Inspection on 06/04/09 for Ross Wyld Nursing Home

This inspection was carried out on 6th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ross Wyld Nursing Home 15/01/09

Ross Wyld Nursing Home 23/04/08

Ross Wyld Nursing Home 08/11/07

Ross Wyld Nursing Home 16/04/07

Ross Wyld Nursing Home 04/09/06

Ross Wyld Nursing Home 11/05/06

Ross Wyld Nursing Home 31/10/05

Ross Wyld Nursing Home 17/05/05

Ross Wyld Nursing Home 02/12/04

Ross Wyld Nursing Home 13/07/04

Ross Wyld Nursing Home 20/03/04

Ross Wyld Nursing Home 06/06/02

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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: Ross Wyld Nursing Home Ross Wyld 458 Forest Road Walthamstow London E17 4PZ     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: Caroline Mitchell     Date: 0 6 0 4 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 31 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 31 Information about the care home Name of care home: Address: Ross Wyld Nursing Home Ross Wyld 458 Forest Road Walthamstow London E17 4PZ 02085218773 02085200690 ross.wyld@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tamaris (South East) Limited (a wholly owned subsidiary of Four Seasons Health Care Limited) care home 54 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: To allow the home to provide continuous care for two named service users and to permit admission of one named service user with mental health needs. Date of last inspection Brief description of the care home Ross Wyld is a care home registered to provide care for a maximum of 54 residents. This includes 25 places for those requiring nursing care, 22 places for older people with dementia and 7 places for younger adults with physical disabilities. The registered 1 6 0 1 2 0 0 9 0 0 7 Over 65 22 25 0 Care Homes for Older People Page 4 of 31 Brief description of the care home provider is Tamaris Ltd, part of the Four Seasons Health Care Group. The home is a large purpose built, three storey detached house with 48 single bedrooms and three double bedrooms located across all three floors. All floors are accessible via a lift. The home is situated on Forest Road, in the London Borough of Waltham Forest. Situated in the Walthamstow area and is close to shops, transport networks and other local amenities. The William Morris Museum and Lloyd Park are local landmarks just opposite the care home. The fees are normally between £450 to £736 for each placement per week, and the people who use the service are expected to pay separately for items such as hairdressing, outings and clothes. Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to the people who use the services and other stakeholders. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was undertaken on an unannounced basis and took 1 days to complete. The lead inspector was accompanied by another inspector, Margaret Flaws. We stayed for lunch and took the opportunity to speak to several of the people living in the home. We observed care practises throughout the course of the inspection. We spoke to staff and managers. We met and spoke to several people as we toured the premises. We checked a number of documents including peoples case files, the record of complaints, visitors book, kitchen records, the record of accidents, health and safety records, the staff personnel and training records and the residents financial records. The temporary manager was not on duty at the time of the inspection. However, the regional manager acting deputy and senior carer very helpful and the residents and staff welcoming. The Pharmacist Inspector for the Commission also visited the home on 15th April and the findings from that inspection are included in this report. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Although progress has been made, there is room for further improvement in the care plans and risk assessments to make sure that they are kept up to date when there are any changes, to make them more person centred and for residents to be more involved in their creation. There is a need to remind staff to properly complete medication administration records for all medicines and it is recommended that the home carries out regular audits on medication to pick up and address any issues, as they arise. Work needs to be continued to improve staffs understanding of the needs of the residents with mental health issues, learning disabilities and physical disabilities, and staff need to be provided with training in these areas. It is also recommended that staff be provided with training about the prevention of falls and training to raise their awareness of peoples different ethnic, religious and cultural needs. The team need to continue with the development of assessment round peoples social, leisure and occupational activities and develop services in the home that are suitable for each persons background, interests, developmental needs and lifestyle, and to continue to focus on supporting people to use resources in the local community that provide social, cultural, occupational and educational activities that are suitable for each persons background, interests, developmental needs and lifestyle. To acknowledge that the plans are in place and some progress has been made, recommendations are made about continuing with this work. Care Homes for Older People Page 7 of 31 In terms of health and safety, the home needs to make sure that the records of inhouse fire equipment tests and fire drills are kept up to date. 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has developed a Statement of Purpose, which sets out the aims and objectives of the home and includes a Service User Guide, which provides basic information about the service and the specialist care the home offers. There have been no recent admissions. Therefore we were not able to assess the admissions process in practise. However, the managers of the home have showed that they are clear about the criteria for admission. The managers are clear that the service would look properly at all assessment information to see if they can meet the prospective residents needs before they make the decision to accept the application for admission. Evidence: As with the last inspection, we were unable to look at the referral and admission process in depth because no residents have been admitted to the home for some time. Historically, some people who had been admitted to the home were outside of the registration criteria, and the home was accommodating a number of people whose Care Homes for Older People Page 10 of 31 Evidence: needs would be better met in other settings. At this inspection we found that a small number of these people were still living in the home. However, their needs have been re-assessed by the placing authorities and if their needs cannot be met in the home, more suitable placements sought with the agreement of the people concerned. Who the home can accommodate is now made clearer in the Statement of Purpose. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is becoming more person centred, although there is still room for improvement because of the diverse needs of the people living in the home. People have access to health care services both within the home and in the local community. Health needs are monitored and action taken. There are care plans, risk assessments and a record of health care information in place for each person. There is room for involving residents more and writing information in a more person centred way. Staff training is still necessary in some areas. The home has a medication policy which is accessible to staff. Medication records are generally up to date for each resident, although there is room to improve records of medicines administered. Staff are aware of the need to treat people with respect and to consider dignity when delivering personal care. People living in the home are generally happy with the way that staff deliver their care and respect their dignity and rights. Evidence: We read the written records for 3 people living in the home. We spoke to several people and observed the staffs care practises. We spoke to staff and managers and we toured the premises. We also took note of a number of complaints and Care Homes for Older People Page 12 of 31 Evidence: safeguarding alerts that had previously been received about the quality of care and services in Ross Wyld. Peoples records contained a variety of detailed notes including assessments, care plans, risk assessments, monitoring forms and daily records. There was evidence that work to improve the assessments has been ongoing. We also noted that the assessments included peoples mental capacity, especially in the area of their capacity to manage their financial affairs. Care plans were of a reasonable standard generally, it was evident that work had been done to improve them. There is further room for improvement in making the care plans and monthly reviews more person centred and presenting them in a larger print so people can be more involved in the way the plans are developed. Some concerns were raised recently by one person who uses the service, about staff needing to be more aware of the persons ethnic, religious and cultural needs. The home has taken all of the necessary action to address the particular issues raised. However, these changes were not reflected in the persons care plan or risk assessments and two requirements are made about this. At the last inspection we made a recommendation about improving continence management. This was also raised in relation to a recent issue about safeguarding in the home. We looked at the staff training records and found that half of the staff providing care had recently been given training in this area. We saw evidence that professional health care support is provided including district nurses to support residents on the top floor (which is registered as a residential unit and does not provide nursing care). There was evidence that GPs visit regularly, as do, dentists and opticians. Risk assessments that were in place included peoples nutrition, moving and handling, oral health, tissue viability, continence, and falls. Risk assessments about the use of bed rails were in place for those people whose files were seen and there was very clear and regular monitoring of their safe use. The prevention of pressure ulcers was raised in relation to a recent safeguarding issue about the care given to one person in the home. Managing changes in peoples health was raised in relation to a recent safeguarding issue about the standard of care in the home generally. We looked at the staff training records and found that half of the staff providing care had recently been given a training update in the prevention of pressure ulcers and some staff had been given training in managing changes in peoples health. Care Homes for Older People Page 13 of 31 Evidence: At the last inspection a recommendation was made about training staff in falls management. This recommendation remains relevant at this inspection The manager monitors falls and this information is given to Four Seasons, in a risk monitoring report, on a monthly basis. Some improvement had been made in the area of understanding and meeting the needs of the residents with mental health issues, although this remains an area for improvement. There is some support from Community Psychiatric Nurses (CPN) for those residents who have a mental illness and all of the residents had been reassessed by the social workers involved. Alternative placements are being sought for those residents whose needs are not best met by living in the home. At the last inspection a recommendation was made for the management team to focus on continuing to improve staffs understanding of the needs of the residents with mental health issues, learning disabilities and physical disabilities, and that staff be provided with training in these areas. This recommendation remains relevant at this inspection. We spoke to several staff during the course of the inspection. They were well informed about the residents, their care needs, their personal history and their family circumstances. They also demonstrated a caring and thoughtful approach to residents. We inspected medication records, medication storage areas and training on both the nursing and residential units. We also looked at training for staff, in particular the induction for agency nurses following on from a complaint. Generally, medicines are handled well, storage facilities are good, medicines are held securely, and staff in charge on both units on the day of the inspection were knowledgeable on medication issues. All prescribed medicines were available at the home, and records showed that people are receiving their medicines regularly and as prescribed. The prescriber also reviews medication regularly. There is a policy on the use of agency nurses, which makes sure that agency nurses are given an induction to the unit before giving medicines, and both the staff and the Manager confirmed that this is followed. Agency staff are also not left on the unit without any permanent staff present. Staff who give medicines on the residential unit have had appropriate training, including recent refresher training in medication. One person is being supported to use his own medicines, and a risk assessment is in place to ensure his safety, together with a lockable space to store his medicines. There are a small number of minor issues with recording that are listed below. Care Homes for Older People Page 14 of 31 Evidence: However, none of these put people at risk. Controlled drugs are stored securely, according to legal requirements and all records were accurate except in one case where staff had forgotten to sign the controlled drugs register, although they had signed the medication chart. This was rectified on the day of the inspection. Records of receipt, administration and return are accurate on the residential unit, which means that the home can account for all medicines kept on peoples behalf. On the nursing unit, there were a small number of missing signatures on eight medication administration charts. On inspecting the stock, these medicines had been given. Staff must make sure that they sign for all medicines given. There were also a small number of changes made to prescribed medicines, and a small number of handwritten entries that had not been signed and dated by staff, and occasionally staff are using ticks to show when creams are applied, instead of signing the chart. It is good practise for all handwritten entries to be countersigned, and if any changes are made to prescribed medicines, staff must sign and date the record, with a reference to why and who made the change. The application of prescribed creams must also be recorded in the same way as oral medicines, with staff initials. Temperatures in medicine storage areas (room and fridge) are monitored to make sure medicines are stored at the correct temperature, these are not done daily, it would be good practise to do so. It is recommended that the home carries out regular audits on medication to pick up and address these issues. Care Homes for Older People Page 15 of 31 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. People are given the opportunity to take part in a variety of activities within the home and some in the community, but this could be improved and educational and employment opportunities need to be further explored. There is commitment being shown in the areas of respect, dignity and fairness and some good work is being done around sensory impairment and dementia. Some residents are capable of being involved in more independent living, and this is being developed further. The food in the home is of satisfactory quality, well presented and meets the dietary needs of people who use the service. Work is being done to make sure it also meets everyones cultural needs. Staff are trained to help people who need help when eating and are sensitive in their approach. Evidence: The home employs an activity coordinator. However, improvement in this area has been slow. We noted that there has been some progress with the improvements required at the last key inspection about developing assessment round peoples social, leisure and occupational activities and developing these services in the home. However, there is still a lot of work to do to make sure that people are supported to follow their personal interests and activities, lead their chosen lifestyle and have the opportunity to make the most of their abilities. The quality of the assessments and life Care Homes for Older People Page 16 of 31 Evidence: stories is variable, some for people in the dementia unit are developing well, but most others are not of this standard. All of the life stories could be developed further, with the introduction of large print, personal photographs and other pictures. There is also further work needed to make sure that each person is treated as an individual and to make sure that the home is responsive to peoples race, culture, religion, age, disability, gender and sexual orientation. Some residents are consulted and listened to regarding the choice of daily activity, but this process could be improved. There are suggested programmes of activities. However, these seem targeted to the older people in the home. The records of what activities people are actually engaging in shows a limited number of people engaging a limited range of activities. At the last inspection a requirement was made about supporting residents to use resources in the local community. Again, we found that some progress has been made, but that generally, most people are not getting enough support to make the most of opportunities in the community. Some of the people living in the home have been taking the opportunities presented, to get out in the community. But again, this seems quite limited given the range of different backgrounds, needs and interests people have. Although National Vocational Qualification (NVQ) training does provide some opportunity for staff reflection and learning about peoples different ethnic, religious and cultural needs, a recommendation is made about providing staff with more training. Evidence suggests that in some parts of the home the service might focus on the majority, and not always recognise the maximum potential of everyone living in the home. In some cases the younger people seem to have become over-compliant with the routine of the home as they have had limited opportunity for new experiences. The fact that people do have very diverse needs poses a challenge to the service. The home is still struggling to tailor opportunities round individual needs and interests. There should be more information on community-based events and activities and more attempts to make individual arrangements for people to attend. There has been limited progress, as for some people, educational and employment opportunities are being explored. However, development and progress has been limited. The home is trying to improve flexibility and attempting to improve the service so that it is as individual as possible. There are plans to provide a living space for the people who have physical disabilities, which will give people more opportunities for maintaining and developing their independence. Care Homes for Older People Page 17 of 31 Evidence: In the unit for people with dementia there is evidence of a strong lead around engaging with people and making sure they are given opportunities to engage in a variety of activities. This could be developed further with the introduction of more recognition and reminiscence activities, and more visual cues around the home about peoples cultures and histories. The staff have an understanding of human rights and how this impacts on people using the service. There is commitment being shown in the areas of respect, dignity and fairness. The food in the home is of satisfactory quality and well presented. Improvements are being introduced to make sure peoples dietary and cultural needs are better catered for. Staff are trained to help people who need help when eating and we noticed that they are sensitive in their approach. There needs to be more opportunities for the residents to be involved in food shopping, the preparation of meals and menu planning. Care Homes for Older People Page 18 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Evidence: The home has a complaints procedure that is clearly written and easy to understand. It is given to residents and is displayed in a number of areas in the home. People who live in the home and others involved are helped to understand how to make a complaint and are clear about what will happen if a complaint is made. A comment box is placed prominently in the reception area for people who want to make comments anonymously. The home keeps a record of complaints and this includes details of each investigation and any actions taken. On the day of the inspection the people we talked to said they are happy with the service provided. Staff training in safeguarding is provided regularly. The policies and procedures for safeguarding adults are available and give clear guidance to those using them. The home has a copy of the Local Authorities adult protection, safeguarding procedures, and also its own policy on adult protection. We looked at the records that are kept in the home of safeguarding people from abuse and neglect. There have been a number of safeguarding alerts made since the last key inspection. Some by the management staff of the home and some by other professionals. The management team have Care Homes for Older People Page 19 of 31 Evidence: cooperated with the Local Authorities throughout the safeguarding procedures and have taken action to address all of the outcomes of the strategy meetings. Staff working at the home know when incidents need external input and who to refer the incident to. Some staff recently used the whistle blowing procedure to protect the best interests of people living in the home. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a much improved, safe and well-maintained home that is pleasant and hygienic. There are still some improvements to be made to make sure that everyone living in the home has space and facilities 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. Evidence: We looked around the building and noted that a lot of improvements have been made since the last key inspection in April 2008. The kitchen has been completely refurbished. The large lounge on the ground floor has been divided to provide a lounge and a dining area. There are still some improvements to be made and these are progressing well. What was previously the dining area and hairdressing room are to be converted into a lounge, diner and kitchen, adapted for people with physical disabilities. Several of the bedrooms have been fitted with new floor covering and several have been re-decorated, and work to make sure that all of the bedrooms are in good condition is progressing well. There was a double bedroom on the ground floor that has been converted for one of the people with physical disabilities, so that they can develop their independence. The conservatory is no longer the room where people Care Homes for Older People Page 21 of 31 Evidence: smoke and that this gives everyone a chance to make use of it. Most areas were clean and there were proper sluice facilities, a laundry room and an ironing room. These are well equipped with 2 large washing machines, 2 large tumble dryers and there are facilities for staff to wash their hands to prevent cross infection. The staff room includes facilities for staff to have a shower. Care Homes for Older People Page 22 of 31 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. 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. They are cared for by staff who get the relevant training and support from their managers. Evidence: Four Seasons has developed a good induction format, which provides basic training for staff for a twelve week period when they first start work. We observed and spoke to several members of staff. They were confident in the way that they communicated with the residents. They showed patience and sensitivity when supporting people, particularly when helping people to eat. All had completed National Vocational Qualification (NVQ) training at level 2. We have mentioned in part 4 of this report that there have been a number of issues about safeguarding people living in the home. The outcomes of these included recommendations for staff to have training about continence management, pressure sores, record keeping, complying with care plans and spotting changes in peoples health. We were provided with a copy of the most recent monitoring record about training for the team. This indicated that adequate numbers of the care staff have received this training. There was lots of evidence that staff are receiving the training that they need generally, on an ongoing basis, to help them to meet the needs of the people living in the home. Other training on the planned schedule included various core health and safety training sessions, such as Care Homes for Older People Page 23 of 31 Evidence: back care, COSHH and, fire safety, along with training in areas such as the deprivation of liberty and sensory impairment. The people we spoke to said they were happy with the way the staff supported them. Comments included, I like the staff and They are nice, good. The home provides twenty-four hour support including an emergency on-call procedure and waking night staff. The planned rota showed that there were enough staff to meet the needs of the thirty seven people living in the home at the time of the inspection. There are generally one trained Nurse and three care assistants for the nursing unit and one senior carer and one care assistant on duty in the residential unit. The home had policies in place on recruitment and selection and equal opportunities. We looked at the personnel records for four staff. There was evidence that the home operated a robust recruitment process and undertook the necessary pre-employment checks for staff before employing them in the home. Each staff members file included a written application, Criminal Records Bureau check (CRB) details and two written references. A number of staff have been interviewed and recruited recently and we met two, who were having their induction. Care Homes for Older People Page 24 of 31 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. People have confidence in the manager and are looking forward to her return. Four Seasons have made sure that there have been temporary managers running the home while she has been away. The home have been working on making sure that 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 checks are carried out, although some records need to be updated. Staff are supervised and supported by their managers. Evidence: A full time manager has been appointed. She joined the management team in March 2007. At the time of the inspection the manger was in maternity leave and a temporary manager was covering until her return. A senior member of staff has recently been appointed as acting deputy manager. The regional manager visits the home at least once a week and is available for people who live in the home and their relatives to talk to. Care Homes for Older People Page 25 of 31 Evidence: We looked at a number of records including peoples case files, kitchen records, health and safety checks, the record of complaints, of accidents, the staff personnel records and the residents financial records. Most were being maintained in good order, with some areas for improvement noted in some sections of this report. We were shown the arrangements around peoples money by the administrator. There are very good records and the system is geared to safeguarding peoples financial interests. Most people have relatives who support them with this. The administrator said that some people come to the office for money and staff sometimes take people out to buy toiletries. Expenditure is authorised by the manager and recorded. Receipts are kept. Signed by the person or their representative, the manager and the administrator. People are advised not to bring very valuable items, but there is a facility for them to be kept securely in the office. We looked at the records of health and safety checks undertaken to keep the home and the equipment safe. All checks, such as the electrical and gas safety certificates were in place and a contractor had tested the fire alarm, the hoists and the lift. There are good quality environmental and fire risk assessments in place. The record of the regular tests that staff do of the fire alarm, door closures, emergency lights, fire alarm and fire fighting equipment needed to be updated and a requirement is made about this. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 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 7 15 The registered person must make sure that the care plans are improved. To make sure that plans are more person centred and for each resident to be more involved in the creation of their plan. 19/06/2009 2 7 13 The registered person must ensure that peoples risk assessments are kept up to date. To make sure that peoples current risks are being properly managed. 18/06/2009 3 7 15 The registered person must ensure that peoples care plans are kept up to date. To make sure that peoples current needs are being acknowledged and met. 18/06/2009 Care Homes for Older People Page 28 of 31 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 4 9 13 The registered person must make sure that the medication administration records for all medicines are properly completed. To mask sure that medicine is administered safely. 18/06/2009 5 38 23 The registered person is required to make sure that the records of in-house fire equipment tests and fire drills are up to date. To make sure that the people who live in the home, staff and visitors are kept safe from the risk of fire. 18/06/2009 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 8 8 It is recommended that staff be provided with training about the prevention of falls. It is recommended that work be continued to improve staffs understanding of the needs of the residents with mental health issues, learning disabilities and physical disabilities, and that staff be provided with training in these areas. It is recommended that the home carries out regular audits on medication to pick up and address any issues, as they arise. To continue to focus on supporting people to use resources in the local community that provide social, cultural, occupational and educational activities that are suitable for 3 9 4 12 Care Homes for Older People Page 29 of 31 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 each persons background, interests, developmental needs and lifestyle. 5 6 12 12 To provide staff with more training to raise their awareness of peoples different ethnic, religious and cultural needs. To continue with the development of assessment round peoples social, leisure and occupational activities and develop services in the home that are suitable for each persons background, interests, developmental needs and lifestyle. Care Homes for Older People Page 30 of 31 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. 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