Inspection on 18/11/08 for Rose Cottage Nursing Home

This inspection was carried out on 18th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rose Cottage Nursing Home 29/12/06

Rose Cottage Nursing Home 20/01/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rose Cottage Nursing Home 47 High Street Haydon Wick Swindon Wiltshire SN25 1HU     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: Kathryn Silvey     Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Rose Cottage Nursing Home 47 High Street Haydon Wick Swindon Wiltshire SN25 1HU 01793706876 01793706876 rose.cottage@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Katharine Elizabeth Ann Pearson Type of registration: Number of places registered: Hemingway Management Services Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Rose Cottage is a care home for older people that is registered to accommodate up to eighteen people requiring nursing care. It is located in Haydon Wick, Swindon, and situated about a quarter of a mile away from local amenities. The home is a two storey building and has sixteen single bedrooms and one double. A passenger lift is provided to access rooms on the first floor. Although no bedrooms have en suite facilities, each room does have a wash hand basin. The home has a lounge near the front entrance and another lounge with an integrated dining area at the rear of the building. Patio doors from the rear lounge lead to a level garden area. A registered nurse is on duty at all times supported by care assistants. Laundry, housekeeping and catering services are also provided. Care Homes for Older People Page 4 of 32 Over 65 18 0 Care Homes for Older People Page 5 of 32 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 judgments contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. We, the Commission completed this unannounced key inspection over two days. Fourteen people were accommodated and six people had a conversation with the inspector in their own rooms. We spoke to three people in the communal rooms and one friend who was visiting the home. There was direct contact with the the registered manager, the clinical manager, two members of the care staff, the housekeeper, the cook and the activity coordinator. Care Homes for Older People Page 6 of 32 A number of records were looked at including care plans, risk assessments, health and medication records. The care records of three people accommodated were looked at in detail. The environment was inspected and staff were observed engaging with people living in the home. The registered manager had completed the Annual Quality Assurance Assessment, this is an annual self-assessment about the home and is a legal requirement. The fees range from 495 pounds to 650 pounds depending on the room size and care provided. The fees cover regular chiropody, a shared evening newspaper for six days of the week, activities, and trips out. What the care home does well: What has improved since the last inspection? The new experienced activity coordinator, who is also a member of the National Association for Providers of Activities for Older People, NAPA, provides thirtyfour hours of activity support and has developed many new activities. She is able to give one to one attention to everyone weekly, which include trips out locally. We spoke to people living in the home about activities, and although some were unable to communicate fully their pleased expression indicated that they were enjoying the activities and the Care Homes for Older People Page 8 of 32 individual attention. Five people had recently made some cakes and we saw photographs of them completing the activity. The staff use a new nutritional screening tool to identify people at risk, and contact a healthcare professional when required. The AQAA told us that in the last twelve months the front of the home has been repainted, and the gardens improved with a new Gazebo for people to sit under. Twelve bedrooms have been redecorated and all rooms on the ground floor have new furniture and bedside lamps, which is the start of gradually replacing all furniture in the refurbishment plan. The home has four new electric profiling beds and the manager plans to continue replacing beds with these as required. There is new bedding, curtains and soft furnishing in some bedrooms marking a start in using improved quality bedding. The kitchen has a new dishwasher and freezer, additional tiling around the sink area, new portable appliances and new cupboards. The home has a new hydraulic hoist for assisted bathing, and a new wet room facility on the first floor, which provides easy access for people that use a shower. The AQAA told us that during the last twelve months equality and diversity have become part of the staff training. Examples seen for people living in the home were news tapes for blind people obtained from Swindon Talking Newspapers, adapting activities and menus to take into consideration older peoples wishes, liaison with relatives about peoples cultural dietary needs and favourite foods, the celebration of different religious and cultural events in the year. What they could do better: The care plan monthly reviews could be more meaningful, and the daily records should have more information and address the specific actions completed in the care plans. Medication is generally well managed, however, to improve audits additional records need to be kept, and the homely remedy procedure requires updating. The AQAA told us where improvements in menu planning could be made, and the need to review the current four week menus to provide more choice. One person spoken to said the standard of the food varies, but the breakfasts are good. One complaint had been received in the last twelve months, we looked at the record of the complaint, and we recommend that a record is kept of the investigation, what the complainant was told and any subsequent action taken. An additional call bell panel has been recently fitted upstairs as an improvement to the system, however, there is no emergency ring tone should staff require help quickly and call bells cannot be silenced in individual bedrooms, which may mean that the caller may not always get attention when required. The home has sufficient staff to meet the needs of the people, however, too many agency staff may be used to achieve this. Recent recruitment strategies may help to improve continuity of care and lessen the need to employ agency staff. Care Homes for Older People Page 9 of 32 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 10 of 32 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 32 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 relevant information to help them make a decision about moving into the home. Their needs are assessed in detail by a registered nurse before they move in to help ensure that the home can meet their needs. Evidence: We looked at pre-admission assessments for two people admitted during the last six months. One person had already stayed in the home during a crisis period and had decided they wanted to return, and the assessment was completed by the manager in their own home. All the areas in standard 3 of the National Minimum Standards for a needs assessment had been addressed, there was detailed information, which helps the manager decide whether the home can meet peoples needs. The involvement of a community mental health professional had been included in one assessment, which was good practice and provides information to help ensure that the home can meet continuing needs. The clinical manager, also a registered nurse, sometimes Care Homes for Older People Page 12 of 32 Evidence: accompanies the manager when assessments are completed. Each person had a Service User Guide and a summary of the Statement of Purpose in their bedroom on display for their reference. The range of fees are included in the Guide and what they cover, there should be information which indicates that some rooms vary in price due to the size. The AQAA informed us that an admission agreement and contract are also included in the Guide, which is given to people before they move in to help them make a decision. It was evident that peoples needs were being met, by the positive comments received from people living in the home, and from the contentment displayed by people who were unable to communicate well. The manager told us that trial visits can be arranged. Care Homes for Older People Page 13 of 32 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. The care plans seen had some good actions to help staff meet people needs and were regularly reviewed. Minor improvements in record keeping may help ensure continuity of care. Healthcare professionals support people to help ensure that all their needs are well met. Medication is generally well managed, however, to improve audits additional records need to be kept, and the homely remedy procedure required updating. Evidence: We looked at four care plans in detail, and four assessment records in peoples bedrooms when we spoke to them. The assessments gave an overview of what peoples needs are, and we were told that they are helpful to the agency staff that the homes uses, and as a reminder to the care staff. They are updated every six months or more often when there are changes. There was some good information recorded in the assessments, however, the care plans had much more detail for staff to refer to. There were core care plans for some Care Homes for Older People Page 14 of 32 Evidence: assessed needs, which means they covered the same areas for all people, for example personal hygiene and continence care. Continence care plans should record when the continence adviser has visited and any new instructions, together with the size of continence aids used during the day and night. The frequency of continence care night checks, especially for people with double incontinence, should be recorded to help ensure that tissue viability is maintained and pressure ulcers are prevented. There were no pressure ulcer wounds recorded. Additions had been made to the core plans to individualise them and to be more specific than the standard descriptors. All care plans had a manual handling, tissue viability,and nutritional risk assessment. There were many individual care plans for specific problems or needs with good detailed actions and regular monthly reviews by the clinical manager. Good examples of individual care plans were pain control for osteoporosis, a communication care plan for a person with sensory impairment and the management of a Percutaneous Endoscopic Gastrostomy (PEG) to provide additional liquid nourishment. We looked at an example of a chart for pain control ,which the manager was about to implement. The care staff record when people have a bath and, where necessary, urinary output and bowel movements to help ensure that any irregularities are rectified early. Currently there were no wounds that require dressings, however, the manager told us their usual practice is to send a swab off for analysis, measure and photograph all wounds. The monthly reviews could be more meaningful and include a summary of the daily records where reference should be made to specific care plan outcomes. However, the daily records should have more information and address the specific actions completed in the care plans. The manager told us that healthcare professional visits and the outcomes are recorded in the daily records. However, they were difficult to find and visits from the Speech And Language Therapist team, SALT, when supporting the person with a PEG should be recorded in the care plan review. We recommend that there should be a record of all healthcare professional visits or appointments in the care plan,which may aid continuity of care. Where applicable people also have an annual review completed by social services. We looked at the medication administration and storage and completed a spot check of the controlled drugs, which was correct. The return of medication to the pharmacist also recorded what medication may have been destroyed and the record was appropriately signed. The amount of medication entering the home is not recorded, which means that an accurate audit cannot be completed. A regular accurate medication audit should be completed for all people living in the home. The manager completes a regular visual audit of the medication records, where gaps in administration may be noted. The medication records had a photograph of each person and were well recorded with good transcribed records that were countersigned where applicable for safe administration. The doctor visits the home regularly and reviews Care Homes for Older People Page 15 of 32 Evidence: peoples medication, however, there was no record of the reviews. It is recommended that medication reviews are recorded to include any changes made. The home has a medication procedure for staff to follow and we looked at the policy for the administration of homely remedies The manager told us that this procedure had recently been discussed and required updating as it was last signed by the doctor in 2004. We recommend that the procedure for homely remedies states how long the remedy can be used before the doctor is informed. There was a medication reference book available in the home. The medication fridge temperature was recorded daily We observed people being cared for with dignity, and their privacy was respected when personal care was being given. Care Homes for Older People Page 16 of 32 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 beginning to have more social contact and individual activities since the new activity coordinators employment. The activities organised include trips out in the community, and people can choose what they want to take part in. The meals have improved but there is room for further improvement in choice. Evidence: We looked at the notice board in the home where activities for the coming week were posted, these included Aromatherapy, nail care and reading to people. Two people were taken out to a local church coffee morning by the activity coordinator during the inspection. We spoke to the new activity coordinator who had been at the home for five weeks and completes thirtyfour hours of activities over four days at the home, she is also a member of the National Association for Providers of Activities for Older People (NAPA) and has regular information from them about new activities, and attends regular meetings. The experienced activity coordinator was very enthusiastic about her role, she told us there is no limit to the homes budget for activities at present. She had completed an induction and food hygiene training as she helps to feed some people and serve drinks. Care Homes for Older People Page 17 of 32 Evidence: We observed the one to one activities completed during the inspection, which included looking at old ration books from the second world war, looking at a 1950s reminiscence picture book about groceries and reading to people. Other one to one activities recorded were board games, dominos, letter writing, shopping at the local supermarket, a walk locally, gentle chair exercises, and generally talking to people. The coordinator aims to see everyone on a one to one basis each week as well as providing group activities and organising regular monthly musical entertainment. People are sometimes taken out using the local dial a ride service. We spoke to people living in the home about activities and although some were unable to communicate fully their pleased expression indicated that they enjoyed the activity coordinators individual attention. The staff we spoke to told us the new activity coordinator had made a difference for people living in the home who were more involved with everything going on. Five people had recently made some cakes and there were some photographs of their efforts, and one person nursed in bed had a homemade mobile to look at. The co-ordinator had also made letter games for people who had suffered brain trauma for example a stroke and word search games, which a few people enjoyed doing. Social histories were being completed, we saw an example of an excellent history that all staff could access to enable them to understand peoples diverse lives and the individual values that had shaped them, making it easier to meet their individual needs. The AQAA told us where improvements in menu planning could be made and the manager said they need to review the current four week menus to provide more choice. One person spoken to said the standard of the food varies, but the breakfasts are good. A relatives survey told us that the home provides good food. The home had been awarded 4 stars by Environmental Health for food safety this year. We looked at the four week menu and spoke to the chef about the special diets provided, which included soft and sugar free diets. The kitchen was well organised and the food looked appetising. The cook prepares a cooked breakfast when requested and knows everyones food likes and dislikes. The dining area was attractively decorated and staff were calmly helping people in a dignified manner with their food there or in their own bedrooms. One person had a Percutaneous Endoscopic Gastrostomy(PEG) feed, but also ate regular meals. There were no culturally different diets required. The cooks prepare all the food including breakfasts, but the care staff serve the teatime meal at the weekend, and all staff handling food have basic food hygiene training. Care Homes for Older People Page 18 of 32 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 have a large print complaints procedure in their bedrooms for reference, however, concerns are generally dealt with as they occur. People are enabled to record an advanced directive about their wishes should they become unable to communicate them at a later date, and advocates are made available as required. The protection of vulnerable adults is taken seriously and staff have appropriate training and procedures to follow, which helps safeguard people. Evidence: We looked at the complaints procedure, which is in the service users guide in all the bedrooms. Large print is used to help people with sight impairment. The complaints procedure is also in the hall and there are complaint forms available there to be completed as required. One complaint had been received in the last twelve months, we looked at the record of the complaint, and we recommend that a record is kept of the investigation, what the complainant was told and any subsequent action taken. The AQAA told us that residents and relatives are able to have good communication with the manager to discuss matters of concern before they become a problem. We saw how accessible the manager was during the inspection as her office was near the entrance to the home. The people we spoke to during the inspection had no concerns about their care and felt able to go to the staff or manager should they have any. Care Homes for Older People Page 19 of 32 Evidence: In the last twelve months the home has introduced a record called What I want for the future enabling peoples wishes for the future to be recorded. This will help to ensure that staff and relatives are aware of what the person would like to happen, should they become unable to convey their wishes. We looked at an Advanced Directive form completed and the daughter of a person living in the home had agreed to carry out the end of life wishes. The manager knew about the need to use Independent Mental Capacity Advocates (IMCA) should a person living in the home need support to make a decision when they do not have any relatives to help them. We looked at the homes procedures for identifying and reporting any suspicion of abuse, which included whistle blowing. The manager was able to tell us about the procedures and the staff told us that they had received training in the protection of vulnerable adults. All staff have abuse training during their induction, one new carer told us about their induction training. The AQAA told us the home intends to increase the level of abuse training for staff to help ensure people are well protected. Abuse Awareness training had been completed in January and July 2008, a total of nineteen staff attended. Care Homes for Older People Page 20 of 32 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 well maintained and has appropriate equipment to meet peoples changing needs and there are planned improvements to continue the refurbishments. People are not at risk from scalding or burns as all rooms have guarded radiators and hot water temperatures are regulated. Personal possessions in peoples bedrooms help to make them look homely. The home was clean and fresh smelling throughout, but not all cleaning fluids were safely stored. Evidence: We looked at all areas in the home and the gardens. The AQAA told us that in the last twelve months the front of the home has been repainted and the gardens improved with a new Gazebo for people to sit under. Twelve bedrooms have been redecorated and all rooms on the ground floor have new furniture and bedside lamps, which is the start of gradually replacing all furniture in the refurbishment plan. We noticed that the vent in the ground floor bathroom was not working and the commode stored there had rusty wheels. The manager told us that the commode needs to be replaced and the new handyman would soon repair the vent. Some paint was peeling off in bedroom three and the wash hand basin tiles were loose, the manager told us this room will soon be refurbished. Care Homes for Older People Page 21 of 32 Evidence: The home has four new electric profiling beds and the manager plans to continue replacing beds with these as required. There was new bedding, curtains and soft furnishing in some bedrooms marking a start to using improved quality bedding. The managers office, currently near the front of the home, provides more space and the new furniture and fax line installed has improved facilities for multidisciplinary meetings and communication. The kitchen has a new dishwasher, freezer, additional tiling around the sink area, new portable appliances and new cupboards. The home has a new hydraulic hoist for assisted bathing, and a new wet room facility on the first floor, which provides easy access for people using the shower. The home was clean and the manager told us that the new good quality carpet shampooer had improved the standard of cleanliness. The dining room and lounge has been refurbished which included light fittings, and the finishing touches were being completed during the inspection. People living in the home had been consulted about the colours of the paint used in the refurbishment of the communal rooms. We spoke to a person living in the home who was experiencing a problem with her own easy chair, which the manager agreed to help with. Bedrooms were personalised with peoples personal possessions. An additional call bell panel has been fitted upstairs as an improvement to the system, this enables staff to know who is calling when they are on the first floor, however, there is no emergency ring tone should staff require help quickly. Also call bells cannot be cancelled at source to to avoid cancellation before seeing the person that needs help. An additional buzzer has been fitted in the dining room as previously the call bell was difficult to hear there. The manager had recently contacted local television cable companies to help improve the reception in the home. The laundry is cramped and there should be information available there to assist staff with infection control. We spoke to the housekeeper who was experienced and knowledgeable about infection control. All cleaning fluids were not safely stored. The new maintenance person has increased working hours to help complete the improvements in the home. All radiators are covered and there is safe hot water in all bedrooms to help prevent accidents. The radiator thermostatic controls are inaccessible, however, there are plans to change the radiator covers to provide access and give people control over the temperature of their room. The AQAA told us about the planned improvements for the next twelve months, which indicates that the manager knows that more improvements can be made to ensure people have a comfortable, safe and attractive home to live in. Care Homes for Older People Page 22 of 32 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. The home has sufficient staff to meet the needs of people, however, too many agency staff may be used to achieve this. Recent recruitment strategies may help to improve continuity of care and lessen the need to employ agency staff. The care staff have a clear induction and are well trained. Thorough recruitment practices help protect the vulnerable people accommodated. Evidence: Fourteen people were accommodated during the inspection. We looked at the staff rotas and spoke to some of the staff and the manager. Most days there are two qualified nurses on duty, not including the manager, which helps to ensure people have professional support at all times. There are usually five staff on duty in the morning and four in the afternoons including the manager, and three staff on duty each evening. The manager told us that there would be four staff each evening when the home is full again. The home uses agency staff but the manager told us that recent incentives have improved the recruitment of the homes own bank staff, which helps to improve continuity of care. There is an overlap of care staff most mornings to help ensure that people are ready for their breakfast and the cook now comes in earlier to prepare the breakfast. There are two staff on night duty. Care Homes for Older People Page 23 of 32 Evidence: The manager does not have a deputy, however, there is a clinical nurse manager responsible for improving clinical practice. We spoke to the clinical manager who was enthusiastic and knowledgeable about the role. Clinical audits are completed for nutrition, medication and tissue viability. The clinical manager is also responsible for infection control coordination in the home. We spoke to people living in the home and they said the staff were kind and helpful, and that they were treated with respect. One person told us the night staff were splendid. We spoke to three staff individually and one told us the home is well organised and formal supervision is held where training needs are identified. They also told us that there is a thorough handover between shifts, which helps to ensure continuity of care, and that regular staff meetings take place. We looked at the minutes of one staff meeting, which was detailed and recorded, for example, how the keyworker system should work and that all people should have a named manual handling sling. We looked at the record of night staff duties where people are helped to get up if they wish, currently three people are helped to get up before the day staff come on duty. We looked at the comprehensive training information on the staff notice board and the manager gave us a list of all the training planned for the year, which included equality and diversity, abuse awareness, health and safety, manual handling, fire training, first aid, continence care, food hygiene, infection control, accountability for nurses, dementia care, Care Of Substances Hazardous to Health (COSHH), and communication. The AQAA dataset informed us that all but two of the care staff have achieved an NVQ level 2 or above in care or health and social care. We also looked at the separate rota for domestic staff and the AQAA told us that an additional domestic staff member had been recruited. We spoke to the housekeeper who told us that there were sufficient staff for domestic and laundry duties, and appropriate equipment. We looked at three recruitment records and Criminal Record Bureau and Protection Of Vulnerable Adults checks for eleven staff recruited since the last inspection. The home uses the Skills for Care induction modules, we looked at an example. Three staff that had Protection Of Vulnerable Adults checks were waiting for their Criminal Record Bureau checks to arrive and were being supervised by experienced care staff when on duty. Two references had been obtained, recent interviews had been recorded and any gaps in employment explored, we looked at copies of training certificates, and staff had contracts and job descriptions. All staff have an individual training plan and record, we looked at a sample. Care Homes for Older People Page 24 of 32 Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is dedicated and enthusiastic, the staff team are supportive, and there is a good relationship between them and the people living in the home. The quality assurance systems help ensure people, relatives and healthcare professionals can influence the standard of the service provided. The staff are well supported and supervised to help ensure that their training needs are met. The home has safe working practices and polices and procedures for staff to follow. Evidence: The manager has completed the Registered Manager Award and since the inspection has been successful at the interview with us to become the homes registered manager. The manager is experienced, and we spoke to the staff and people living in the home who were positive about the way the home is managed. Not all people knew the manager well but she was completing care duties during the second day of the Care Homes for Older People Page 26 of 32 Evidence: inspection, and we observed the friendly but professional relationship she had with the staff and the people accommodated. The manager does not have a deputy, however, the clinical nurse team leader is able to provide some support. The manager has improved recorded processes for staff to follow to help improve the care and ensure that outcomes are good for people, we looked at some examples. Quality assurance surveys had been completed by residents, relatives, the GP and the Chiropodist as part of the homes quality assurance system, with positive results. We looked at the surveys completed in May 2008, they covered the cleanliness of the home, the politeness of the staff, the care received and the meals provided. We recommend that an audit of the results is completed for people to see the results and any actions taken to improve the service. We also looked at a positive letter about the home from the person providing a religious service there. The fire safety records were well recorded, however, the manager needs to ensure that the frequency of training for staff is appropriate. The following week training was planned to help ensure that staff knew how to use the fire safety equipment. The home had appropriate fire safety resources for training and had also purchased a sledge for evacuation, and completed a fire risk assessment. We looked at the homes maintenance plan and there was clear evidence of the work required monthly and the actions taken. All the windows were cleaned during the inspection. The AQAA informed us that equipment and systems in the home are regularly maintained, serviced and tested as recommended by the manufacturer. The AQAA also told us that all polices and procedures in the home have been reviewed in 2008. We looked at the record of personal monies and recommended that two signatures and the total money remaining is recorded every time there is a transaction. The manager is responsible for completing all health and safety risk assessments in the home. We recommend that appropriate health and safety training is provided to help ensure that the manager is able to complete this important role with confidence to keep everyone is safe. We looked at the accident records, which the manager audits monthly, we recommend that the time of day of an accident is added to the audit to help with staffing level reviews, and that any methods of prevention are recorded. There were no accidents that required reporting under the Reporting of Injuries Diseases and Dangerous Occurrences Regulations (RIDDOR). The manager and the clinical team leader have started completing formal supervision of the staff, we looked at one record. Annual appraisals are also completed for all the staff employed in the home. We looked at a Regulation 26 record completed monthly Care Homes for Older People Page 27 of 32 Evidence: by the provider to enable an opinion to be formed about the standard of care provided and the premises. The record mentioned the refurbishment which is soon to start upstairs. We recommend that there is more information recorded from talking to the people and staff in the home. We completed an Annual Service Review (ASR) for the home in June 2008 when we sent surveys to people living in the home, relatives and staff. As this key inspection took place less than six months after the ASR we did not send further surveys this time. The comments made then, which required action by the manager, have been addressed, this included; additional garden seating and improvements in the garden, more activities and trips out for people, and more staff in the morning to enable needs to be met with regard to getting people dressed appropriately. The AQAA told us that during the last twelve months equality and diversity have become part of the staff training and also part of the homes recruitment and admission process. Some examples include; news tapes for blind people obtained from Swindon Talking Newspapers, adapting activities and menus to take into consideration older peoples wishes, liaison with relatives about peoples cultural dietary needs and favourite foods, the celebration of different religious and cultural events in the year, and recording what I want for the future for all people in the home with the help of relatives or supporters where necessary. We spoke to a person living in the home that wanted a talking newspaper and would prefer not to share a bedroom, we relayed this to the manager. Care Homes for Older People Page 28 of 32 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 29 of 32 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 The registered person shall make arrangements for safe management of medication. The registered person must ensure that the amount of medication entering the home is recorded, which means that an accurate audit can be completed. 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. No. Refer to Standard Good Practice Recommendations 1 1 We recommend that there should be information in the Service User Guide regarding the varying charges with regard to room size. We recommend that health professionals instructions should be recorded in the care plans, an example was the Continence Adviser. We recommend that the procedure for homely remedies states how long the remedy can be used for before the doctor is informed. We recommend that the procedure for homely remedies states how long the remedy can be used for before the doctor is informed. Page 30 of 32 2 7 3 9 4 9 Care Homes for Older People 5 16 We recommend that a record is kept of the complaint investigation, what the complainant was told and any subsequent action taken. We recommend there is an emergency ring tone to the call bell when required and that the call bells can only be cancelled at source to help ensure that staff know when to respond quickly, and to avoid cancellation of a bell before seeing the person that needs help. We recommend that information is available in the laundry about infection control procedures. We recommend that there is more information recorded in the Regulation 26 reports from talking to the people and staff in the home. We recommend that an audit of the quality asurance survey results be completed and for people to see the results and any actions taken to improve the service. We recommend that two signatures and the total money remaining is recorded every time there is a personal monies transaction. We recommend that appropriate health and safety training is provided to help ensure that the manager is able to complete this important role with confidence to ensure everyone is safe. We recommend that the time an accident occurs is added to the accident audits to aid prevention and help with the staffing level reviews. We recommend that the registered manager, responsible for health and safety in the home, has appropriate health and safety training. 6 19 7 8 26 33 9 33 10 35 11 38 12 38 13 38 Care Homes for Older People Page 31 of 32 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 32 of 32 - 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!