Inspection on 01/12/08 for Poplars

This inspection was carried out on 1st December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Poplars 11/01/08

Poplars 09/02/07

Poplars 29/11/05

Poplars 22/07/05

Poplars 18/06/04

Poplars 23/09/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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: Poplars Poplars 15 Ickenham Road Ruislip Middlesex HA4 7BZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Collisson     Date: 0 4 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Poplars 15 Ickenham Road Poplars Ruislip Middlesex HA4 7BZ 01895635284 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Appcourt Limited Trading as: care home 27 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: 27 The registered person may provide the following category of service only: Care Home only - Code 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 - Code OP Date of last inspection Brief description of the care home The Poplars is a care home registered for 27 older people. The home is on three floors and there is a lift to all floors. The home is situated in the centre of Ruislip, close to shops and public transport. There is a large rear garden and a large parking area to the front of the home. All bedrooms are single and have their own en suite toilets. Two rooms have their own shower. The staff room and laundry are to the rear of the property. The weekly fees for the home range from £450 - £605 per week. There are additional charges for hairdressing, chiropody, toiletries and newspapers. 0 Over 65 27 Care Homes for Older People Page 4 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out on the 1st December 2008 from 10.00am to 3.35am. The Manager was in the home. There were three care staff on duty, instead of five. Two staff were absent and no replacements could be found. The home does not use agency staff and has very limited bank staff. The Manager was providing support to the residents alongside the care staff. We also attended on the 4th December 2008 to look at the staff records and meet with more residents. The Manager was also present at this visit. The inspection took a total of eight and a half hours. We were accompanied on the first day of this inspection an Expert by Experience. Care Homes for Older People Page 5 of 33 The Commission for Social Care Inspection is trying to improve the way it engages with people who use services so as to gain a real understanding of their views and experiences of social care services. It now uses Experts by Experience who are an important part of the inspection team and help Inspectors get a picture of what it is like to use a social care service. The term Expert by Experience used in this report describes a person whose knowledge about social care services comes directly from their experience of them. During the inspection we looked at a variety of records, including care planning files, staff recruitment, training, complaints, finances, medication and maintenance. We met with most of the twenty three residents during the course of the inspection. One person was in hospital and there were three vacancies. We sent surveys to residents, staff and professionals. We received fourteen from the people living in the home or their relatives, and five from staff. The majority of the comments were positive, and people were complimentary about the Manager and her staff. There were some adverse comments about the lack of activities. The comments have been used in the report as appropriate. We toured the home on both visits. The majority of the residents were in the lounges but some were, by choice, in their rooms. One person was about to go on holiday with a nearby community group. A small number of people are able to access the community and its facilities independently. The Expert by Experience observed the lunch on the first day. The Manager provided us with the Commission for Social Care Inspections Annual Quality Assurance Assessment, which gave us information about the service, its plans for the future, and the statistical information about the residents and staff. We found that there are no special cultural requirements to be met at the present time. People have religious needs met by the either visits to local churches or the minister visiting the home. We gave feedback to the Manager at the end of both of the visits. The Expert by Experience said, in conclusion that, The Poplars has a warm friendly atmosphere and the staff on duty, who communicated well with each other, seemed to be aware of and have the ability to meet the needs of the residents and I witnessed friendly interaction been the staff and clients. The overriding factor was that all the residents spoke very highly of the Manager and her staff but they all seemed equally aware of how very busy they are all the time and I believe that this is as a direct result of staff shortages or rota problems. We felt that people need to confident that there are sufficient staff to meet needs, particularly in respect of activities and outings. We made three requirements at the January 2008 inspection. We have made fourteen requirements at this inspection which include the medication, staffing, activities and some environmental shortfalls. What the care home does well: What has improved since the last inspection? What they could do better: We found that the information available to the prospective and current residents was not up-to-date and needed to be reviewed. The medication administration was in need of improvement to ensure that there is a clear audit trail of medication received in the home, administered and disposed of. Some environmental and safety changes are needed to ensure that the residents are able to sit comfortably in one of the lounges on sunny days, and toilet and bathroom doors can be unlocked in an emergency. Not everyone is satisfied with the provision of activities and the opportunity for outings. Sufficient staff need to be on duty to ensure that there is a good choice offered to people. The staffing levels, on the first day of the inspection, were below those considered sufficient by the home. There is a shortage of staff, which needs to be addressed. Sufficient management time needs to be available to ensure that improvements can be made in the record keeping. We have recommended that a computer and Internet access would aid the manager to improve both the standard of the record keeping and have useful access to new legislation and good practice guidance. Staff recruitment has been difficult to achieve but the Manager must ensure that staff have all of the necessary checks, such as POVA First and references, before they commence work. The home has a fire risk assessment but it had not been reviewed in accordance with the newest legislation. Care Homes for Older People Page 7 of 33 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 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the information they need to help them to make a decision about the home but updating is required. People are fully assessed prior to admission. There is the opportunity to visit the home before making a decision. Evidence: The documentation that is available, to help people to make a decision about the home and its facilities, is in need of updating. The Manager said that the colour brochure is to be redone shortly and will have new photographs to reflect the changes to the homes enviroment. The Service Users Guide and Statement of Purpose, which are combined in one document, have some details which are out of date. The Manager said that these are corrected, for new residents, by using labels placed over old information but the home needs to ensure that everyone in the home has the current details. Care Homes for Older People Page 10 of 33 Evidence: We saw a variety of assessments in each of the four care planning files we examined. One person due to be admitted shortly had assessments and preliminary risk assessments in place. Although there are no specialist assessment forms used, such as nutritional or dependency levels, the care plans showed information to ascertain where there might be concerns. As the home has people with diabetes and other illnesses, a nutritional assessment should be carried out. It is recommended that the Manager looks at providing a more comprehensive system of assessment to ensure that any special needs are identified and reviewed on a regular basis. Although the home does not admit people with a diagnosis of dementia, there are some people who appear to have developed some symptoms and its needs to be ensured that they have the referrals to the appropriate health professionals. The home will need to provide training to meet any needs that may arise from this and show that it can continue to meet any specialist needs. The home has a small number of steps in some areas, which means that people using those rooms need to be reasonably mobile. At present there is no one who requires the use of a hoist for their transfers. Equipment is available to help people to use the bathing facilities. The Manager said that people can visit the home prior to admission and they are invited to spend time in the home. This was confirmed by people we spoke to. The people soon to be admitted had not visited due to their personal circumstances but their representatives had done so on their behalf. All people start in the home on a months trial. We saw contracts in all of the files examined and a sample copy is in the Service Users Guide. A person who had recently moved into the home said she was now settled and felt people had really tried to make her feel welcome. The home does not provide Intermediate Care so this National Minimum Standards could not be assessed. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are basic but have the information to describe peoples needs. They are not seen to have been compiled in conjunction with the person concerned or their families. Health needs are met through community services. People are protected by risk assessments being carried out. Some medication procedures need improvement to ensure good administration. Poeple say they are treated with respect. Evidence: We examined four samples of care plans in peoples files. The care plans have basic information on the needs of the person, and some personal information, regarding preferences, likes and dislikes. Risk assessments are completed on moving and handling, bathing, medication and going out of the home. These identify where people require assistance. These, and the care plans, were seen to be reviewed, although not monthly. There was no evidence that the care plans were compiled in conjunction with the people living in the home or their representatives. There was also some information in the care plans which could have been more positively written in respect of peoples manner and attitude. The Expert by Experience observed a resident who Care Homes for Older People Page 12 of 33 Evidence: had some confusion being teased inappropriately by a member of staff. Although people in the home said that staff were kind to them, some training or supervision in this area is advised to ensure that the staff use appropriate language. The health needs, and the outcomes of visits by general practitioners or visits to clinics, are recorded in the daily notes and each person has a separate book for these. It was recommended to the Manager that any general practitioners visits or other health visits are recorded in red, or marked in some way, so that it is easier to follow any treatment or the outcome of any visits. The Manager has found that, with the permission of the resident, obtaining their medical history from their GP, has assisted them in knowing the extent of the health needs of the person and the support they require. The home has access to a number of GP practices in the area. One of the items identified by the Manager in Annual Quality Assurance Assessment was the lack of chiropody support from the NHS except for people in the at risk category. Private chiropody is accessed. She confirmed that none of the residents have a pressure sore at present. The district nurses visit the home should any medical assistance be required. We checked a sample of the medication. The majority of the medication is in weekly dosette packs, filled and sealed by a local pharmacist. There was also non-dosetted and as and when medication in the trolley which we also checked. The Manager said that these are sent every four weeks. New Medication Administration sheets (MAR) are sent each week and the new weeks sheet had just commenced. However, the stock of the non-dosetted medication is not brought forward to the new sheet, so a stock check was not possible. The Manager confirmed that the stock is only checked upon receipt every four weeks. A record is kept of the medication returned to the pharmacy. There must be an audit trail from receipt, through to administration and disposal, and the Manager must be seen to have made regular checks. We did not find that medication in packets or bottles had been marked with the date of opening, which would aid the checking of stock. We also saw a member of staff sign a MAR sheet in advance of giving medication. While the staff member said that this was not usual, the Manager must ensure that staff follow the correct policies and procedures for administration. We asked if the medication for the person going on holiday had been recorded. The Manager said that the person had taken sufficient but they had not recorded it. All medication going in or out of the home must be recorded and be accounted for. There is a short medication risk assessment in each care planning file. One person was selfmedicating and each person has a locked cabinet for their medication and private Care Homes for Older People Page 13 of 33 Evidence: items. The Manager said that the in-house medication training is carried out and the local pharmacy makes visits to the home. Care Homes for Older People Page 14 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to choose how they would like to spend their time. There are some activities but they do not always suit all of the people and some people would like more opportunity for outings and more varied activities. People generally like the meals and choices are provided. Evidence: We found that the people we spoke to were happy with some aspects of the activities, such as bingo and quizzes. There is no Activities Organiser and staff have to provide any activities which take place. The shops are nearby but people said that they have little opportunity to visit them. One person wrote in a survey that there are only sometimes activities in which they can take part. They wrote that they could do with more stimulation as, apart from colouring and bingo, there is no other entertainment. Christmas plans were underway. The residents said that they enjoy Christmas in the home. They said they appreciated the entertainment and additional activities at Christmas and we saw this years programme, which include two events to which families are invited. Care Homes for Older People Page 15 of 33 Evidence: The Expert by Experience said that There did seem to be quite a few activities planned for the Christmas period, such as a Gala Dinner, Christmas Mince Pies and Sherry, and a Christmas party and everyone I asked seemed quite happy with this. However, the comments were made by two or three residents that they would like to get out more, maybe go the shops or just go for a walk up the road. One lady said she would love to go on a coach trip. I did see an activity timetable which has been framed and hung on the wall but was told by one person that this had not changed for years. We found that people do have choices as to where they spend their time. We found the people who wish to stay in their rooms are able to do so and, as the rooms are single, each has some personal space. People are able to meet with their relatives as they wish and people confirmed this. The Expert by Experience spoke to a visitor who said she had waited for a room to become available at the Poplars and that she was very happy and contented with the way that her relative was being cared for. She said that she was pleased to be able to approach the manager and the staff if anything was wrong because she knew it would be put right straight away. The cook is able to provide for people who are diabetic or vegetarian. There are no cultural needs to be met at present. For lunch on the first day of the inspection there was smoked haddock or omelette. Those people who did not wish to have either of these had a meal of their choice. There is a three-week rolling menu and this is changed in summer and winter. Diabetic desserts and cakes are available. One person said, the cook makes us nice meals and two other people said, you cannot fault the meals. In replying to the surveys, most people said that they always or usually liked the meals, but four people said only sometimes. One person commented that the meals are plain and adequate. Another person said, A more sensible diet for adults could be provided and said that some of the food, such as tinned spaghetti, was difficult to eat. The main meal on the second day was a roast turkey lunch, with jacket potatoes as the alternative. The desserts are served from a trolley with apple strudel, fruit salad, custard and ice cream being available on the second day. The dining room is a pleasant area and tables are nicely laid. There are no menus displayed in the dining area and the breakfast menu is in the hall. Staff were seen to ask people what they would like to eat the following day. It is recommended that the menus are made available in an easy to read format for the residents, in an accessible area so that they are able to make their choice and have a reminder of what is on offer. The Expert by Experience wrote, Lunch was a very unhurried affair and everyone offered the opportunity of going to the toilet before being escorted to their table. One Care Homes for Older People Page 16 of 33 Evidence: client has fallen asleep and I witnessed her being woken up very gently by a carer and helped to stand up to walk to the table. Everyone I spoke to about the food said it was good, there was always a choice, I could have something else if I wanted like an omelette or egg and chips and the chef seemed aware of individuals likes and dislikes. Lunch looked appetising and there was plenty of food available with seconds being offered at both main meal and pudding. The chef came out to check that everyone was OK and was enjoying their dinner which, I thought, was a very nice touch. It was also noted that anyone that needed assistance to eat their dinner was given help in a friendly, unhurried way. The cook works for six days a week. In his absence, and for the evening meals, the Manager and staff are required to cook. As these staff are also working as care staff this takes away the number of staff available to support people living in the home. The television is located where it cannot be watched by many people, probably no more than six due to its position. However, it could be difficult to place it in a more convenient position. One person said that it was easier to go to your bedroom to watch a programme. A number of people were reading and we noted that there is a small selection of books and tapes but they were not easily accessible because there were chairs in front of the storage area. People said that they were able to follow their religion, and some are visited by ministers of religion in the home. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to complain and say they would do so if the need arose. People are enabled to vote at elections. Staff training in safeguarding adults issues help to protect people. Evidence: We found that no complaints have been recorded in the home since 2005. The Commission had received two anonymous complaints about the home in the last year, but it did not appear that the home had been informed of these by the people making the complaints or the residents. Although most people said that they had no reason to complain, we did find a small number of people who raised concerns. These could be recorded to show that people have been taken seriously and to show how the concerns have been resolved. Most of the people replying to our surveys said that they were aware of the complaints procedures and the procedure is displayed. There were three meetings with people living in the home held in the last year where they have the opportunity to express their opinions. The home has also carried out its own surveys. We saw information in peoples files to show that they have been registered to vote and have the opportunity to cast their votes at elections. Training in safeguarding adults procedures has been undertaken recently. There have been no issues raised in the home. Care Homes for Older People Page 18 of 33 Evidence: Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and people are able to personalise their rooms. People said that their rooms were suitable for their needs. The home is clean and hygienic. People do not always feel they are consulted about changes to the environment which could be beneficial to many residents if carried out. Evidence: We found the home to be maintained in good order, and it was clean. People living in the home reported that it was always or usually clean. There are two lounges and a dining room, which are interconnected. They are comfortably furnished, with one lounge having a television. The quieter lounge overlooks a pleasant garden and people said that they enjoyed using the garden in summer. There is no separate lounge for people to meet with their visitors in private but, as everyone has their own room, there is private space available. The ground floor office is used for small meetings. Each person has their own toilet en suite and two rooms also have their own showers. There are two toilets close to the lounge and dining area, but one was being used for staff and visitors. People living in the home mentioned that they were concerned about only one toilet being available as going to own their rooms could take some time. By the second visit, the manager had changed the toilets to provide one for male residents and one for female residents. Staff and visitor facilities were available Care Homes for Older People Page 20 of 33 Evidence: elsewhere. The home has a lift to all floors but, in a small number of areas, there are steps. The stairs in the home are quite steep but the manager said that there have been no accidents involving residents. We saw in the files we examined that equipment, such as special mattresses, have been provided where necessary. There are four bathrooms although one, which does not have specialist equipment, was being used as a storage area. Although the National Minimum Standard of having one bathroom available for every eight residents is nearly met by the three bathrooms which are in use, consideration could be given to bringing this room back into use as it also has a toilet. Appropriate storage needs to be made available for the unused equipment. The staff said that the most popular facility was the Parker assisted bath but showers are also available should they be preferred. We found that the water in the bath, which has a digital display, was four degrees over the safe level of 43 degrees Centigrade and the Manager was asked to ensure it is adjusted. There was no thermometer available for staff to make checks on the water temperatures. We saw bedrooms which were suitably furnished and personalised. One person said that they had been able to bring their own pictures and could have brought in items of furniture had they wished. The Expert by Experience spoke to one person whose room was very bright and airy. She had been encouraged to bring in personal items when she moved in to make the room feel more like home. Other people told us that they had been happy with the furniture that the home provided. However, one person would gave liked to purchase a larger bed, but had been told this was not allowed. It is recommended that the Manager discusses with people and their families any preferences they may have to see if they can be accommodated, particularly if they are willing to pay themselves and it would improve their living standards. The Manager provided information about the areas of the home that had been improved with new carpet and redecoration. There is an ongoing programme of redecoration carried out by one of the homes staff. In one room, the new carpet was badly stained and there was some odour. It was discussed with the Manager that it might be better to provide the type of floor covering, in the part of the room affected, which could be more easily cleaned. It is important to keep all rooms clean and hygienic. Action is required to improve this situation. Care Homes for Older People Page 21 of 33 Evidence: We noticed that the toilet doors do not have locks which can be unlocked from the outside in case of an emergency. One person using the toilet was told to unlock it from the inside in case they got locked in. This does not support the dignity of the residents and suitable locks should be fitted for both privacy and safety on all toilets and bathrooms. In the afternoon of the first visit, we noticed that people have to move around the lounge facing the garden as the sun was in their eyes because there are no curtains or blinds. This was mentioned to the Manager and we have made it a requirement to ensure that people can sit in comfort in that area. We found that people had small grumbles which could be easily resolved and be beneficial to the majority of the residents. These included the number of toilets available on the ground floor, the provision of blinds and access to the books and music. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a small staff team and it is insufficient to cover any gaps at time of leave or illness. There is evidence that the staff shortages and the additional duties affect the daily lives of the people in the home by restricting activities and outings. The recruitment practises are not always sufficiently robust to ensure that people are protected. Evidence: We found that the home was, according to the rota, two care staff short on the first day of the inspection. The Manager was helping the care staff to support with residents with any care they needed. We noted from the rota that there were days when there were less staff than the number which the home has said is sufficient. The Manager had been unable to get anyone to fill the gaps on the first day as agency staff are not used and there are limited bank staff. As most staff also cover the waking night duties, the number of staff available for an additional shift is limited and some staff were working double shifts. They also have to cook the evening meals, which may be for up to twenty seven people, and to cover when the cook is not available at lunchtimes. They are also undertaking all of the activities for the residents. It was evident from speaking to people that, although they very much appreciated what the staff did for them, they said they were always very busy and they felt the home was short staffed. Although there were four resident vacancies in the home, there still needs to Care Homes for Older People Page 23 of 33 Evidence: be sufficient staff to ensure that there is time for all of the work that needs to be done. As the Manager is also required to spend time away from management tasks, including cooking duties, the Registered Providers need to look at ways in which the situation can be improved. The staff rota was not easy to read and the Manager was in the process of rewriting it at the second inspection. She was asked to ensure that her own hours are now shown and that any changes are recorded at the time. The availability of a computer to the Manager could assist her to provide easier to read documentation. The Manager reported that ten staff have a National Vocational Qualification at level 2. Although we were were provided with a list of staff who have undertaken training in 2008, there is no record of all of the training undertaken by each staff member to show that they have all of the necessary basic courses and advanced training they require. The Manager said that staff have refresher training each year, mainly using the DVDs and handouts which are also used for staff induction. She was asked to ensure that there is a record of all of the staff training, and the dates it was undertaken, to provide evidence that all staff are up-to-date. The Manager is responsible for all of the staff recruitment, including interviewing, and obtaining all of the documentation associated with it. She said that she had interviewed many potential staff but had been unsuccessful in recruiting. The home recruits through the Job Centre, local advertisements in shops or word of mouth. We examined five records and found that there were some shortfalls in the employment processes. A new member of staff did not have written references, a POVA First check or a Criminal Records Bureau disclosure (CRBs). The Manager said that the person was not employed in providing personal care but she undertook not to continue to employ her until the minimum documentation had been obtained. We saw CRBs in the remaining files we checked. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager and her staff work hard to maintain a good standard of care and support to the people in the home. Staff and residents were positive about the way in which they are treated by the Manager and her staff. Staff are supported by supervision and meetings but these could be more frequent. People are protected by maintenance checks being carried out regularly but some needed to be evidenced better. People are asked for their views but these are not always translated into action. Evidence: The Manager has a National Vocational Qualification in care at level 4. She had commenced the Registered Managers Award (RMA) but there had been problems with the company running it and she has had to cease this. She hopes to take the new Leadership and Management qualification, which replaces the RMA, in due course. She has worked in the home for eleven years and knows the home and its residents well. The Manager provided us with the Commission for Social Care Inspections Annual Care Homes for Older People Page 25 of 33 Evidence: Quality Assurance Assessment which was handwritten as she does not have a computer available to her. We found that the record keeping in the home could be greatly improved by having a computer available to the manager and staff we discussed with her the need for her to be up-to date with new practices and guidance, as well as new legislation, and to be aware of what is on the Commission for Social Care Inspections Internet site. The Manager cited, in the Annual Quality Assurance Assessment, that excessive documentation was not helping the staff to provide a service to the people in the home. We found the documentation to be quite basic and some improvements were needed. The Registered Providers need to look at ways in which the Manager can be supported to improve the record keeping and the technology to do this should be available. We found some evidence that the staff were being formally supervised although the sessions do not meet the National Minimum Standard of a minimum of six sessions a year. The Manager is currently undertaking all of the supervision. As she has senior staff, she should look at ways that work can be delegated, after suitable training has been put in place. The Manager confirmed that the home does not manage the money for people living in the home but holds only small amounts from families for hairdressing or newspapers. Although people have been asked for their views through surveys and meetings, the Manager has not yet put these into a development plan to improve any shortfalls identified by the residents. This was a requirement at the last inspection and is repeated. We looked at a sample of records of maintenance. Small electrical appliance testing had been undertaken in November 2008, the lift was last checked in September 2008, and the Gas check in October 2008. The fire risk assessment was out-of-date and did not appear to have been updated in line with the new legislation introduced in 2006. The fire alarms were checked in August 2008 and the extinguishers in November 2008. The last fire drill was held in October 2008. Weekly test of alarms of the fire alarms were usually held although the last one was dated in early October 2008. The Manager said that the devices for holding the fire doors open were regularly checked but there was no written evidence for this. The call alarm system was checked in June 2008. The Commission for Social Care Inspections certificate and the Employers Liability Insurance certificate were displayed as required. Care Homes for Older People Page 26 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 33 24 The Registered Provider and 01/05/2008 the Registered Manager must include the outcome of resident surveys in the annual development plan. Care Homes for Older People Page 27 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The Registered Manager 28/02/2009 must ensure that all of the information provided to people, including the Service Users Guide, is up to date. To ensure that all prospective and current residents have current information about the home. 2 7 15 The Registered Manager must ensure that care plans are regularly reviewed in conjunction with the people using the service or their representatives. So that it can be seen that people have care plans which are current and have their agreement. 28/02/2009 3 9 13 The Registered Manager must ensure that an audit trail of all medication can be carried out. 31/01/2009 Care Homes for Older People Page 28 of 33 That all medication which is received, administered and disposed of can be accounted for. 4 9 13 The Registered Manager must ensure that staff only sign for medication after it has been administered. That people have been given their medication correctly. 5 12 16 The Registered Providers must ensure that sufficient staff are on duty to undertake outings and leisure activities in accordance with the wishes of the people living in the home. To ensure that people have the opportunity to go out and to undertake activities within the home. 6 21 13 That the Registered 31/12/2008 Providers fit suitable locks to bathroom and toilet doors so that privacy is maintained but doors can be opened in an emergency. That residents privacy and dignity are met by being able to lock door but they are not put at risk by being trapped in the bathrooms or toilets. 7 25 23 That the Registered 31/01/2009 Providers fit suitable window coverings to ensure that people can sit comfortable in 31/01/2009 31/12/2008 Care Homes for Older People Page 29 of 33 the lounge in sunny weather. That the residents are able to sit comfortably in all areas of the communal spaces. 8 25 13 The Registered Manager 31/12/2008 must ensure that staff check on hot water temperatures on a regular basis to ensure they are maintained at a safe level. To ensure that people are not put at risk of scalding. 9 27 18 The Registered Providers must ensure that the staffing levels are sufficient to meet the needs of the people living in the home and that sufficient staff are employed to cover the rota. To ensure that there are sufficient staff available to cover for leave, training and emergency absences. 10 29 19 The Registered Manager must ensure that all staff working in the home have the employment checks required. To ensure that people are protected by staff having appropriate recruitment checks in place. 11 30 18 The Registered Manager 31/01/2009 must ensure that evidence is in place of current training for all members of staff. 31/01/2009 28/02/2009 Care Homes for Older People Page 30 of 33 To provide evidence that staff are fully trained and the training is up-to-date. 12 36 18 The Registered Manager must ensure that all of the staff have regular supervision, and this is maintained on a regular basis. To ensure that staff are supported in their work. 13 37 17 The Registered Manager must ensure that all of the required records are maintained in good order, are available for inspection, and are up-to-date. To provide evidence of checks being undertaken and all required records being available for inspection. 14 38 23 The Registered Manager must ensure that the fire risk assessment is completed in accordance with the fire legislation Regulatory Reform (Fire Safety) Order 2005 which came into force in October 2006. To ensure that people are protected by up to date fire practices and precautions. 31/01/2009 31/01/2009 31/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Older People Page 31 of 33 No. Refer to Standard Good Practice Recommendations 1 3 That the Registered Manager looks at introducing a more comprehensive assessment procedures so that nutritional and dependency levels are assessed upon admission. That staff have training and guidance on writing appropriately worded care plans. That visits to and from health professionals and to hospitals are recorded more prominently so that health needs and outcomes can be easily identified. That menus are displayed in an easy to read format and in an accessible place. That the home records the concerns raised by the people living in the home, or their representatives, so it can be shown that they have been addressed and resolved. 2 3 7 8 4 5 15 16 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!