Inspection on 17/11/08 for Pinehurst Care Centre

This inspection was carried out on 17th November 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pinehurst Care Centre 30/11/06

Pinehurst Care Centre 19/12/05

Pinehurst Care Centre 11/08/05

Pinehurst Care Centre 09/01/05

Pinehurst Care Centre 08/07/04

Pinehurst Care Centre 18/02/04

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: Forest Healthcare Crowthorne 38-44 Duke`s Ride Crowthorne Berkshire RG45 6ND     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: Denise Debieux     Date: 1 7 1 1 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: Forest Healthcare Crowthorne 38-44 Duke`s Ride Crowthorne Berkshire RG45 6ND 01344774233 01344780168 pinehurstcare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Christine Hazlewood Type of registration: Number of places registered: Pinehurst Care Ltd care home 50 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 50. The registered person may provide the following category/ies 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 categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Forest Healthcare Crowthorne is a registered care home with 50 beds providing a residential care service for older people over the age of 65 and is located within Crowthorne, close to the High Street and local amenities. The home consists of four houses: Pine House, Fern House, Cedar House and Hurst House all located on one site. The home was previously registered under the name of Pinehurst, the name was changed to Forest Healthcare Crowthorne when the provider company was purchased by a new organisation in July 2008. Care Homes for Older People Page 4 of 31 Over 65 50 0 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 Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out by Denise Debieux, Regulation Inspector. A regional manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the regional manager and any information that CSCI has received about the service since the last inspection on 30th November 2006. Service users at this home prefer to be referred to as residents. For clarity and consistency this term will be used throughout this report. Care Homes for Older People Page 6 of 31 A tour of the premises took place. On the day of this visit the inspector spoke with eight residents and six on duty staff. Prior to the inspection, survey forms were sent to residents, staff employed at the home, care managers and GPs. Survey forms were returned by eleven residents, no other survey forms were received. These survey forms were correlated and the results were shared with the regional manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation and shared with the regional manager. Care was taken to exclude any comments that could identify the writer. The regional manager demonstrated a very pro active attitude to the results of our survey and plans to explore any concerns raised further as part of the homes quality assurance process. Some of the comments made to the inspector and made on the survey forms are quoted in this report. The regional operations manager had completed an annual quality assurance assessment (AQAA) and residents care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all sampled on the day of this visit. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Fees range from 514 to 550 pounds per week. This information was provided on 20th November 2008. The inspector would like to thank the residents, management and staff for their time, assistance and hospitality during this visit and the residents who participated in the surveys. What the care home does well: What has improved since the last inspection? 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 8 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 9 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. Each resident is only admitted to the home following a comprehensive needs assessment to ensure that the home can meet the residents identified needs. This home does not offer intermediate care. Evidence: In the AQAA, to demonstrate what the home does well, the home described their pre admission procedures: Each resident has an individualised pre admission assessment to establish whether the home can meet their needs; if we feel we cannot provide an appropriate service then an explanation of why is given to the proposed resident. For those residents who are referred through Social Services or are receiving home care/hospital, the home obtains a summary of the care management assessment and a copy of the care plan. Residents are provided with comprehensive documentation pre admission, which explains the way in which the home is run, i.e. the service user guide. Each resident is given the opportunity to visit the home and spend some time Care Homes for Older People Page 10 of 31 Evidence: within the home before a decision is made. If the resident is unable to do so, the home will offer to send a manager out to see them and answer any questions they have. Pinehurst offers a one month settling in period and then both the home/the resident & their families are able to re assess the placement. We offer respite breaks to prospective permanent residents to ensure we can meet their care needs and they are happy with the Home. Three care plans were sampled during this visit. In each case comprehensive pre admission assessments had been carried out to ensure that the home could meet the residents identified needs. Data provided in the homes AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Residents surveyed all felt they had received enough information prior to moving to the home. One residents commented: I came here for respite originally and decided to stay on a permanent basis as I am very happy here. Care Homes for Older People Page 11 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. Personal care and healthcare support and assistance was seen to be provided, where needed, in a respectful and sensitive manner but action must be taken to ensure that care plans and risk assessments are kept up to date and accurately reflect the actions staff need to take to meet the residents current and changing needs. Policies, procedures and practices are in place to ensure the safe administration of medication. Evidence: Three care plans were sampled at this inspection, two for people recently admitted to the home and one for someone who had been living at the home for some time but whose care needs had recently changed. The care plans sampled were all based on pre admission assessments and preliminary care plans had been drawn up before each of the two new residents had moved into the home. The two preliminary care plans set out the actions which need to be taken by care staff to meet the health and personal care needs of the residents. These two care plans also included preliminary risk assessments for risk of skin breakdown, mobility and nutritional risk, meeting a Care Homes for Older People Page 12 of 31 Evidence: requirement made at the last inspection. The regional manager explained that the procedure in place is that the duty manager should complete more in depth risk assessments and check the preliminary care plan on a residents day of admission. This had not been done in either case. In one care plan the daily notes highlighted an increased risk relating to the persons mobility and a note had been made that the resident should be monitored when mobilising. However, no further in depth risk assessment had been carried out, the care plan had not been updated to include the newly identified problem and there was no evidence to show that staff had been made aware of actions they should take to reduce the risk of injury to the resident. In the second care plan the daily notes identified confused and wandering behaviour and there were also notes made that the resident was verbally aggressive to staff and should be monitored when angry. Again, no further in depth risk assessment had been carried out and the care plan had not been updated to include the newly identified problem. There was no evidence to show that staff had been made aware of actions they should take to effectively deal with the behaviour being exhibited or that a risk assessment had been carried out to ensure that other residents were not at risk. From conversations with the regional manager it was clear that management were dealing with the situation and an appointment had been made for the resident to be assessed by a health professional later in the week of this inspection. In both the above examples staff had noted that increased monitoring was required, however, there was no evidence to show that management had been made aware or that steps had been taken to review staffing levels in case increased staffing was needed to ensure that all residents needs could be met. In the third care plan the resident had been living at the home for some time but her care needs had recently changed following a fall. The care plan had not been updated to include the residents changed care needs and neither the care plan nor the mobility assessment had been reviewed since three months before the resident had fallen. However, staff spoken with were aware of the residents changed needs and the resident confirmed that the staff were providing the extra care she needs at this time. No care plans had been signed by residents or their representatives and there was no evidence to show that residents had been involved in, or agreed to, their plan of care. In the AQAA the regional operations manager stated that: Our care planning systems are constantly reviewed and developed to include residents choice and preferences. We review our care planning systems monthly or sooner as and when changes arise. Care Homes for Older People Page 13 of 31 Evidence: The findings in the care plans sampled on the day of this inspection did not support this statement and a requirement has been made. It is positive to note that the regional manager took prompt action and, on the day following the inspection, the inspector was advised via email that: the residents care plans are being reviewed and will all have a complete review by 24th November 2008. Of the eleven residents who returned surveys, three said that they always receive the care and support they need, seven answered usually and one answered sometimes. One resident commented: Not always enough staff available when I need them and another that: I have always been well cared for and happy at Pinehurst. In the AQAA, to demonstrate what the home does well, the regional operations manager stated that: We care for residents in a person centred manner respecting individuality. Residents continue to have a choice of either male or female carers to attend to them. We ensure the privacy of residents is respected by knocking on doors before entering, providing personal telephone lines, having areas for private discussions. The lunchtime medication round was observed and the medication administration records, medication storage, policies and procedures were all sampled and found to be in order. During the tour of the home staff were observed to always knock before entering the residents bedrooms and all interactions observed between staff and residents were seen to be caring and respectful. All residents spoken with agreed that they felt their privacy was always respected. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provided by the home are varied and include contact with the local community both within and outside the home. Contacts with family and friends are encouraged. Meals are well balanced and varied with individual choices and preferences catered for. Evidence: The routines of daily living are arranged to suit individual residents preferences and choices. This was confirmed by residents spoken with. The activity programme for the week of this inspection was posted on notice boards around the home. Activities provided included: Pamper morning (hairdressing, manicures, foot spa); music and poetry; games; music for health; arts and crafts; movie afternoon; flower arrangement and music and sherry. In the AQAA, to demonstrate what the home does well, the regional operations manager stated that: We have employed an activitys coordinator to ensure residents are stimulated and entertained daily. The activitys coordinator is auditing residents requests for group activities. We have monthly church services at the Home and we Care Homes for Older People Page 15 of 31 Evidence: have access to local community churches, transport can be arranged. Plans for improvement in the next 12 months and noted in the AQAA included: To provide external trips and encourage service users to suggest venues and to Provide more exercise based activities. One of the eleven residents surveyed stated that there were always activities they could participate in, five answered usually and five answered sometimes. One resident commented: Because of my mobility I choose not to take part in most of the arranged activities and another that: I enjoy activities/entertainment that is provided. At present the residents individual care plans do not include individualised social care plans. The inspector was advised that the activity coordinator carries out in depth activity assessments with each resident but this information is not incorporated into the care plans and is kept in her office, which is locked when she is not working. It is important that all staff are able to access this information at all times and that care plans include details of how a residents individual social care needs are to be met, taking into account their personal preferences and their physical and cognitive abilities. The requirement relating to care plans made in the previous section of this report incorporates the need for social care to be included in individual care plans. The inspector left details of the National Association for Providers of Activities for older people (NAPA). This is a voluntary organisation dedicated to increasing the profile and understanding of the activity needs for older people, and equipping staff with the skills to enable older people to enjoy a range of activity whilst living in care settings. Further information can be found on the NAPA website at: http:/www.napaactivities.co.uk/m This organisation also provide a free self assessment document Activity Provision: Benchmarking good practice in care homes that is available for download from that site and that the home may find helpful. Residents are able to choose which activities they attend or participate in and their individual rooms were all seen to contain many personal possessions which were arranged to suit their individual wishes. There are no restrictions to visiting times and staff support and encourage residents to maintain family links and friendships inside and outside the home. Menus sampled showed that the home offers a varied and well balanced menu, with residents able to choose alternatives if they do not want the dish that is on the menu on the day. The lunchtime meal was taking place during this visit, the food was well presented, the atmosphere in the dining room was pleasant and relaxed and staff were Care Homes for Older People Page 16 of 31 Evidence: available to offer help and assistance as needed. In the AQAA, to demonstrate what the home does well, the regional operations manager stated that: We are planning new winter menus. Menus are altered on a regular basis after consultation with residents. Of the eleven residents surveyed, four said that they always liked the meals at the home, three answered usually and four answered sometimes. One resident commented: The homes policy of offering residents an alternative to the set menu works quite well and I appreciate it and another that: We always have a choice of menu. Care Homes for Older People Page 17 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 has a simple, clear and accessible complaints procedure which includes timescales for the process. Policies and procedures are in place to protect residents from potential harm or abuse. Evidence: The home has a complaints procedure in place that is available to all residents and their relatives and is also included in their service users guide. No complainant has contacted the Commission with information regarding a complaint or allegation made to the service in the past twelve months. Of the eleven residents surveyed, six said that they always knew who to talk to if they were not happy, two answered usually, two answered sometimes and one answered never. Nine said that they knew how to make a complaint and two said that their family would do it for them. One person added that: A carer is on hand day and night and a manager is in and out of the house several times a day. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure. Training in safeguarding adults is included in the homes staff induction and the training log evidenced that staff receive updated training when needed. In the AQAA, to demonstrate what the home does well, the regional operations Care Homes for Older People Page 18 of 31 Evidence: manager stated that: The complaints procedure is posted on the notice boards and is given to each resident as part of their contract on entry to the Home. All complaints are responded to and dealt within a period of 14 days. The regional manager is aware of the Mental Capacity Act and in their AQAA the regional operations manager stated that: Residents are assumed to have full mental capacity unless proved otherwise. Staff are able to assess on an individual decision basis whether a resident has capacity and assist them in making decisions, therefore promoting independence. Pinehurst is working towards the application of recent government initiatives, i.e. Mental Capacity Act. All residents spoken with said that they felt safe at the home with one resident adding Oh yes! and another commenting that The staff are all nice and very kind. Care Homes for Older People Page 19 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 location and layout of the home and gardens are suitable for their stated purpose. An ongoing maintenance and redecoration programme provides the residents with clean, pleasant and homely surroundings in which to live. Evidence: Forest Healthcare Crowthorne is located within Crowthorne, close to the High Street and local amenities. The home consists of four houses: Pine House, Fern House, Cedar House and Hurst House all located on one site. Residents spoken with expressed their satisfaction with the accommodation provided at the home. Of the eleven residents surveyed, three said that the home was always fresh and clean and eight answered usually. The home was toured during this visit. The furniture and furnishings were seen to be of a good quality and personal bedrooms were all seen to be personalised to the individual residents wishes. The maintenance and redecoration programme for the home was seen to be ongoing. Laundry facilities are sited on the ground floor in one of the houses with washing machines suitable for the needs of the residents at the home. Care Homes for Older People Page 20 of 31 Evidence: In the AQAA the regional operations manager stated that they have now employed a full time maintenance person. On the day of this visit the home was found to be warm and bright with a homely atmosphere and a good standard of housekeeping apparent. Care Homes for Older People Page 21 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. The staffing levels need to be reviewed to ensure that the needs of all residents are met at all times and current staff recruitment practices are placing residents at risk of harm and abuse. The home has a staff training programme which incorporates all areas needed to ensure, as far as reasonably possible, that residents receive care and support from well trained staff. Evidence: The care team at the home comprises of the new manager, two duty managers, eight senior carers and twenty five carers. The four houses that make up the home are in the grounds and there is a separate administrative block. Pine House and Fern House are adjoining and connected via the communal rooms of the building. These two houses are staffed as one unit with the morning (8am to 2pm) shift being covered by three care workers, three care workers cover the afternoon/evening shift (2pm to 9pm) and the night shift is covered by two waking care workers. Hurst House and Cedar House are sited next to each other with a connecting door in between the two houses. These houses are staffed individually. Hurst House has two care workers covering the morning and afternoon/evening shift and one waking night staff. Cedar House has one care worker covering the morning and afternoon/evening Care Homes for Older People Page 22 of 31 Evidence: shift and one waking night staff. The staff rota indicated that staff are provided in sufficient numbers to meet the needs of the residents at the home. However, using the Residential Forum staffing tool, the staffing levels provided in Pine/Fern Houses would be indicated for people with low dependency needs. During the tour of the home and whilst in Pine/Fern Houses, care staff were busy with personal care and there were a number of residents sitting in the communal lounge alone, none were able to mobilise and they had no means of calling for assistance as the only call bell was on a wall out of reach. One resident, on seeing us come into the lounge, called out to us that she needed assistance, the regional manager went and found a carer. Nearby the lounge a resident was sitting on a chair in a corridor, this resident was disoriented having recently moved rooms and told the inspector she had managed to dress herself but did not know where to go, again the regional manager was able to find assistance. Further on in the tour but still in the same building, the resident discussed earlier in this report where staff had written that she needed monitoring when mobilising, came, unaided, half way down the stairs and sat on a stair to talk with the regional manager who had gone up the staircase to help. During lunch time the three staff on duty were busy dishing out the meals that had been sent over from the kitchen and taking the meals to the residents in the dining room or in their own rooms, this meant that there were no available staff to provide monitoring or additional assistance that residents may need. It is positive to note that, on the day following this inspection the regional manager advised the inspector in an email that: The dependency levels in one particular house will be reviewed, from today an additional staff member has been assigned to help over the meal time. However, a system must be put in place to ensure that, at all times, staff are provided in sufficient numbers to meet the assessed and changing needs of the residents living at the home and a requirement has been made. Of the eleven residents surveyed, three said that staff are always available when needed, six answered usually and two answered sometimes. Of the thirty five care staff, five hold a National Vocational Qualification (NVQ) level 3 in care, nine hold an NVQ level 2 in care with a further four currently undertaking NVQ level 2 and six starting this month. During this visit the files of three recently recruited members of staff were sampled. All files were seen to contain proof of identity, completed application forms and two references. However, the home were unaware of new regulations that came into force in July 2004 and had not been verifying applicants reasons for leaving previous employment with children or vulnerable adults; had not been obtaining full Care Homes for Older People Page 23 of 31 Evidence: employment histories and gaps in employment for two of the applicants had not been explained or explored. Although each file contained two references, all three people had previously worked with children or vulnerable adults and the home had failed to obtain a reference covering their last employment in care, as required. An enhanced Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) list certificate had been obtained for one person, the other two staff members were awaiting their completed CRB certificate but the home had carried out a POVAfirst check as required. However, it was noted that the name on the CRB application for one of these staff members did not match their name on the proof of identity provided. This potentially makes the POVAfirst check obtained invalid. It was discussed with the regional manager that, whilst a change in legislation has made it possible to employ staff to work at a care home pending the receipt of a full CRB check, this is only allowed in very exceptional circumstances and where residents may be placed at risk because the home are having difficulty in recruiting sufficient staff, this should not become normal recruitment practise. The home were advised to obtain a copy of the Department of Health Protection of Vulnerable Adults Scheme guidance document which explains the circumstances when a care home may employ a person pending receipt of a full CRB certificate. The amended recruitment regulations and the amended Schedule 2 of The Care Homes Regulations 2001 were reviewed with the regional manager. The current recruitment practices at the home are potentially placing residents at risk of harm or abuse and requirements have been made that must be actioned without delay. It is positive to note that, following this inspection and on the day after the visit, the regional manager advised the inspector in an email that: Staff files are currently undergoing a complete and thorough audit. We are working alongside the schedule 2 guidelines. Any omissions in their employment history will be addressed. The regional manager also advised that she has now downloaded a copy of the updated regulations from the CSCI website. Staff induction is in line with the new, mandatory Skills for Care common induction standards and the inspector was advised that staff are supervised until they have completed their induction. The training log sampled evidenced that staff are booked on additional training and updates as required. In the AQAA, to demonstrate what the home does well, the regional operations manager stated that: Assistant managers no longer provide sleep over shifts on site and this reduction in manpower has been overcome by having an additional waking staff member on during each night shift. All the staff working within the home Care Homes for Older People Page 24 of 31 Evidence: complete mandatory training, applicable to their role within the company, i.e. POVA, manual handling, infection control, and fire safety. In their AQAA the home have identified that they could do better if they: Increase the range of training to extend beyond mandatory subjects. Of the eleven residents surveyed, ten said that the staff always listened and acted on what they said with one answering sometimes. One resident added: As far as it is possible. All interactions observed between the staff and residents throughout the day of this inspection were caring and respectful. 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 the clear management approach at the home providing an open, positive and inclusive atmosphere. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents. Policies and procedures are in place to protect residents financial interests. All policies, procedures and practices are in place to ensure, so far as is reasonably practicable, the health safety and welfare of residents and staff. Evidence: The previous registered manager has recently retired and a new manager has been appointed and started working at the home on the day of this inspection. The new manager is a registered nurse and has over ten years management experience in healthcare settings. The inspector was advised that the process for the manager applying to become registered with CSCI has already begun. Care Homes for Older People Page 26 of 31 Evidence: In the AQAA, to demonstrate what the home does well, the regional operations manager stated that: We ensure the wellbeing of all residents and staff, adapting positively to the ever changing needs. A positive relationship culture with residents and relatives is promoted. We have quarterly residents and relatives meetings. Quality assurance questionnaires are sent out to residents/relatives. We speak to each resident personally throughout a one month period. The regional operations manager carries out monthly monitoring visits to the home as the representative of the organisation. This meets a requirement made at the last inspection. Policies and procedures are in place to protect residents financial interests. The regional manager stated that the home does not handle the financial affairs for residents. Small amounts of personal monies are held for residents at their request, clear auditing procedures are in place with detailed receipts and account sheets kept for each individual resident. Health and safety monitoring check sheets were sampled and found to be well maintained and up to date. All staff have received required safe working practice training and updates. Staff were observed to be following appropriate health and safety practices as they went about their work. The home are to be congratulated on recently being awarded a five star excellent rating by Bracknell Forest Council Scores on the doors food safety star rating scheme for the food hygiene standards found on the day they inspected. All interactions observed between the staff and residents were inclusive, caring and respectful. 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 The registered person must 17/12/2008 ensure that each resident has a plan of care setting out how the residents health, personal and social care needs will be met. Appropriate risk assessments must be completed and kept up to date and newly identified needs must be promptly added to the care plan. Care plans must be reviewed at least monthly and should be signed by the resident or their representative to evidence their involvement in drawing up the care plan and their agreement to the content. In order that residents can be confident that the home can continue to meet their identified needs and that they can be confident that the home will take appropriate steps to ensure Care Homes for Older People Page 29 of 31 that their health, welfare and safety is protected. 2 27 18 The registered person must 17/12/2008 ensure that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are sufficient to meet the health, personal and social care needs of the residents living at the home. In order to ensure that there are enough staff on duty to meet the residents current and changing needs. 3 29 19 The registered person must 17/12/2008 ensure that all staff involved in recruitment are fully aware of, and adhere to, the requirements of the Care Homes Regulations 2001 as amended by The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004 and ensure that no person is employed to work at the home without all the required checks and documents having first been obtained. In order to protect the residents from the potential risk of harm or abuse. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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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