Inspection on 19/03/09 for Rosewyn House

This inspection was carried out on 19th March 2009.

CSCI found this care home to be providing an Adequate 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

Rosewyn House 29/10/09

Rosewyn House 28/03/07

Rosewyn House 14/02/06

Rosewyn House 21/09/05

Rosewyn House 18/11/04

Rosewyn House 11/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rosewyn House Alverton Terrace Truro Cornwall TR1 1JE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diana Penrose     Date: 1 9 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 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Rosewyn House Alverton Terrace Truro Cornwall TR1 1JE 01872279107 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): rosewynhouse@gmail.com Mr William Percival Dawes,Mr Gregory Brian Murrell Name of registered manager (if applicable) Mrs Jennifer Eileen Spargo Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Rosewyn House provides care for up to twenty elderly service users. The registered providers are Mr Dawes and Mr Murrell who are actively involved in the management of the home. Mrs Spargo is the registered manager. Rosewyn House, is situated within walking distance of the centre of Truro. Rosewyn is a large old house situated in pleasant grounds. The house has two floors with access to the first floor via either a staircase or lift. There is one double bedroom and eighteen single bedrooms. No bedrooms currently have en-suite facilities. There are suitable bathroom facilities. There is a large lounge and a large separate dining room. The home is pleasantly decorated throughout. There is also a block of supported living flats next door to the home, which are also managed by the registered persons. Some of the service users from there have their meals at the home. Although the flats are not registered for personal care, some move in to the care home as peoples needs Care Homes for Older People Page 4 of 32 0 Over 65 20 care home 20 Brief description of the care home change. A copy of the full inspection report is available from the manager, and it is suggested a copy is requested from them or CSCI if required. The fees at the time of the inspection were 420 pounds per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An inspector visited Rosewyn Care Home on 19 March 2009 and spent eight and a half hours at the home. An expert by experience assisted with this inspection. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that peoples needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that peoples placements in the home result in good outcomes for them. All of the key standards were inspected. On the day of inspection 19 people were living in the home. The methods used to undertake the inspection were to meet with a number of residents, relatives, staff and the registered manager to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector and expert by Care Homes for Older People Page 6 of 32 experience toured the building. The registered manager has returned a completed Annual Quality Assurance Assessment, which has informed this inspection. Also CSCI surveys have been returned in respect of 10 residents, 4 staff and 3 professionals, and these too have informed this inspection. This report summarises the findings of this inspection. What the care home does well: What has improved since the last inspection? Staff training has improved to ensure that regular statutory updates are undertaken and other training relevant to the client group is provided. More staff have achieved NVQ qualifications and the AQAA states that the manager is trying to recruit staff who already have an NVQ qualification to improve the skill level of staff employed. The arrangements for administering medicines at lunchtime have been changed to be more convenient for the people using the service. Redecoration and refurbishment has been ongoing to ensure the home is a pleasant place to live in. Various checks in respect of health and safety have taken place, for example to improve the fire precautions and prevent the risk of Legionella. The AQAA states that several people have moved rooms which are better suited to their needs. i.e. sight issues, problems with mobility etc. Care Homes for Older People Page 8 of 32 What they could do better: The registered manager was given feedback throughout and at the end of this inspection. She is aware that regulations have been breached and agreed to address the issues. Some breaches have been discussed with the manager and reported in the body of this report others have been notified as requirements and recommendations. The assessment process needs to comply with standard 3.3. The individual records need to be more detailed to ensure that the home can meet the persons health, personal, social and religious care needs. Care plans are in place but need to be more specific to fully inform and direct staff on the total care to be provided. The plans must include religious, cultural and social needs. Risk assessments should be referred to in the care plans especially when a scoring system is used. Daily records could be more informative as to what people have done each day. Suitable moving and handling equipment must be provided for the safe handling of residents and the safety of staff. For example a hoist needs to be provided. The current pharmaceutical guidelines for care homes need to be obtained and available to staff. Handwritten instructions on the medicine charts should be witnessed with two signatures recorded. Appropriate signage should be displayed where oxygen cylinders are stored. Controlled drugs must be stored in a cupboard that complies with legislation. Care plans need to be in place for people requiring medicines on an as required basis, they should include how people are to be assessed prior to the administration of the medicine. The manager should review the activities and entertainment on offer with residents and staff so that people using the service receive more stimulation. It should be more evident that routines are flexible and residents are encouraged to live a life of their choice. There is no evidence that the management have monitored when residents get up and go to bed to ensure they have a choice so the recommendation made at the last inspection remains in this report. People would benefit from having the menu for the day available to them in advance of the meal so they can make an informed choice on what to eat. The manager needs to monitor and deal with any problems with the attitude of staff towards the people using the service, as concerns have been raised to the Commission regarding this. Some residents also said staff can be abrupt in their manner. A washer disinfector would improve the disinfecting of commode pots and urinals. Records of pre employment interviews should be maintained to show that interviews are fair and thorough. The registered manager must ensure that she complies with the legislation in respect of POVA and CRB checks. Staff must not commence work in the home until a satisfactory POVA check and two satisfactory references are received. There must be evidence to show that staff are then fully supervised until the CRB disclosure is received. The head of care needs to have a suitable job description to define her roles and responsibilities as she is very involved in the management of the home. The registered manager must be able to show that she keeps her knowledge and skills up to date in order to fulfil her role. She has no formal qualifications and has not attended regular training courses or update sessions. The environmental health officers report should be addressed. 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.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 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. Residents are only admitted to the home following an assessment of their needs; more detailed records will help to ensure that individual needs can be fully met. Evidence: The registered manager said she visits prospective residents to assess their needs prior to admission and she completes a specific form. The form seen does not cover all of the areas specified in Standard 3.3 and this was discussed with the manager. Three peoples assessment records were seen and none of them contained personal care, religious or social needs. Again this was discussed with the manager. We were told that assessment information from the department of adult social care and discharge information from hospital is obtained where appropriate and documentation was seen in the care files. We were told that prospective residents and their relatives could visit the home before Care Homes for Older People Page 12 of 32 Evidence: the admission is arranged to see the home and meet staff and other residents. They could stay for a meal if they wished. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person using the service has a written care plan but they are not detailed enough to direct staff and ensure that all healthcare needs are met. There is an appropriate system for the use of medicines but there are some issues that need to be addressed to ensure that people using the service and staff are safeguarded. Evidence: Each person using the service has a care plan written by a member of the care team, some have been signed by the resident. Three care files were examined in depth during this inspection. They were all brief and did not contain sufficient detail to fully inform and direct staff on the care provision. The plans did not fully detail religious, cultural and social needs. They need to be more specific, for example, when directing staff to ensure people drink plenty of fluids, as each carer could interpret this differently. Some risk assessments are included but not always referred to in the care plan. There is no evidence that staff have received training on how to undertake risk assessments in particular for moving and handling. There is evidence that care plans are reviewed and this is usually every six months unless needs change prior to this. Care Homes for Older People Page 14 of 32 Evidence: The care plans are in the staff room and are accessible to staff. Daily records are brief and not very informative. People told the expert by experience that they were well cared for but staff could sometimes be abrupt. Seven of the ten surveys received from people using the service said they usually receive the care and support they need. There was little interaction between residents and staff during this inspection but when observed it was good. There are records of visits by doctors and other healthcare professionals. A chiropodist visits and some people do exercises with a visiting entertainer. One resident said they can request a visit from a doctor via the manager who determines if it is necessary. Six surveys said that people usually receive the medical support needed one person commented My doctors surgery is excellent. The manager said there are good relationships with the local Doctors and community nurses, who visit regularly. She said that special mattresses for pressure relief are available and one person, admitted with a pressure sore, was seen on an airflow mattress. Equipment is provided for moving and handling but the home does not have a hoist. One person was seen to be very immobile, and dependant on the care staff for all of her moving and handling needs. Staff spoken with and staff surveys said that a hoist is needed in the home. It is evident that this is the case and was discussed with the manager. A recommendation has been made in this report. There is a satisfactory medicines policy that is available to staff. The current pharmaceutical guidelines for care homes must also be available and the manager said she would obtain a copy. A monitored dose system is in place for medicines and the receipt, administration and disposal records are satisfactory. Staff administering medicines have undertaken suitable training, a pharmacist visits regularly and is on hand for assistance. Handwritten instructions on the medicine charts were not witnessed with two signatures recorded. For the few people prescribed to have medicines administered, when required, we found that there were no care plans in place about the use of this medicine, or any directions on how to make an assessment if this medicine is required. General medicines storage and those requiring refrigeration are satisfactory. Controlled drugs must be stored in a cupboard that complies with legislation. The issues regarding medicines were discussed with the registered manager who agreed to address them all. Peoples privacy was upheld during this inspection and people using the service said their privacy is upheld at all times. The AQAA states We will continue to encourage clients to maintain their individuality and dignity. There have been concerns raised to the Commission in respect of the staffs attitude to residents is is advised that the Care Homes for Older People Page 15 of 32 Evidence: manager monitor the interaction of the staff with people using the service and address any issues promptly. This will help to ensure that people using the service are treated with respect at all times. There are currently no residents or staff from ethnic minorities, the local population is predominantly Cornish, and from a White UK background. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some activities and entertainment are provided but they do not necessarily meet everyones needs and interests. Links with family and friends are encouraged, good food is provided and people have some choice as to how they live their lives. Evidence: Care staff provide activities for people using the service as part of their daily work but there were no activities during this inspection. Posters advertising activities are displayed in the home. Activities include bingo, games and quizzes. No arts or craft take place but some people seemed keen to participate in knitting squares. The television was on all day in one part of the lounge and it appears there are no alternatives such as music or radio. The manager said the residents choose to have the television on. Religious ministers visit regularly to provide Holy Communion and the manager said some people go out to church. An entertainer provides Music for Health monthly which seems to be very popular and provides exercise for residents. Efforts have been made to activate residents but it is limited and not performed on a regular basis. The manager said it is not easy to please everyone and some people really do not want to join in. People who do not join in said their wishes are respected. Every two weeks outings are on offer and several people talked enthusiastically about Care Homes for Older People Page 17 of 32 Evidence: these. People using the service said they do not have access to the local library or large print books but can order newspapers and magazines through the manager. The manager said that people can have library books delivered to them, she needs to ensure that residents are aware of this. People said they are not taken shopping but are able to order items from Tesco through the manager who orders on line. One survey comment was Support on a one to one basis could be looked at to enable other residents and myself to go shopping, visit church etc. One resident said he goes walking once or twice a day and visits a local pub occasionally. Records of activities were held in a book but the manager devised an individual recording system for each resident during this inspection. We were told that the night staff get everyone up for breakfast in their rooms and they get washed and dressed after breakfast. We were told that people go to bed when they wish. Everyone was suitably dressed in clean clothes. The bedrooms are homely and personalised with peoples belongings and furniture. There are suitable arrangements in place for residents to receive family and friends and the visitors book showed that people visit regularly. We were told that the practice of people having to remain seated after meals, in the dining room, until the medication round is completed, has ceased. It did not happen during this inspection. Currently only two of the bedroom doors are lockable, but the manager said people could have a bedroom door lock if they wanted this facility. There are no risk assessments in place for this. Lockable space is only provided for those who self medicate. Meals are prepared in a large kitchen, a cook prepares the lunchtime meals but care staff prepare breakfast and tea time food. Residents have their meals in a spacious dining room where the tables are set with table cloths and napkins, or in their bedrooms. There was a four-week menu in the kitchen but it was not displayed for residents to see. The manager said that people tend to ask what it is for lunch each day. There is little choice on the menu but we were told that alternatives are available. Fresh fruit and vegetables are included and homemade cakes are provided sometimes with afternoon tea. We were told that special diets are provided if required. The expert by experience enjoyed a vegetarian meal which was well cooked and presented. The three residents who shared her table had varying size portions and different meals which implied that staff were paying attention to individual needs. A choice of a hot and cold evening tea is offered. Suitable records of the meals provided are maintained. CSCI surveys show that people usually like the meals only two said always. One Care Homes for Older People Page 18 of 32 Evidence: person commented There is no weekly menu at the home; we are given no choice of meals each day. There were no other comments about the food. Care Homes for Older People Page 19 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. There are suitable policies and processes in place for complaints and adult protection to ensure that people using the service are safeguarded. Evidence: There is a suitable complaints policy in the home. Residents surveys show that they usually or always know who they can speak to if they are unhappy. There have been no complaints to the home or the Commission in the past year. The home has an adult protection policy and a copy of the local authority procedures in the home. Staff confirmed that they have received training in the prevention of abuse and adult protection. Two separate anonymous concerns have been raised to the Commission mainly regarding the attitude of staff in the home and these were discussed with the manager during this inspection. The concerns are that staff do not listen to residents, they talk abruptly to them and some use swear words. Staff spoken with said they get on well with the rest of the team and have not witnessed any swearing or abruptness. Residents said they are treated well and there was no swearing or bullying, however staff could sometimes be abrupt. Another concern was that people have to sit in the dining room until medicines are Care Homes for Older People Page 20 of 32 Evidence: finished. This had been discussed at the last inspection and did not happen during this inspection. Another concern was that the television is always loud, which was not the case today. Residents told the expert by experience they felt safe in the home. Care Homes for Older People Page 21 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. Rosewyn House provides a pleasant, homely, clean and well-maintained environment for people to live and feel at home in. Evidence: The home is warm, comfortable and homely with no unpleasant odours. It is well ventilated and there is domestic style lighting. All areas of the home appeared well decorated and well maintained. The grounds are tidy with lovely well laid out flowerbeds and patio areas. The lounge is divided into three areas, which enables people to move away from the television if they wish but it can still be heard. The home is clean and surveys were positive in this area one resident commented The hygiene is excellent. Suitable laundry facilities are provided and seem to work well. Personal clothing is laundered in the home but bed linen and towels go out to contractors. One resident commented that occasionally clothes do go astray and are given to other residents. Staff receive infection control training and some were attending an external course during this inspection. Protective clothing is provided for staff. Handwashing facilities for staff, with liquid soap and paper towels, were seen in bathrooms but not at each hand washbasin. We were told that commode pots are Care Homes for Older People Page 22 of 32 Evidence: washed regularly in the laundry room and then soaked in bleach in one of the baths. A disinfectant spray is used between soakings, this is not best practice. It is recommended that a washer disinfector be provided for disinfecting commode pots and urinals for better infection control. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are a suitable number of staff employed, staff hold NVQ qualifications and receive regular training to ensure they have the knowledge and skills to care for the people using the service. Recruitment procedures are not robust enough to ensure that people using the service are protected and safe. Evidence: Staffing levels seem to be satisfactory. The rota shows there are usually four staff on duty in the mornings, two in the afternoons and evenings and two overnight, one of whom sleeps in. The registered manager lives in a flat in the grounds and can be called if needed. Cooks are employed to produce the lunchtime meals and cleaning staff are also employed. One of the registered providers is responsible for maintenance. The manager said that agency staff are not employed, staff cover the shifts if people are sick or on annual leave. Staff interaction with residents was professional during this inspection and residents said they are well cared for. 71.5 of care staff are qualified to at least NVQ level 2 in care and two are working towards a qualification. Four staff files were examined, three were for new employees working at the home since January 2009. All had application forms, health questionnaires and evidence of Care Homes for Older People Page 24 of 32 Evidence: training, although most was training provided by their previous employers. Recent employees have NVQ qualifications and induction checklists were seen. The manager said she has yet to add their photographs to the new files. She said that terms and conditions of employment are only issued after the probation period and one was seen. No interview records were kept to show that recruitment is fair and thorough, this was discussed with the manager who said she would keep records in future. The last three members of staff have commenced work prior to a satisfactory POVA first check being received and one has no references on file. These are breaches in regulations and a requirement was set at an inspection in 2005, that all staff must have recruitment checks undertaken by POVA and Criminal Records Bureau before they can commence employment. After gaining the POVA check, no staff member is to be employed unsupervised until relevant CRB checks are in place. This is notified again in this report. The manager said that new staff are supervised until their CRB disclosure has been obtained and explained a colour coding system on the rota. Staff told us that new people are supervised but not necessarily continuously or by a specific person. There was no written evidence in the files of who the supervisor would be. Staff said they were shadowed on several initial shifts, and shown how to carry out their work. Induction checklists were seen but no full induction programme. There is a board displaying an up to date staff training matrix and certificates were seen in files and displayed in the staff room. There was a list of training to be undertaken and some staff were attending courses on the day of this inspection. The head of care said she attends courses and is responsible for some in house training. She said she has done the trainers course for adult protection. One of the registered providers is responsible for fire training and the records were up to date. The manager admitted that she has not kept her own mandatory training up to date even though she works on the floor sometimes. Staff were very positive about the training they have received both in house and externally. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has run this home for many years but does not undertake regular training so her knowledge and skills may not be up to date for her meeting the needs of this client group or for directing staff. Systems are in place to ensure the home is safe and to monitor and improve the service for residents and staff. Evidence: The registered persons have suitable experience, skill and knowledge to run the home. The registered manager lives in a property in the grounds, and the registered providers visit the home most days during the working week. The registered manager has no formal qualifications and has not achieved the Registered Managers Award. She admitted that she has not attended many training courses and she relies on feedback from the head of care. She told us that one of the registered providers reads the care magazines more than she does. She has attended medicine training. She was going to attend a course with the head of care on the Deprivation of Liberties, the day after this inspection. She must be able to show that she keeps her knowledge and skills up to Care Homes for Older People Page 26 of 32 Evidence: date in order to fulfil her role. CSCI staff surveys say that the manager sometimes meets with them to give support and discuss their work. Staff spoken with during this inspection said the home runs well, one person said the manager is strict but she needs to be. CSCI Survey results say mandatory training is for staff but not the manager. The manager is not up to date with laws and legislation, she relies on the head of care. Some new employees have commenced work before a POVA first check has been received and one before any references were received. There is insufficient evidence that staff are fully supervised until a full CRB disclosure is received. It seems that the head of care assists in the management of the home but has no job description setting out her role or responsibilities. This needs to be addressed. There is a suitable quality assurance policy and an annual survey of residents, their relatives and staff takes place. The last survey was done in November 2008, and was positive about the services provided. No audits take place, we were told that accident reports are looked at but not formally audited. Staff meetings are irregular and tend to be at change of shift when more staff are available, no minutes are kept. There are several memos on the board to inform staff of what is expected. No resident or relatives meetings take place, the manager said they have tried these in the past without success. She said she sees the residents every day and they can air their views. A new staff supervision system is in place which staff said enables them to talk to the manager. The manager has completed the Annual Quality Assurance Assessment (AQAA) and returned it to the Commission within the allotted timescale. Most people control their own money with the help of their families. The manager said she collects pensions for four people, she takes out the fees and then they are given their personal allowance. She only holds money for one person. Suitable records are kept regarding this. Money is mainly used for hairdressing but no receipts are kept, the manager said she would ask the hairdresser to sign the record sheet. Money is stored safely in a locked facility and the manager and head of care hold the keys. The manager said she is available out of hours. The registered providers have a health and safety policy. Records kept of the checks required by regulation are very good. Health and safety risk assessments are satisfactory and there are suitable checks to assist with the prevention of Legionella. There are suitable records regarding the central heating system being serviced, the electrical hardwire circuit test is due in 2012 and portable electrical items have been Care Homes for Older People Page 27 of 32 Evidence: tested. We were told that new fire door closers are to be fitted soon. The environmental health officer inspected the kitchen in January 2009 and has strongly recommended that the home purchase a dishwasher. A small cylinder of oxygen is stored in the home and appropriate signage needs to be displayed. Staff mandatory training looked to be up to date. A hoist must be provided as mentioned earlier in this report to assist with the moving and handling of people who are frail and immobile. 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 9 13 Arrangements must be made to ensure that controlled drugs are stored in accordance with the current regulations This will comply with regulations and ensure that storage is safe and secure. 26/06/2009 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 2 7 7 Risk assessment information should be included in the plan of care. This will direct staff on the actions they are to take. Individual care plans should be mre detailed and should include religious and social needs. This will inform and direct staff to meet peoples needs more fully. Handwritten instructions on the medicine charts should be witnessed with two signatures recorded. This will reduce the risk of errors being written. Management should review the activities and entertainment on offer to people using the service and update as necessary. This will help to ensure that people are stimulated and have things to do that they enjoy. Page 30 of 32 3 9 4 12 Care Homes for Older People 5 14 Management should monitor when people get up and go to bed. This will evidence that individual preferences are being respected. The registered manager must be able to show that she keeps her knowledge and skills up to date in order to fulfil her role effectively. Appropriate moving and handling equipment should be provided along with suitable training. This will ensure that practice is safe for the resident and the staff. Appropriate signage should be displayed where oxygen is stored. This will provide information on the dangers for the safety of everyone in the home. 6 31 7 38 8 38 Care Homes for Older People Page 31 of 32 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. 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!