Inspection on 06/10/08 for Pinewood Nursing Home

This inspection was carried out on 6th October 2008.

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

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

Other inspections for this house

Pinewood Nursing Home 22/11/06

Pinewood Nursing Home 09/11/05

Pinewood Nursing Home 11/07/05

Pinewood Nursing Home 06/10/04

Pinewood Nursing Home 20/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Pinewood Nursing Home 33 Victoria Place Budleigh Salterton Devon EX9 6JP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 0 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 30 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 30 Information about the care home Name of care home: Address: Pinewood Nursing Home 33 Victoria Place Budleigh Salterton Devon EX9 6JP 01395446161 01395443096 mail@pinewoodonline.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Elmwood Nursing Home Ltd Name of registered manager (if applicable) Mrs Karen Thomas Type of registration: Number of places registered: 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 who can be accommodated is 35 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Pinewood Nursing Home provides 24-hour nursing care and accommodation for up to 35 people over retirement age. It is owned by Elmwood Nursing Home Ltd., and is managed by a registered nurse. The home stands in its own grounds, approached by way of a steep hill, in a residential area close to Budleigh Salterton town centre and the sea front. Bedrooms and shared facilities are over four floors, with lift access between floors. Twenty bedrooms have en Care Homes for Older People Page 4 of 30 care home 35 Over 65 35 0 Brief description of the care home suite facilities. There are two lounges, a smaller quiet room, and a dining room. There are grounds and gardens, including areas that are accessible to people with mobility problems, with a car park outside the front entrance to the home. The home employs a physiotherapist, activities co-ordinator, and has shared use of a minibus. The weekly fee at the time of this inspection were 450-800 pounds, depending on care needs and the bedroom occupied. Extras include private telephones in bedrooms and items requiring specialist dry cleaning (- the home takes these to a dry cleaners on behalf of the individual), which are charged at cost price. There is no extra charge for items laundered at the home. Items from the homes shop are charged at or very near to cost price. The home does not charge transport costs for the homes weekly minibus group outings. Individuals can request the homes transport for their own purposes; this is charged at 40p/mile only after the sixth mile, plus 5 pounds/hour for the driver. Theatre-goers were charged 15 pounds to cover ticket prices and staff escort costs. Current information about the service, including our reports, is available through the homes senior staff. The home also has its own website, at: www.pinewoodonline.co.uk. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place as part of our usual inspection programme. Our unannounced site visit to the home took place over 10 hours on a week day. Before our visit, we had sent the home a questionnaire (the Annual Quality Assurance Assessment, or AQAA), which was returned by Mr Philip Sadeghi, a director for the company that owns Pinewood. The AQAA included the homes assessment of what they do well, any plans for improvement, information about people living at the home, staffing, policies, and maintenance of facilities. We had also sent surveys to the home for them to give to 10 people living at the home and to 10 staff. We also sent surveys to 12 health and social care professionals who Care Homes for Older People Page 6 of 30 support people living at the home. We received five back from residents, eight from staff and three from the professionals. We met at least 11 of the 31 people who lived at the home. Most of the 11 people were able to share their views in some detail. We also talked to a visitor and six staff (care and ancillary staff), as well as looking around the home. We case-tracked three people, which means we looked in more depth at their care. They included someone new to the home, someone with complex or changing needs, privately and Social Services funded people. We read their care records and related information (medication records, personal monies records, etc.). We met them, observed some of the care and attention given to them, speaking to staff and looking at the accommodation in relation to their needs. We checked staff recruitment files, information on staff training, quality assurance information, and records relating to health and safety (such as accident and maintenance records). We ended our visit by discussing our findings with Mr Sadeghi and the newly registered manager Karen Thomas, who both assisted us fully during the inspection. Information included in this report is from all these sources, and from communication with or about the service since our last inspection. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes pre-admission practices and procedures help to ensure that the home can meet the needs of people who move in. Evidence: Four surveys from people living at the home said they had received enough information about the home before they moved in (- another person couldnt remember). A relative confirmed the home had been very efficient, considerate and helpful when they first made inquiries about the home. And they were extremely pleased regarding the subsequent admission of their parent, and the trouble taken by senior staff at what was a difficult time. One person recently admitted confirmed the manager had carried out an assessment of their needs before they moved in. Care Homes for Older People Page 10 of 30 Evidence: We saw information gathered when the person first inquired about the home had included their dietary preferences, their life history and hobbies, their medical history and the level of care they would need. We noted that peoples faith needs were not as well recorded as other areas, at this stage, but were addressed after admission. Some assessments would have benefited from a little more specific detail. One person said the homes staff had discussed their needs with their family, and we saw information had also been obtained from nursing staff who had previously been looking after the individual. The person told us they were satisfied with the support they were receiving. However, they also said they used to have baths at home whereas they now had showers, which they didnt like as much but they didnt know what to expect of a care setting. We noted their assessment wasnt specific, with their care plan saying they were to have a bath or shower regularly. Another persons assessment didnt say what the persons usual rising or bedtimes were, something we saw the home had recently checked with everyone now living at the home. Three surveys from people living at the home said they had a contract; one said they didnt, and one couldnt remember. We looked at records relating to someone who initially came for a short stay at the home, but who then became a permanent resident. Records showed the home had sent the person information about the home and our inspection report, before they moved in. They were sent terms and conditions for their initial stay, which differed from the terms and conditions for their permanent stay in that it had a shorter notice period. The latter included the room they were to occupy. We saw the home was open and clear with individuals about variations to the terms and conditions of occupancy or residency, providing the details in writing before the person moved in. In one case, this included circumstances when someone might have been asked to move rooms. Senior staff told us they had consulted with and obtained consent from all relevant parties before the person had moved rooms, when the circumstances arose. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel treated with respect, because their privacy and dignity is upheld. And safe medication procedures and practices promote peoples welfare. However, some individuals care records lack detail, creating a risk that they may not receive timely, person-centered care to meet all their personal and health needs. Evidence: People we met looked comfortable and generally as though their personal care needs had been well attended to, whether sitting in their bedrooms and day rooms, or in bed. Those we spoke with said they were satisfied with the care they received, or were happy at the home. Surveys from visiting professionals either said they thought staff usually or always had the right skills and experience to care for people. There was evidence that people or their supporters were given the opportunity to be involved in the planning of their care. However, two people we spoke with indicated that they fitted in with staff so as to be helpful; one of these also said they had no experience of other care homes to know what they should or could expect. One person Care Homes for Older People Page 12 of 30 Evidence: said they used to get up later, but now got up earlier because they thought staff were more available. Senior staff said they were aware of this and had discussed it with the person, who we saw had signed a document confirming what time they wanted to get up. This differed with a later time given in their care plan. Care records showed systems were in place to assess and monitor risks to people relating to malnutrition, pressure-related wounds, and falling. Peoples spiritual needs as well as general care needs were well addressed. One person had a chest infection, but their care plan had not been fully updated to reflect this new problem, such as in relation to their changed mobility needs. Staff had noted medical advice that someone should have blood tests, but it was not clear if this had been followed up at the time. People who needed or wanted special diets for health reasons said the home dealt with these well. Kitchen staff had guidance on various special diets people might require in such a care setting. One person we case-tracked was being cared for in bed, and needed full assistance to eat and drink. Some staff told us they had had specific training on how to do this, from a community-based professional, which they had found very useful. We saw staff positioned the person properly, and offered a choice of drinks to encourage them to drink. Fluid intake charts were in the persons bedroom. There was no daily intake target in their care plan, staff we asked said there was no target set, and the intake charts had not been totaled up regularly or reflected in the persons daily care notes. Thus there was a lack of information to enable staff to ensure the person was having enough fluids. There was also a repositioning chart in the persons room. During our visit, we saw they had a pressure-relieving bed mattress, and their position was altered at intervals to a certain extent. However, this was not sufficient to relieve one half of their body of restriction or pressure for a reasonable period of time. This could have been particularly important to someone with a chest infection, where lung function and drainage can be compromised by poor postures. It also meant they remained in effect facing a wall, and they were less able to see anyone entering their bedroom since the door was behind them. We discussed these observations with senior staff. We were later told that the individual had been reluctant to change their position, or had changed their position after staff had turned them. Staff accepted this should have been reflected in care records, including a care plan that addressed such eventualities. We saw information for staff about maintaining hearing aids, in relevant individuals Care Homes for Older People Page 13 of 30 Evidence: bedrooms. Someone with impaired sight said information provided by the home was in sufficiently clear print for them. There was an on-site physiotherapy room, with a physiotherapist providing a service to residents (free of charge) and to people from the local community. One person told us the home was getting them a higher bed to help them use it more easily, promoting their independence. Staff felt they had enough equipment to do the work asked of them and to meet peoples needs currently. Some peoples care records lacked detail to properly inform the regular care plan reviews or evaluations that were done. There was lack of clarity in daily notes and care plan evaluations about someones wounds (which they had been discharged with from hospital). The manager said there was a separate wound audit book. It would be useful if this were cross-referenced to individuals other care records. One person had few recent daily entries relating to their daytime care. Staff said this was because entries were generally made only if something different happened. Another persons notes had little about if or how their social needs were being met, to reflect their social wellbeing. Surveys from visiting professionals either said they thought the care service usually or always met individuals health needs.There was evidence of regular contact with community-based professionals such as GPs, specialist wound care nurses, district nurses, etc. to help ensure peoples health needs were met in the best way possible. A GP suggested it would be helpful if there were somewhere at the home that visiting doctors could record notes (for example, if visiting out of hours). Comments in surveys from three GPs included under what the service does well, Empathetic, kind...provides good, well organized care. Another said, The nurses in charge are well trained and highly competent in the management of patients with complex care needs, including end of life care. I have always found them extremely helpful and demonstrating an individual, caring attitude towards our patients. Most people had their medications given to them by staff, and those we asked were satisfied with this arrangement. Risk assessments had been carried out for someone who was self-medicating during a short stay at the home; they confirmed that they had been involved in this, and it had been repeated each time they stayed at the home. Records were kept of medicines received into the home and disposed of if not needed. Where variable doses were prescribed, staff had recorded what the person had been given. There was a lockable fridge for medication requiring cool storage; staff we Care Homes for Older People Page 14 of 30 Evidence: asked knew the temperatures that this should be kept at for safe storage of items. Controlled drugs were stored and recorded appropriately. When asked if staff respected peoples privacy, one person told us the staff always asked if they wanted their door open or shut, as they left them. Others felt they were treated respectfully, and given sufficient privacy. This upholding of peoples privacy and dignity was also noted by visiting professionals who completed our surveys. We asked staff how they knew what people liked to be called. They said they would ask each individual on meeting them for the first time, explaining that individuals might wish to be addressed in different ways by different people. We noted a preferred name was also recorded in most peoples care notes. Employment of male carers had been discussed at a Residents/Relatives meeting this year, to encourage people to say if they would rather not have personal care given by them or if they didnt mind. Care Homes for Older People Page 15 of 30 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. Peoples lives are improved by choices offered in the daily life and social activities of the home, which include the community outside the home, giving them some control and individuality in their lives. Evidence: Of four responses about provision of activities, in surveys from people living at the home completed before our visit, one said there was always something they could do; three said sometimes there were, with one adding that their participation was affected by the disabilities of their peers (such as deafness or their mental frailty). People we spoke with said they didnt get bored, either because of what was offered by the home or because they occupied themselves. One person confirmed they knew there were organized activities, but chose not to go, including when offered opportunities to go on outings. We saw peoples interests were recorded in preadmission assessments or soon after admission, although we didnt ascertain on this occasion if the activities we were told about during our visit related to such information. Care Homes for Older People Page 16 of 30 Evidence: The homes AQAA said a seated line dancing session and flower arranging demonstration had been arranged as a result of suggestions from individuals at a recent residents-and-relatives meeting. A seated Tai Chi class took place during our visit, which someone from the local community also attended. A firework display was being planned in partnership with a local charitable organization. Staff confirmed, as also stated in the AQAA, that ministers of different denominations visited people within the home, giving Holy Communion regularly. The home has a minibus for outings that is shared with two other homes, so it is available once a week as a minimum. It can accommodate three people who have to remain seated in wheelchairs, as well as other seated passengers. Staff pointed out the homes library to us and told us about a couple of people who currently used it. One person told us about the homes newsletter, adding they had had one of their poems published in it. People told us they had their post and newspapers delivered to them, in a timely way. An Activity Co-ordinator works at the home six hours a week including on Sundays. It was discussed at a Residents/Relatives meeting held at the home this year that although peoples surveys said a greater variety of activities would be appreciated, no suggestions were made, with a request that people try to do so. People we asked felt they were offered choice - in their daily routines, with regard to meals, etc. - although two said they fitted in with staff. One added this was necessary if the home was to be able to run efficiently. When asking someone about their care and care plan, we were told they were asked by staff as they went along, Do you want so-and-so?. The person added, Things are not thrust upon you. Also in relation to promoting choice, we asked staff about peoples rising and bed times. One staff said they were told this at handover; however, they went on to describe individuals preferences - who might ask for extra time in bed, and who preferred a more precise routine to their day. Peoples bedrooms were personalized with their own possessions. We met someone who had their budgie with them in their room. Staff were mindful to keep a visiting cat away from the area. One person told us visitors could come and go as they pleased, and that they were always welcomed by the staff, who offered them drinks on their arrival. This was reflected by others. A visitor said senior staff were always available if they wanted to speak to them. Care Homes for Older People Page 17 of 30 Evidence: People told us they liked the food, including those requiring a special diet. Menus showed there was a choice of two main courses and two desserts at lunchtime, with a hot snack or light meal as an option at teatime. Colorful salads, liver and bacon casserole, and macaroni cheese were available for lunch during our visit. The desserts were fruit flan, fruit jelly, and icecream. One person told us the home swapped the daily lunch and tea menu for them regularly, to meet their particular needs. Care Homes for Older People Page 18 of 30 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 effective procedures and practices that ensure peoples concerns and complaints are acted upon, and that they are protected from abuse or harm. Evidence: Asked if people would feel able to make a complaint if something were wrong, one told us staff did everything they asked so they didnt think they would need to complain. Others felt able to speak up or complain, including a visitor we spoke with. The homes complaints procedure gave people the information they needed to make a complaint. The homes AQAA said seven complaints had been received in the last year, with the home upholding three. We had received four complaints since our last site visit in November 2006, which were referred to the home for investigation. This was done effectively and appropriately. Staff, including a member of the laundry staff, told us they had had training on safeguarding. Those we asked were able to describe unacceptable behaviors and practices. They knew how to report their concerns if they witnessed these, naming relevant external agencies with safeguarding roles. The safeguarding policy was very readable and comprehensive. Senior staff at the home had recently reported some concerns to Social Services safeguarding staff; a Care Homes for Older People Page 19 of 30 Evidence: multidisciplinary investigation found that the home had followed correct procedures in reporting the matters, but no abuse had occurred. Senior staff had had recent training on the Mental Capacity Act, and were planning how to relate this to care practices. One person we asked about the bedrails on their bed - a potential form of restraint said they were happy to have them. We noted there was no protective cover to prevent the person hurting themselves on the rails or getting entrapped. The manager said these were on order. Mr Sadeghi, the director, had sought our view on staff accepting jewelery from someone living at the home, who at the time was apparently keen to make a gift to someone. Our subsequent discussion had included that he might review the homes gift policy and share it with people at the home, so as to avoid such a situation in future. We saw on our visit that the policy had been reviewed; although it did not preclude people from making such gifts, the home asked that such gifts were not offered, for various given reasons. And if a gift were to be made, written consent had to first be obtained from the resident, their family, and senior members of staff. Care Homes for Older People Page 20 of 30 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. People enjoy well-maintained accommodation, having pleasant surroundings with ongoing adaptations that meet their various needs. Evidence: People we asked were satisfied with their own accommodation, confirming they had enough light in the evenings, heat, etc. They had their own lockable storage facility, provided by the home. Since our last key inspection, eight en suite bedrooms, a lounge and other facilities have been created at the home, in a new extension. The original lounge was out of use on this visit, because structural repairs were necessary to its ceiling. Most people, including staff, told us repairs or hazards were dealt with quickly. One comment on a survey was that one of two handymen had left and the home could really do with another one to replace him. One person told us they appreciated the cheerfulness of the remaining handyman. A concern raised since our last visit, which the home investigated, included a problem with an en suite floor. The area was satisfactory on this visit. One person told us they saw how the owners had invested in the home over time, in Care Homes for Older People Page 21 of 30 Evidence: environmental and other improvements. Since our last inspection, directional signs have been put up to help people find their way more easily around the home, which we found very helpful. People who used mobility aids said they felt they could get about safely. There is a lift between floors. Modern level access showers on three floors can be used by people who use wheelchairs. There were also adapted baths to make bathing easier for people with mobility problems. People told us they used the garden areas in better weather, although one person who could not walk commented that at present there were few accessible areas for people with mobility problems. People thought their accommodation was kept clean enough. A room-by-room cleaning rota/schedule has been introduced since our last inspection, which people can request to see. We saw that kitchen staff washed their hands on returning to the kitchen from elsewhere. The kitchen is to be re-fitted within six months, to address problems such as the damaged floor covering. Relevant food safety guidance was in use. Fridge and freezer temperature records showed safe temperatures were being maintained, with leftovers in fridges covered. Care staff described appropriate procedures for reducing cross-infection between individuals, and said disposable gloves and aprons were always available to them. The laundry was designed to enable a dirty-to-clean system, whereby dirty washing was brought in at one end, was dealt with, and taken out clean at the other end. Washing machines had recommended programmes for thorough cleaning of laundry. Alginate bags were used for soiled washing. Care Homes for Older People Page 22 of 30 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. Robust recruitment and staffing arrangements ensure that people are looked after by a staff team of individuals who are suitable to work in a care home, and who as a team have the skills to meet peoples needs. People would benefit if more care staff were qualified, so they receive a safe level of care at all times. Evidence: When we arrived, there were five care assistants and a nurse (the deputy manager) looking after 31 people, with another nurse doing administrative work and the manager (who is also a nurse) on duty. One of the care assistants was from an agency. The care team were supported by a receptionist, two kitchen staff, two housekeeping staff, a laundry staff, and the handyman. Mr Sadeghi was also based at the home. The AQAA said that three quarters of the people at the home needed two or more staff to care for them. One staff survey had expressed concerns about staffing levels and suggested some staff work many hours in a week, but staff we spoke with said staffing levels had improved, as a result of recruitment. An extra daytime staff member had been employed - giving five carers in the morning, and four in the afternoon; there was also always at least one nurse on duty. Some said shortages might occur when people rang in sick, but agency staff would be requested as soon as possible. Staff said Care Homes for Older People Page 23 of 30 Evidence: relatively few agency staff were used, and that they were usually familiar with the home. One staff member said managers were taking action to address sickness absences. Surveys from people living at the home said they always or usually got the care and support they needed, and that staff were always or usually available when they needed them. People we spoke with said staff very pleasant, they seemed competent, knowing what they were doing, etc. And although staff sometimes told people they had a lot to do, they still responded promptly to call bells. A visitor said the staff were very good, and always smiling. We checked recruitment files for three staff and these had required information, with either a basic police check or full disclosure obtained before people started working at the home. There was a system for checking that nurses were still registered to practice as such. Induction packs for the new staff included a relevant code of conduct and appeared to meet recognized standards. Conversation with new staff confirmed they had undergone appropriate recruitment procedures, and had commenced the induction programme. The AQAA stated there were 19 permanent care staff. We were told that, at the time of our visit, there were 17 care staff, of whom 7 had a recognised care qualification (NVQ2 in Care, or an equivalent). The National Minimum Standards for Care Homes for Older People recommends that half of the care staff, as a minimum, are qualified so that people receive a safe level of care at all times. An overview of staff training for the year was displayed in the office, so it could be seen which staff had had certain training. Medication updates had been made available to bank nurses as well as the permanent staff. Fire safety training had taken place in August 2008, and safeguarding in July 2008. Staff said they would be keen to do more training related to the needs of the people they cared for. Staff told us they had supervision every three months, when they could discuss training needs and got feedback about their performance; we saw a planner kept by the manager, to ensure she saw everyone regularly. Care Homes for Older People Page 24 of 30 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 generally run in the best interest of people at the home, although their continued welfare is compromised by one aspect of health and safety that needs action. Evidence: Mrs Karen Thomas, the newly registered manager, is a Registered Nurse who has left the National Health Service relatively recently. She is taking a course on management in care settings, and has the NVQ (National Vocational Qualification) Assessors award. The Director, Mr Sadeghi, is also at the home regularly, and clearly knew the homes residents and routines well. People living at the home said senior staff were available, one saying of the manager, Shes there if you want her. The home sought peoples views through annual surveys - sent to people living at the home, their visitors, and visiting professionals. Meetings were also held, with minutes Care Homes for Older People Page 25 of 30 Evidence: taken, and there was a Suggestions box at one entrance to the home. Minutes from a Residents/Relatives meeting earlier this year included discussion of the homes survey results. There was also a request by Mr Sadeghi for volunteers residents or visitors - to start a council or representative group, to help with staff interviews, planning a new kitchen, etc. We were told on this visit that no-one has come forward yet. Minutes from staff meetings showed that staff had been reminded of their responsibilities in relation to medication and care planning, and equipment had been discussed. Mr Sadeghi attends these meetings, and staff told us they could raise matters for discussion. Ancillary staff were being supported to obtain qualifications relating to their work. No staff act as appointee for anyone living at the home. Rather than the home keeping personal monies on peoples behalf, people were billed in arrears for any expenditure. Health and safety records kept by the home included monthly water temperature checks and weekly fire safety checks. Radiators had covers to protect people from burns. A visitor said fire drills were held regularly; these included the people living at the home. We did not see fire safety risk assessments or evacuation plans for each person, however, and discussed this with Mr Sadeghi. We also discussed whether new staff had certain training repeated to ensure they take in all essential information when beginning their employment, since a relatively new staff member was not clear about fire safety procedures. He confirmed he would address this. We noted some windows were restricted, but others on upper floors were not, where we checked them at random. Risk assessments for these windows stated they should be restricted, although it was suggested to us that the risk assessments were incorrect. Senior staff agreed to review risk assessments of all windows (since we had not checked all windows at the home) within a fortnight, to ensure people were not at risk of falling from them. A new staff member said they had not yet had manual handling training so they did not undertake such duties at present. Other staff said confirmed they were regularly updated on safe working practices. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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 8 12 (1)(a) You must ensure that the health and welfare of each person living at the home is promoted, particularly regarding nutritional screening (which includes fluids), maintaining an appropriate care plan, record of nutrition, & action taken. So timely and sufficient action is taken to ensure people at risk of dehydration have enough fluids to meet their health needs. 01/12/2008 2 38 13 (4) You must ensure that (a) all parts of the home to which people have access are so far as reasonably practicable free from hazards to their safety; (b) any activities which people do are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the 24/11/2008 Care Homes for Older People Page 28 of 30 health or safety of people at the home are identified and so far as possible eliminated, especially with regard to provision and maintenance of window restrictors. So that people at the home are protected from avoidable harm, such as falling from a height. 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 7 You should ensure there is sufficient and up-to-date detail in all care plans, daily notes and evaluations or reviews of these, so that a) All individuals will receive the person-centered care they need and want, in a timely, consistent way that meets their changing needs, and b) The effectiveness or otherwise of care plans can be properly evaluated, to inform future person-centered care planning. You should ensure that at least half of the care assistants are trained to NVQ Level 2 or equivalent. 2 28 Care Homes for Older People Page 29 of 30 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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