Inspection on 04/03/09 for Regent Hotel

This inspection was carried out on 4th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Regent Hotel 15/03/10

Regent Hotel 07/03/07

Regent Hotel 04/01/06

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Regent Hotel 11 North Marine Drive Bridlington East Yorkshire YO15 2LT     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: Jean Dobbin     Date: 0 4 0 3 2 0 0 9 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 35 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Regent Hotel 11 North Marine Drive Bridlington East Yorkshire YO15 2LT 01262673338 01262403607 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sandylane Ltd Name of registered manager (if applicable) Mrs Elizabeth Annie Finney Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Regent Hotel is a large detached building situated on the front, of Bridlingtons North Beach. It is part of a residential area away from the town centre. Local shops and amenities however are only a short walk from the home. The home offers accommodation and personal care for up to 29 older people some of whom may have a dementia-like illness. Regent Hotel has mainly single rooms, the majority with ensuite facilities. People can enjoy the views from the communal room, which overlooks the bay. There is a small garden area at the front of the home with seating and tables available. Limited parking is available behind the house. On-street parking is close by, though because of the homes position on the seafront, there is a fee for this. Weekly costs to stay at the home, provided on 4 March 2009, are between 350 and 410 pounds. Additional charges are made for hairdressing. chiropody and personal items Care Homes for Older People Page 4 of 35 care home 29 Over 65 29 29 0 0 Brief description of the care home like newspapers and specific toiletries. A large file containing information about the home and the latest report by the Commission for Social Care Inspection are kept in the entrance area, for people to read. Care Homes for Older People Page 5 of 35 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: The last key inspection at Regent Hotel was 7 March 2007. This is what was used to write this report. Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. Information from surveys, which were sent to people who live at Regent Hotel, to staff and to other professional people who visit the home. 10 were sent to people at the Care Homes for Older People Page 6 of 35 home, and 5 were returned. 8 were sent to healthcare and social care professionals and 2 were completed, 5 were sent to staff at the home and 4 were returned. A visit to the home by one inspector, which lasted about 8 hours from 9 until 5. This visit included talking to people who live there, and to staff and the manager about their work and training they had completed. Two visiting healthcare professionals were also spoken with. Some parts of the home were looked at as well as some of the records, policies and procedures that the home has to keep. Some time was also spent watching the general activity to get an idea about what it is like to live at Regent Hotel. Information about what was found during the inspection was given to the registered manager and the provider at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 35 Care planning records and risk assessments could be written in more detail. This could include emphasising what people can do for themselves. This will help care staff to understand peoples abilities so that they can be supported in maintaining those life skills for as long as possible. It will also help to make sure people receive consistent and safe care. Some medication storage and checking systems could be improved as a way of ensuring and demonstrating that medicines are being well managed in the home. Care staff could make sure that when people require assistance at mealtimes, then this is provided in a respectful way so that the meal can be an unhurried social occasion. All staff working at the home could attend training so that they know what to do should they witness or suspect any abusive behaviour. This will help to keep people living there safe. This could include looking at how people are to be kept safe without restricting them from walking around the home as they choose. The present bathing arrangements could be looked at to see if the home could have at least one larger bathroom, which could accommodate two care staff and the hoist, so that people with decreased mobility can still have a bath and care staff can support them with this in a safe manner. Peoples personal care needs could be explored in detail as part of their pre-admission assessment to make sure these facilities will always be suitable for them. Recruitment documents could be available in the home for authorised people to look at. If these are stored centrally then there could be written evidence in the home that the manager has read these documents and recorded that the person is fit to work at the home. Written evidence could be kept that staff, starting work before their police check is available to look at, are being supervised properly. This will help to show that people are being protected from harm. Some record keeping related to managing complaints and monitoring incidents and accidents at the home could be improved as this would help the manager with her monitoring of how the home is running. Prepared foods could be labelled to show when they were prepared. This would make it easier to check the age of the food and whether it needs to be thrown out. This would prevent it being served to people when it is unfit to eat. Hot water temperature monitoring could be carried out more often so that the risk of people being scalded by water that is too hot is minimised. 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. Care Homes for Older People Page 9 of 35 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 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 pre admission assessment ensures that individual care needs can be met at the home and the prospective resident receives information and help to enable them to choose whether Regent Hotel is the right place for them. Evidence: Four of the five people living at Regent Hotel, who completed a survey, said that they had been given enough information prior to moving to the home to know that the home was the right place for them. Four of these surveys had been completed either by the individual, or with the help of a relative. Several people said that the home had a good name so were pleased to be there. All the care records looked at contained an assessment completed by a senior person at the home. This process is done to find out the kind of support and help people need, to make sure the staff at the home have the skills and knowledge to support them Care Homes for Older People Page 12 of 35 Evidence: properly if they decide to move to the home. The records looked at also contained a needs assessment by a care manager. None of the people spoken with however, could remember this pre-admission assessment process. The manager says that a brochure is sent out to people expressing an interest in moving to the home. This provides information about the facilities and services the home provides. People are invited to visit the home and talk with people there. And there is also a file which provides a lot of information about the home, and includes peoples views about what its like to live there. This is kept in the entrance area so is available for people to read. The Regent Hotel does not provide intermediate care, however a room is made available for short respite stays and this was in use on the day of the visit. Care Homes for Older People Page 13 of 35 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. Whilst the health and personal care needs are generally well addressed, the written records do not always underpin that care, meaning that staff may not have up to date information about how to support people. Evidence: People living at Regent Hotel looked well cared for. Staff were observed speaking to people gently and respectfully. There was a lot of humour and gentle banter. Care staff spoken with stressed the importance of ensuring that people kept some control of their lives and staff provided choices whenever possible so that people could stay in charge of their day to day lives. People spoken with said that staff were available when they needed them and responded to call bells promptly. Three peoples care plans were looked at in detail and three more briefly. These are in place to describe the care and support people need. They are also there for care staff to refer to, to check that the care they are providing is the right care. Care Homes for Older People Page 14 of 35 Evidence: Whilst these records provided some information, with daily, weekly and monthly reviews and regular checks by the manager, they were not always in enough detail. People also should be consulted about their care needs and encouraged to sign that they agree with what has been written. This will help them to feel included in decisions made about them. The records were not written in a person-centred way, emphasising peoples strengths and abilities and how staff should support them so that they can maintain these skills. For example needs help with bathing does not make clear how much help people need. If they are able to do some of this task for themselves then this needs to be recorded so that staff do not take over nor do they expect the individual to do things for themselves, when they are not able to. The care plans contain assessments of risk to the person from developing a pressure sore, falling or becoming malnourished because of a poor appetite or other health problem. Where risk was identified, a care plan had been written, but these too lacked detail and it was not always clear what systems the manager had put in place to minimise the risk of people coming to harm. People had moving and handling assessments in place but these also need to describe how much help they need so that care staff can provide that in a safe, consistent way. If peoples abilities vary from day to day then different ways of helping them move needs to be recorded. This is so that staff can provide the right care and support dependent on the persons abilities at that time. Despite these comments people spoken with said that staff provided good support and knew what they were doing. One person wrote in their survey that they receive outstanding care and attention. Four of the five surveys completed by people living there said the carers always listen and act on what they say, with the fifth person saying sometimes. The home has good links with health care professionals and good written records are kept of the discussions with these people. These record for example, links with the doctor, community nurse, optician and dietitian. Two health care professionals were spoken with on the day of the visit and both said the home was well run, peoples wellbeing was promoted and guidance and advice was sought from them appropriately. Medication systems looked at were generally managed well. The home uses a NOMAD system where weekly supplies are dispensed by the pharmacist into named cassettes. Care Homes for Older People Page 15 of 35 Evidence: The drugs are administered by senior staff who have received accredited training, so they understand their role in ensuring this task is done safely. Records were well kept and controlled drugs stored correctly. Two items were stored in the fridge, which should have been kept at room temperature, although one of these was only being used by the community nurses. Drug information leaflets provide guidance about how medicines are to be stored so it would be good practise for care staff to check this information about drugs they are not familiar with. Hand written drug record sheets need to be signed and dated by the person who writes them, and it would be good practise to get a second person to check and countersign what has been written as this will reduce the risk of possible errors. Finally it would be good practise to count the numbers of tablets of drugs dispensed in their original packages, to check that this tallies with the expected number as recorded on the medication charts. This would be a way of checking that drugs are being given and signed for correctly. The numbers of tablets should be carried forward from the old to the new drug record sheet. This would help with stock checks and also provide an accurate record of drugs stored at the home. Care Homes for Older People Page 16 of 35 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 are supported to lead the life they choose and receive a varied and nutritious diet. Evidence: People spoken with appeared very contented to be living at the home. One person said Its lovely. And absolutely like home. People said they could choose how they spend their time and generally staff support them in what they want to do. This helps them to stay in charge of their lives as much as possible. One person has a computer and telephone in their room and explained how they enjoyed making cards. Another person gets the paper delivered each day and enjoys doing the crossword. Outside entertainers visit regularly, with one person visiting to play the organ on the day of the visit. Movement to music sessions take place each week and one staff member has extra responsibility for providing games and quizzes. Most people choose to spend their time in the communal room, however several choose to stay in their rooms, and have their meals there too. Care Homes for Older People Page 17 of 35 Evidence: All the surveys completed by people living there said that there were activities in which they could participate, and they were also able to choose what they do each day. The hairdresser visits weekly and one person confirmed that a religious service takes place each month. The home produces a newsletter monthly, informing people of future events. This is good practise as it enables people to look forward to things that interest them. Residents meetings are held periodically but one person spoken with said they never bothered to attend. Minutes from the last one in January 2009 were available to read. Visitors are welcomed anytime. One person said their relative visited regularly and was always welcomed. They said that visitors could have a meal at the home, but added that their relative had never eaten there. People spoken with said they liked the meals at the home. There is a four week menu, which gets changed according to the seasons , and people get asked their views about the meals in surveys, which the manager organises. One person said the food was excellent. Recently there has been a change in the catering arrangements and now the main meal is prepared at the sister home nearby, which has much better catering facilities. This means that a lot of foods are no longer kept at the Regent Hotel, however foods suitable for making snacks are still stored there. Meals are now transported and kept in a heated trolley until they are served. One person said that although initially there was an issue with keeping the food warm enough, this has now been resolved and they think the new system is working well. A cooked breakfast is available if wanted and people choose their main meals for the day, in the morning. There is one main meal offered, although the home provides a list of several examples of alternatives, which can be provided each day. These alternatives are the same each day. It would be good practise to offer two main meals each day, so that people get a real choice. There is a choice of hot and cold meals each teatime and a cook prepares these at Regent Hotel. On the day of the visit there was winter beef casserole, potatoes, parsnips and peas, with honey and raisin pudding and custard. People have juice with their meal and hot drinks after the meal are offered. The mealtime was generally a relaxed social event. Some people had aids to promote their independence. One care worker though was observed assisting someone, whilst stood up. This is disrespectful and does not promote an unhurried social occasion. However there were Care Homes for Older People Page 18 of 35 Evidence: exceptional circumstances unrelated to the visit, on that day, and some dining furniture had been moved. This meant there was less room for staff to move around and to sit with people. Also when the mid morning coffees were served the member of staff handed people biscuits, instead of allowing people to choose their own. These small choices are important as they allow people to make decisions for themselves. Care Homes for Older People Page 19 of 35 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 can be confident that their complaints will be looked into properly however not all the staff employed at the home have a good understanding of what constitutes abuse and what their responsibilities are, should they suspect an abusive situation. Evidence: All the completed surveys stated that people knew how to make a complaint if they were unhappy about something. However whilst people said they felt safe living at Regent Hotel three people spoken with said that they wouldnt complain if someone was horrid to them. One person said I think you should be able to look after yourself. Although the complaints process is displayed in the entrance hall the manager and staff must keep reminding people living there of the importance of telling someone if they are unhappy about something so that the home has the opportunity to put things right. The commission has not received any complaints in the last year although there have been five complaints to the home. These have all been investigated and addressed by the home. The way this information is written down however could be improved, to make it more clear that the complaint has been properly looked into, and to record how the home will prevent a similar incident happening. It would also be good practise to obtain the complainants signature, confirming they are satisfied with the way their complaint has been handled. Care Homes for Older People Page 20 of 35 Evidence: Three members of staff were asked about abuse and what they must do should they witness anything which might suggest abusive behaviour. One person was very clear about what they should do in that situation, but the other two were less so. Currently only care staff generally attend abuse awareness training, however all staff working at the home must be aware of the need to urgently report any incident that may be abusive. The owner contacted the commission in the days following the inspection to say that she had arranged more training for all the staff, and the manager was to attend different, but related, training in safeguarding adults. Knowledgeable staff contribute to keeping people safe. When walking around the home a piece of equipment was seen, being used to restrict a persons ability to walk around freely. Restraining people in this manner, in these circumatances is not acceptable, and the equipment was removed straight away. The manager needs to look at different ways of meeting this persons needs. The provider contacted the commission in the days following the inspection to tell us how the home was now managing the situation. Care Homes for Older People Page 21 of 35 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. Whilst people live in a clean, comfortable and well maintained home some facilities need upgrading to ensure that peoples needs can always be met. Evidence: As its name suggests Regent Hotel was once a hotel. It is an old, detached house on the seafront and has been a care home for many years. It was noted to be clean, warm and comfortable, with no unpleasant odours. The furniture and furnishings were to a good standard and wheelchairs and aids were stored tidily. People spoken with and the survey responses said that the home was always kept clean and fresh. Bedrooms looked at had been personalised with items and sometimes furniture to make the room seem more like home. All of the private rooms have en suite facilities, including a bath or shower though because these are standard baths many of the people living there are unable to use them because of the help they need. Three rooms are larger and are suitable for couples or people who want to share. There is one large communal room, which contains both dining and lounge areas. Whilst the home has divided these areas with the layout of furniture, it still means that Care Homes for Older People Page 22 of 35 Evidence: people have limited choice of where they spend their time. The main part of the lounge has a large television, which was on, though not loudly. And the window area within the dining room,which is described as the quieter area also had a small television on. This means that on the day of the visit, if people did not want television then they would have to sit in their rooms. The call bell system in the communal area is fixed and staff are not always present in this room. This means that if people need help they have to rely on someone being able to call for assistance on their behalf. The manager could consider having some remote call bells, which can be detached from the wall, so that people can ring for staff attention more easily, should they need it. There are two house bathrooms at the home. Whilst both are assisted baths, the rooms are small and there is no room to hoist a person from their wheelchair to the assisted bath hoist. This means that if an individuals mobility worsens, so that it became difficult for them to walk, then the current facilities would mean that they couldnt safely have a bath. This was commented on in the last report, written two years ago. This needs to be addressed in order to be able to meet the changing needs of people as well as protecting the health and safety of the people and staff at the home. The current bathing facilities also need to be discussed with people as part of their pre-admission assessment. The manager though said that a bathroom, which accommodates a wheelchair as well as a hoist, will be created in the weeks following the inspection to enable all people living there to have a bath, if they choose. On the day of the visit one bathroom was being used as a store room. Whilst this was sorted on the day, the overall bathing facilities within the home are not adequate to meet the needs of the people living there. Some changes have been made to the downstairs layout, to create greater office space, so that records can be stored more securely and a private room is now available for meetings. The manager says that there are also plans to create a disabled toilet on the ground floor. The need for this was also commented on in the last report. Care staff need to be able to help people to move in a safe manner and the current small toilet room makes this manoeuvre more difficult. It would also provide better disabled facilities for visitors. The manager says this is something they hope to achieve later this year. The laundry area was satisfactory and the manager makes sure that appropriate aids are available and used to make sure that people living in the home are protected against infection. Care Homes for Older People Page 23 of 35 Care Homes for Older People Page 24 of 35 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. Peoples needs are generally well met by a staff group who are recruited, trained and supported properly. Evidence: The rotas confirm that there is one senior carer and three other carers on the early shift, one plus two carers on the late shift and two carers at night. The manager is not included in these numbers. This is for 27 people currently at the home. There are also cleaning, laundry and kitchen staff working each day, and an administrative person during the week. A maintenance person is employed to work at Regent Hotel and the sister home. Following a recent comment from a person at the home an extra carer also now works between five and seven in the evening, to help both with meals, and to assist people who choose to go to their room after their tea. People spoken with said that staff were very competent and also very kind. One person said were being very well looked after. Four survey responses state that staff always treat them well and are available when needed, with the fifth stating usually. One person though commented that the staff are always very hard-pressed and they dont think theres enough. The manager has addressed some concerns by having an Care Homes for Older People Page 25 of 35 Evidence: extra person over the teatime period, however staffing levels need to be continually monitored as peoples needs change, in order to make sure those needs can always be met. There are male and female care staff employed and one person said she had been asked her preference about receiving personal care. She said that she had requested this help from female staff and so far this had always been respected. She added the staff are very careful and patient. The home has a key worker system where staff are given extra responsibilities for providing care and support for specific people. However this support does not include bathing, as currently one carer each day is identified to help all people with bathing. It would be much better practise for key workers to help their people with bathing as this is often the opportunity to learn more about them and for relationships to be strengthened. This was discussed with the manager who said this used to happen at the home and she would consider reintroducing the system again. More than half the care staff have achieved a National Vocational Qualification Level 2 in Care. This provides staff with good up to date training, which meets recognised standards. It also help staff to work in a safe, consistent way when providing people with care. The manager keeps an up-to-date computerised staff training programme and this shows that staff are generally attending refresher training in a timely way. A number of staff have attended training on death and dying in the last year, to improve their skills and knowledge of caring for people needing palliative care. One health care professional commented that care provided to people at the end of life stage is to a very high standard. Two staff recruitment files were looked at. Both files contained a completed application form and two references. Whilst one person had not started at the home until after their CRB (Criminal Records Bureau) check was completed, this information was stored at the sister home, so the manager had to phone through to the other home to find this out. The manager needs to satisfy herself that all the recruitment checks are complete and satisfactory before deploying someone and if these documents are not stored at the home then she needs to record that she has seen this information. The second person had a PoVAFirst check completed before starting at the home. This confirms that a person is not barred from working in a care setting because of a previous offence, but this check is not as thorough as the CRB. The manager said that the person was being supervised until the CRB check is available to look at, but she Care Homes for Older People Page 26 of 35 Evidence: should keep records to evidence that this is happening. Robust recruitment systems are needed as they contribute to keeping people safe. One staff member confirmed that they had spent three days shadowing staff and looking at the homes policies and procedures when they started working at the home. Although they had not yet received formal fire safety training they were very clear about procedures, should there be a fire at the home. They said they had a planned induction programme to follow and the manager and senior staff had checked informally that they were settling in to their new role. They said they felt very much part of a team. Care Homes for Older People Page 27 of 35 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. People benefit from a generally well managed home, in which their needs and wishes are put first. Evidence: The registered manager has been in post for a number of years and has attained extra qualifications to help her in her role. She has continued to attend training to ensure her knowledge is kept up to date. People spoken with said they knew who she was and saw her regularly in the home. One staff member said in their survey I have found my manager to be fair and honest in any discussions Ive had with her. The manager promotes an open door policy and all the staff surveys state that the manager regularly meets with them to provide support and discuss their work. Staff meetings are held monthly and minutes of the last two were seen. Staff also attend two monthly supervision meetings and have annual appraisals where their work and training and development needs can be discussed. Care Homes for Older People Page 28 of 35 Evidence: In the last six months a new owner has bought the shares of the company that own Regent Hotel. She has been introduced to the people living at the home and is working with the registered manager to determine whether changes need to be made in how the home runs. She also carries out her own monthly checks on how the home is running. Surveys are used to gain the views of the people who use the service at least twice a year and an action plan is written to say what changes are to be made as a result of the responses. These survey results were seen. This action plan is displayed on a notice board, however these plans should also be discussed with people, so they know they have been listened to, and know what the home is going to do as a result. Comments from the surveys though are added to the service user guide, so that people thinking of moving to the home can read what other people think about it. This is good practise. Surveys are also used after the menu is changed so that the manager can check what people think about the new meals. The manager should also consider trying to gain the views of other people using the home, like professionals and visitors. This would help her gain an overall view of how the home operates. Some peoples personal monies are stored at the home. These were not formally looked at on this visit. Both the manager and a staff member said, separately, that receipts are kept for all goods purchased and good records are maintained. The manager carries out environmental checks each month when she walks around, checking that the home is being maintained properly and systems, in place to keep people safe, are being complied with. Although accident records are well maintained these also need to be audited each month to check that there are no common themes, which may need addressing. The manager said she would implement this straight away. There are a range of health and safety policies and procedures in place. The home has made proper provision to ensure that there are safe working practises by providing staff training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. Random safety certificates were checked and found to be in date. Hazardous products are stored appropriately. Fire safety checks are carried out regularly. Care staff monitor and record the bath water temperature before people bathe. Care Homes for Older People Page 29 of 35 Evidence: However the water from all the hot taps to which people have access are not monitored regularly to confirm that the valves, in place to prevent the delivery of very hot water, are working properly. The manager needs to be satisfied that the present system of hot water temperature monitoring is adequate to meet the risk of people being scalded by water that is too hot. The fridge in the kitchen contained a number of opened or prepared items that were neither covered nor dated. This makes it difficult to know when foods need to be discarded. As there is not always a cook on the premises at Regent Hotel it is even more important that foods are stored safely and properly labelled, to prevent the risk of food being given to people when it may no longer be fit to eat. Care Homes for Older People Page 30 of 35 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 31 of 35 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 13 When people are assessed as at risk then there must be a clear and detailed written plan of care describing what the home is doing to minimise that risk. If peoples abilities change from one day to the next then a plan needs to be written to describe different ways of managing that risk. This will make sure people always receive safe, consistent support. 30/04/2009 2 18 13 All staff working at the home 18/04/2009 must be very clear of what they must immediately do if they suspect or witness an incident that may be abusive. This will help to keep people living there safe. 3 38 13 All opened stored foods must be covered and dated to say when they were opened 18/04/2009 Care Homes for Older People Page 32 of 35 This will help to make it clear when items need to be recorded, to reduce the risk of people coming to harm from a possible infection 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 All peoples care plans should be written in a way that recognises their ability to contribute to their care and maintain some control of their lives. This will enable people to be supported in a safe, consistent way. Where possible people should be consulted about these care plans so that they feel included in decisions made about their care. A system could be introduced to record medication carried over from the previous months medication record to the new one. This helps with auditing that medicines are being given as prescribed. Care staff assisting people with their meal should be sat with the individual in order to promote the meal as a relaxed social event. Written records of the way complaints are managed could be improved. This should include dates of meetings, copies of correspondence, the outcome of the complaint and an action plan to show how the home will prevent similar incidents. This will help to demonstrate that complaints are taken seriously by the home. The registered person should look at the home having a bathroom that can accommodate a hoist, so that all people regardless of their mobility would be able to have a bath safely and easily. This would also enable care staff to provide this care in a less confined space. It would be good practise for the registered person to keep recruitment documents at the home, for authorised people to look at, however if this is not possible then there must be a record that the registered person has seen these documents and found them satisfactory. The registered person should also keep records to demonstrate that a person working at the home before their full police check is 2 9 3 15 4 16 5 21 6 29 Care Homes for Older People Page 33 of 35 returned, is being supervised properly. 7 38 The registered person should review the frequency of hot water temperature monitoring of all hot taps to which people have access to be satisfied that people are not being put at risk of scalding from the delivery of water that is too hot. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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