for registered nurses. The files show that all staff complete an induction and mandatory training including fire,first aid,moving and handling, infection control and food hygiene. There is also a training programme in place for all staff and training has included Mental Capacity Act,Challenging Behaviours,Dementia Care, including Yesterday today and Tomorrow,Safeguarding Adults,Tissue Viability and Safe Handling of medicines. 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 by a competent manager who makes sure that good quality assurance systems are in place.This means that people receive a good quality care. Evidence: The manager is a first level registered mental health nurse.She has been registered with the Commission and has many years experience in this sector. Audits of care and other services are carried out with actions and outcomes recorded.The regional manager visits on a monthly basis to make sure the quality of the home continually improves. The AQQA was completed and the information gave a good picture of what was happening in the home and also gave clear information about how it plans to develop over the next year. Care Homes for Older People Page 27 of 33 Evidence: Staff,relative and resident meetings take place with minutes kept.The manager holds regular surgeries so that everyone has a chance to discuss anything that concerns them. The personal allowance records demonstrate that receipts and double signatures are maintained for all transactions.These can be cross referenced and regular checks are carried out to make sure there are no discrepancies. Records of monthly staff supervision is available.The quality of the supervision depends on who is completing the record.One nurse has very good supervision and coaching information on the form as well as looking and developing individual staff performance Another record looked at showed the same form was photocopied for everyone and did not look at individual learning and development styles or needs. Mandatory training is up to date and further training is planned.Health and safety risk assessments are clear and up to date. Accidents are recorded and best practice is used to examine and track trends which prevents as fare as possible the same accidents or incidents happening. Internal health and safety checks are available and external contract certificates are up to date. Since the last visit the manager informs CSCI of any incident or accident that affects the people living in the home. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 30 12,18 The registered person must 01/01/2009 ensure that all grades of staff are provided with Dementia care and Challenging behaviour training. Care Homes for Older People Page 29 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 The registered persons must 30/03/2009 ensure that the care plans are detailed,reflect up to date practice and include details of how staff are to manage any behaviour that may challenge. Food and fluid charts are to be completed in detail. This will make sure people receive consistent care and evidence care delivery and best practice. 2 9 13 Medicines must be given as prescribed and a record made at the time they are given. This will make sure that people receive their medication correctly and the treatment of their condition is not affected. 23/01/2009 3 9 13 The registered persons must 23/03/2009 ensure that additional training that reflects best practice guidelines be Page 30 of 33 Care Homes for Older People provided to all staff involved in the administration of medicines. Having well trained staff helps to reduce the risk of medication errors. 4 9 13 Medication must only be administered from the containers supplied by the pharmacy. This will reduce the risk of medication error. 5 9 13 The registered persons must 23/01/2009 ensure that best practice guidance and the providers procedures be followed when medicines are received into the home,disposed of and when giving and recording medicines. This will help to make sure that peoples health and welfare are protected from the risk of medication errors and omissions. 23/01/2009 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 The registered persons should consider the following. A system should be in place to record all medication kept in the home and any carried over from the previous month. This helps confirm medication is being given as prescribed and assists in checking stock levels. The temperature of the treatment rooms used to store medicines is at the upper limit of the acceptable range for Care Homes for Older People Page 31 of 33 the storage of non refrigerated medicines. Action should be taken to ensure that medicines are stored within the temperature range recommended by the manufacturer. The written dosage instructions provided by the anticoagulant clinic should be kept attached to the MAR chart of persons receiving anticoagulant treatment. This makes sure that staff have accurate and up to date knowledge of the dose of anticoagulant to administer. Medicine fridges should be locked when not in use and the key kept with the person in charge of the unit. GPs should be contacted to request medication review for people whose medication has not been reviewed. This will ensure that peoples prescribed medication remains up to date and appropriate for the treatment of their condition. Consideration should be given to relocating medicine storage facilities on the first floor so that the medicines trolley, fridge and additional medicines stock can be held in a single facility rather than being spread across two floors. 2 12 It is highly recommended that activity organisers have training in dementia care to help develop better insight into providing the right activities for those living in the home. It is highly recommended that some self service of meals is offered so that people can retain a degree of independence. It is highly recommended that further review of mealtimes is undertaken on all units. The registered persons should review the deployment of staff at mealtimes and other peak times so that people are not waiting long periods for assistance The registered persons should make sure that the activity staff also complete specialist training in Dementia care The registered persons should make sure that all staff supervision is individualised and covers all areas of practice,philosophy of care and any career development needs. 3 4 5 15 15 27 6 7 30 36 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 © (2009) Commission for Social Care Inspection (CSCI). 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