Inspection on 07/10/08 for Royal Court

This inspection was carried out on 7th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Royal Court 28/09/09

Royal Court 25/09/07

Royal Court 13/02/07

Royal Court 15/05/06

Royal Court 02/02/06

Royal Court 16/06/05

Royal Court 23/11/04

Royal Court 19/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Royal Court Rock Mount King Street Hoyland Barnsley South Yorkshire S74 9RP     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: Anne Prankitt     Date: 0 7 1 0 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 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 35 Information about the care home Name of care home: Address: Royal Court King Street Rock Mount Hoyland Barnsley South Yorkshire S74 9RP 01226741986 01226741986 admin@royal-court.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Linda Ann Bailey Type of registration: Number of places registered: Healthmade Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Persons accommodated shall be aged 60 years and above Staffing levels will be determined using the Residential forum for Care Staffing in Care Homes for Older People. The total persons who can be accommodated at the home cannot exceed 40 Date of last inspection Brief description of the care home Royal Court is a care home providing personal care and accommodation for 40 older people. The homes registered owner is Healthmade Limited. The home is a purpose built single storey building. All bedrooms are for single occupancy and have en suite facilities. An enclosed garden area is provided. There are car parking facilities at the front of the building. Royal Court is located in Hoyland within the Barnsley area and is close to the shopping centre and a doctors surgery. On the day of the site visit the Care Homes for Older People Page 4 of 35 0 Over 65 40 Brief description of the care home registered manager said the weekly fees were 351.50 pounds. People pay extra for hairdressing, private chiropody and optical services. People can get information about Royal Court by contacting the manager. The home will also provide a copy of the statement of purpose and the latest inspection report. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The last key inspection of Royal Court took place on 25 September 2007. This key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last key inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Older People Page 6 of 35 Surveys sent to some people who live at the service (none returned), some staff (two returned), and some relatives (three returned). A site visit to the home carried out by one inspector on 7 October 2008, which lasted for approximately eight hours. During the visit to the home, several people who live there, some staff, the registered manager and the care manager were spoken with. Four peoples care plans were looked at, as well as two staff recruitment files, some policies and procedures, and some records about health and safety in the home. Care practices were observed, where appropriate. Some time was also spent watching the general activity to get an idea about what it is like to live at Royal Court. Feedback was given to the registered manager and the care manager at the close. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Staff could always make sure that anything they write on peoples medication records is checked and witnessed. This will help to reduce the risk to people from getting the Care Homes for Older People Page 8 of 35 wrong medication at the wrong time. Information collected about staff before they start working at the home could be checked more thoroughly, to make sure it gives the information needed when deciding whether they are fit to provide care to people. To make sure they are trained and confident to do their job, new starters could have an induction that meets with the Skills for Care specifications. The fire alarm could be serviced to check that it remains in full working order. And staff could receive an update in fire training so that they are refreshed about what to do should a fire break out at the home. Staff could record when they check bed safety rails so that there is evidence that the check has not been overlooked. And staff could always use all of the equipment assessed as needed to make the bed rails safe for use. Although staff have better information in peoples care plans about how to move people in a safe way, they must makes sure that they always follow these instructions. The planned training in safe moving and handling must be put into practice so that people are moved in a safe and consistent way which meets their needs, and which reduces risk to them. Better arrangements could be in place so people can be assured that they will get the right first aid attention in an emergency situation at all times, day or night. The assessment tool used after people have been admitted explains what overall care people need. It is very good, because it asks for lots of details about the person. It could be used during their pre admission assessment to make it easier for everyone to decide whether the home will be able to meet the persons needs successfully. People could be asked more about what activities would make their social life better so that activities are provided according to their views. During the planned review of meals, people could also be asked about what they would like to see on the menu, including more choice. People could be served their meal a course at a time so they have no need to feel rushed. The faulty valve in the bathroom on the ground floor could be repaired so the room smells fresher for those who use it. The frayed and discoloured towels currently in circulation could be replaced with new ones so they are nicer for people to use. Peoples views, those of their relatives/representatives, and also those of visiting professionals could be collected on a regular basis, and the collective feedback used to find out what they think the home does well, and where it needs to improve. This could be achieved through satisfaction questionnaires, and through regular unannounced visits from a representative of the company. Considering peoples comments when making changes to the way the service is run would reassure them that their views are taken seriously and acted upon. Care Homes for Older People Page 9 of 35 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 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they are admitted to check they can be met. Evidence: People usually get to know about the home through social services or the hospital. Both have copies of the homes brochure. They give anyone interested in living at Royal Court a copy, so that they can get an idea about whether the home might be suitable for them. Before any admission takes place, the care manager, who works for the home, visits people and carries out an assessment. They also collect information from other professionals who have been involved in the persons care, so they can get a full picture of their current needs. This helps to decide whether these could be met at Royal Court. People are also invited to visit the home to look round, to meet staff and other people who live there. Care Homes for Older People Page 12 of 35 Evidence: The assessment completed by the home is adequate. It could be better if the care profile, completed following admission, was used to collect information about the person before they arrived. This was advised at the last inspection, because the information asked for is very good. It covers peoples social and psychological needs as well as their personal care needs, in much more detail. Once people are admitted, they are given a contract, which includes a breakdown of fees, so people can see who is responsible for paying for which area of their care. Following a recommendation made at the last inspection, the registered manager said that she offers people the chance to discuss their contract if they need more explanation about it. It would be problematic if people said following their admission that they wanted to receive their care from a male member of staff, as all care staff are female. The care manager said that she makes sure that people are told about this before they are admitted, although this discussion is not recorded. A reminder could be included in the admission assessment documentation so that this discussion is not overlooked. This way people will be clear that only female staff will be available to assist them with their personal needs. They can then decide whether this would be appropriate for them. The home does not provide intermediate care. It does however provide respite care, where people come into the home for short breaks, then return home. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care is planned and risk to them assessed according to their needs. Evidence: The registered manager has appointed a care manager since the last key inspection. It is her responsibility to make sure that peoples care plans match their needs, and that peoples medication is managed safely. These were two areas where shortfalls were identified at the last key inspection. At this site visit, peoples files were well set out. They gave lots of information about peoples overall needs, including those which were identified before they arrived at the home. Risks to their health and welfare were also identified. This collective information was used to complete care plans for each area of care. The care plans were written in an individual way, gave details about peoples likes and dislikes, and talked about things which were important to each person. For example, one explained in detail how staff could uphold a persons privacy and dignity. Another Care Homes for Older People Page 14 of 35 Evidence: explained ways in which a person may show that they are feeling anxious, because they are not able to tell staff how they feel. Risk assessments were regularly reviewed, and action taken where risk to people had changed. For instance, one person previously at risk from regular falls from bed had been provided with safety rails, and had suffered no further falls. Another person had rails fitted, which the care manager decided were no longer safe or suitable for the person to have, because the person demonstrated that they now restricted their freedom of movement. They were removed on the day of the site visit. In another case, a completed assessment suggested that the person was at risk from pressure sores. Whilst the care manager was able to explain why no preventative equipment had been provided to reduce the risk, this had not been recorded. She agreed to do this after discussion with the district nurse, so it was clear to everyone why and how this joint decision was reached. The care plans showed that people get regular visits from their doctor, the dentist, chiropodist, and other health professionals who help to maintain their health. One person was waiting for an update about a change in their medication. The care manager said that they would talk to them about this, to remind them it had already been arranged. People made comments like Staff are generally good. Different personalities make some staff approach better than others, but I am quite happy and my needs are met, and Theres some fantastic nurses here. One person said about a particular member of staff I shout and they come running! Im alright here. It’s fine. Staff were polite and courteous to people. They knocked on peoples doors before they entered their rooms. This gives people the opportunity to ask staff to come back later if they do not want to be disturbed. Improvements have been made to the way staff handle peoples medication. Many of the shortfalls seen at the last inspection have been addressed. Staff who handle peoples medication have completed a distance learning course, so they know how to do this safely. The staff member spoken with took their responsibilities very seriously. Medication sheets were signed up to date. Where staff decide whether or not someone needs their medication, they always record to say if they have given it, and why. One area needing some further attention was around making sure that a second member of staff checks and countersigns whenever handwritten entries are made on a persons medication chart. In one case, this had not been done. On someone elses Care Homes for Older People Page 15 of 35 Evidence: chart which had just been written up, the frequency that a medicine should be given had not been written down correctly. The care staff made sure this was put right straight away, and asked the care manager to countersign their corrections. Staff look after one persons medication which, when due, they take to the person so they can draw up the correct dose and administer this whilst staff are present. Staff knew what dose the person is prescribed, and so did the person concerned. But this information had not been written on the medication sheet. This was corrected and countersigned at the time. This information will now be readily available should an emergency arise, if the person concerned is unable to say what they are prescribed. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people can maintain important links with their friends and family, they could be provided with a better range of activities so they have more social stimulation, and more choice at mealtimes. Evidence: There is a large recreation room where meetings and large group activities take place. Forthcoming events were advertised, and included a karaoke night, Christmas party and residents and relatives meeting. This gives people the opportunity to plan ahead and keep free the dates of major events that they would like to attend. Religious services are held at the home periodically. This helps people to have their spiritual needs met. And the hairdresser visits regularly. Day to day activities are arranged more informally, and ad hoc. This means that people do not necessarily know what is going to happen on any specific day. Those who are able, or who wish to leave the home, can attend the day centre, which is also run by the registered providers. A relative said I feel more stimulation could be encouraged rather than sitting and watching TV all day which most of the time cannot be seen or heard by some of the residents. Perhaps exercise could be encouraged to help people become Care Homes for Older People Page 17 of 35 Evidence: more mobile. On the day of the site visit, there were no activities provided. People sitting in the communal areas talked with staff when they were free, or with each other. Staff seemed to know them well, and people enjoyed their company. Others watched the television, although it was difficult to concentrate on this, because there was also music playing in the room at the same time. A staff member said there are no activities. They said there was nothing for them (people) to do, although they had found that often people did not want to join in activities when they were organised. Another said they would like to see more going on. People could be asked more about their individual interests. This information could be included in more detail in their care plan. This way, staff would have more information, so that the activities better reflect individual and group preferences. People agreed that their family and friends could visit when they wanted. Staff were seen welcoming visitors into the home. And people said that they could make choices about how they spent their day. For instance, rising and retiring times, where they eat, and what they wear. One person said Staff are very good. I can choose when I do things. The cook said the home has recently changed food suppliers. The quality of food from the new suppliers is still being monitored. He added that if he thinks the quality of the food is not good enough, the registered manager takes his advice, and buys food from a different supplier. He said there is always enough food. Fresh meat, fish and vegetables is delivered regularly. Bananas are the main source of fruit, as it has been found that people do not like other alternatives. This should be kept under review, as peoples preferences may change over time. People are offered three meals each day. They are also provided with supper if they would like it. The cook knew about people with special dietary needs. A cooked breakfast is offered each day. At lunchtime, one meal is prepared. If people want something different, they have to ask for an alternative. It would be better if they were provided with a choice in advance, so that they can look forward to a meal which they know they will enjoy. The menu is quite repetitive. The cook and the registered manager are aware of this, and are looking to make changes to the four weekly menu choice. Now would be a good opportunity to ask people at the home their views about the menu, so that any Care Homes for Older People Page 18 of 35 Evidence: changes made to it are based on their comments and wishes. However, people said they usually liked the food, and one person said we get plenty of drinks. The dining room was pleasant. All of the tables were set with cloths, and staff were available to assist those people who needed help at the mealtime. People needing help with their drinks in between meals were assisted as their care plan said they should be, in a respectful and dignified way. However, those needing assistance with their meals had their desserts brought to their table before they had finished their main course. And the cleaner entered one persons room where they had chosen to eat their meal, and vacuumed before they had finished their dessert. These situations should not happen, as they could make people feel rushed, and spoil their mealtime. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by staff who know what to do if they have concerns about their care, and by a registered manager who will act upon these concerns. Evidence: The complaints procedure is displayed in the entrance hall of the home, so people know what to do if they want to raise concerns. Two complaints were recorded in the complaints book since the last key inspection in September 2007. One was over concerns about the appearance of a person living at the home. The second was about a missing object and some clothing, and an alleged shortfall in personal care. The registered manager had kept a full record of the action taken and outcome from the first complaint. She gave assurance that the second was resolved, and agreed to make a record about what happened, and when, during her investigation. All three relatives who returned their surveys said they knew how to complain. They said that the home always responded appropriately if they raised any concerns. There were a number of commendation cards on display, which thanked staff for the care they had provided to people living at the home. People spoken with were satisfied that they were listened to by staff, who in turn knew what to do if a complaint was made to them. The homes abuse policy states that it supports the local authority guidelines. This is Care Homes for Older People Page 20 of 35 Evidence: good, because the local authority are responsible for investigating all safeguarding matters, and the home has a duty to refer any such allegations to them straight away. The registered manager explained about one incident which happened away from the home, but which concerned one of the people living there. The right steps were taken to inform the right people so this situation could be fully investigated. This is now resolved. Staff said they knew what to do if someone raised concerns about their care and treatment. They have received training in how to recognise abuse, and what to do if they suspect this has happened. All spoken with knew that they could not keep secrets, and that it was their responsibility to pass on any such concerns without delay. This will help to protect people from harm. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a warm and comfortable environment. Evidence: The home was clean throughout. All facilities are provided on one floor. This makes it easier for people to access them independently. The garden courtyard area needed tidying up so that it was safe and pleasant for people to use. The registered manager said that the maintenance man would be attending to this in the near future, ready for use when the weather is better. Some areas of the home have been re carpeted, and we were told that ongoing work is being done to refurbish a bathroom area identified as needing attention at the last inspection, and bedrooms that are currently vacant. An extra walk in shower has been provided. This work will help to improve the environment that people live in. One of the bathrooms had an unpleasant stale odour at this site visit. The registered manager said this was a recurrent problem, which was easily remedied. She said the maintenance man would rectify it. This will make the room more pleasant for people to use. Everyone has a single bedroom with en suite facilities. This gives them a good degree Care Homes for Older People Page 22 of 35 Evidence: of privacy, and allows them a space of their own should they wish to be alone. Their rooms contained personal belongings, which will make people feel more at home. The laundry is situated away from where food is prepared. The washers do not have a sluice facility, and one of the washers that also acted as a destainer had been out of action for some time, although the staff member knew that it was due to be replaced soon. Disposable gloves and aprons are provided to protect staff, and a manual sluice is available if it is ever needed. However, soiled clothes are delivered to the laundry in sealed bags which dissolve in the wash. This means that staff do not have to handle the laundry unnecessarily, and so reduces the risk from cross infection. Some comments were made that the laundry service could be improved. It was said that sometimes stains do not come out of clothes. The registered manager said that this had been discussed at the staff meeting on the day of the site visit, and she was looking to see if there was indeed a problem, and how it could be remedied. A comment was also made about the poor quality of the towels and flannels that people are supplied with. The laundry person said that flannels have recently been replaced with new ones. However, some of the towels, both in the laundry and also in peoples rooms, were discoloured and frayed. The registered manager said that they soon look old because of the constant washing. However, she agreed that these would be replaced. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The vetting of new staff needs to be thorough in all cases. And there are some gaps in staff training. The registered manager has shown a commitment to address these matters. Evidence: The majority of staff thought that there was generally enough of them to meet peoples needs. People agreed that staff were usually available when they were needed, and they did not wait for long periods of time for attention on the day of the site visit. The recruitment records seen showed that in one case, the staff member had begun to work before either the full police or POVAFirst check had been returned. This had been accidentally overlooked by the registered manager, but meant that the staff member was working with people before it was known whether they had previously been barred from providing care. We were assured that the person was supervised until the full police check was returned. Such information must be more rigorously checked in the future to make sure that this error does not happen again. However, other staff spoken with all said that they were not allowed to work at the home until all the appropriate checks had been returned. Care Homes for Older People Page 24 of 35 Evidence: New staff get a basic induction about how the home runs, and what is expected of them in their job role. However, they do not yet undertake the Skills for Care induction. As recommended at the last key inspection, this should be introduced, so that they get a proper and thorough induction about good care, which meets minimum standards. Staff are undertaking some training to help them provide good care. This includes an ongoing programme for staff to achieve National Vocational Qualifications in Care at level 2 and 3. Other recent training includes POVA (protection of vulnerable adults) training, and a distance learning course on dementia care, which we were told included how peoples care can be provided with dignity and respect. This will help to reinforce a good, consistent approach to peoples care. There are some gaps in training that the home is required to make sure staff undertake. The registered manager is aware of these, and has plans to make sure that these are filled. They will be discussed in further detail in the following section of the report, because they affect peoples health and safety. Staff said the care manager supervises them in their work and every day practice. However, this supervision is not written down, and should be, because it is good practice. It helps to identify staffs skills, and where further training may be needed. Staff have meetings periodically, where they can discuss things as a group with the management of the home. This will help to maintain good communication, and give staff the opportunity to say what changes they think could be made to improve peoples lives. Care Homes for Older People Page 25 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has shown commitment to improve the service that people get. Asking people their views about the home, and addressing some shortfalls in staff training would ensure that peoples health and safety is met, and their collective opinions considered, in the running of the home. Evidence: The manager has become registered with the Commission for Social Care Inspection since the last key inspection of the home in September 2007. Neither the registered manager nor the care manager are included in the staff numbers. This means that they can concentrate on their management responsibilities, and oversee the general running of the home. Staff said the registered manager is approachable, and that she listens. When asked about their work, one staff member said I love it. They said they get good support from the management. Another said Linda (the registered manager) is brilliant. Care Homes for Older People Page 26 of 35 Evidence: Since the last inspection, residents and relatives meetings have been introduced, to get their opinions about how the home runs. The registered manager said that these were very poorly attended. So it is currently the views of the minority that are collected. In the past, the registered manager sent out surveys to people, but said that this no longer happens. These should be reissued to people, so they have the chance to express their views about the home and the care they get, anonymously, if they wish. It would be good practice to ask the views of visiting professionals also, so they too can comment on how the home runs. When the manager became registered with the commission, it was agreed that another director of the company would visit the home unannounced to carry out Regulation 26 visits, because she was no was no longer in a position to do this. However, this has not been happening. It should be. By using these visits to periodically assess the service, speak with people living there, or staff working there, the company will get a better overall view from people about where the home excels, and where improvements are needed. The registered manager looks after peoples personal allowance if they wish. She is also appointee for two people, after their family or social services asked her to take on this role. She keeps clear records which show incoming and outgoings of peoples monies, and receipts are also kept where items have been bought on their behalf. This means that peoples finances are being looked after in a responsible way. There is a maintenance man who carries out in house safety checks, such as checking that the hot water is maintained and stored at a safe temperature. Fire alarms are checked weekly to make sure they sound when they are activated. The following health and safety matters were discussed with the registered manager: Outside contractors complete services on equipment which the maintenance man is not able to check. Information was given before the site visit to show when some of these services had been completed. A sample of certificates were looked at where this information was not clear. Discussion with the registered manager confirmed that both the gas appliances and the fire alarm system need to be serviced. The registered manager is already in the process of finding someone qualified to check the gas appliances, and has given her assurance that the fire alarms will be serviced within one week. Some of the records kept in the kitchen were not kept up to date when the full time cook was not on duty. A regular audit of the kitchen by the registered manager would Care Homes for Older People Page 27 of 35 Evidence: help to identify where staff have not completed these as is required of them, to make sure the kitchen is being run in the safest way. The fire officer last visited in April 2008. Their report stated that there were good standards of fire safety evident at the home. The Environmental Health Officer has also made a routine visit to the kitchen. The registered manager was sure that the majority of the recommendations listed had been completed, but has agreed to check the list to make sure that there is nothing more to do to meet their standards. The following health and safety matters were also discussed, and which relate to peoples direct care: The care plans for people who have safety rails tell staff that they must check regularly to confirm that they remain safely fitted for use. However, staff do not record when this check is done. The care manager said she would check all rails straight away, and from then on, introduce a system whereby staff sign to show that they have been regularly checked, so that people can be assured that the equipment remains safe to use. One person was in bed, and their bed safety rails were being used. There were no bumpers in place, and the person had shuffled to the end of the bed because they did not want to be there. We were told that bumpers had been ordered for this person, and that, in the meantime, duvets were used to keep the person safe from entrapment. However, the duvets were not being used at the time. Staff must always make sure that people are kept safe using the correct equipment. The care manager, who decided that they were no longer suitable for the person, removed the bed rails. Problems with the way staff move and handle people have been raised with the home in the past. At this site visit, the way that people were moved was not always well organised. Staff had not thought about how people could be assisted smoothly from chair to wheelchair, by having the right equipment in the right place at the right time. In one case, not all of the equipment identified as being needed in the persons care plan was used, and the person being moved was not told what was happening as staff moved them. In another, a senior member of staff intervened, to show staff how a move could be made a lot easier simply by raising the persons electric chair. Staff need to be confident in how they move people, as this will assure peoples safety. Therefore the update in moving and handling for all staff organised to take place in the next month will be very important, as there are still shortfalls in the way this part of peoples care is offered. The care manager and registered manager agreed with this. The care manager is monitoring staff to make sure that this area of care improves. Care Homes for Older People Page 28 of 35 Evidence: There are not enough first aid qualified staff to make sure that there is a first aider on duty all the time. The registered manager must carry out a risk assessment to check what level of first aid is needed at the home, and make sure that this is provided. In the absence of a risk assessment, a qualified first aider must be available at all times, so that the right action is taken in an emergency situation. In addition to moving and handling and first aid training, the registered manager was aware that some other training was needed to make sure that all staff are up to date about how to work in a safe way. The registered manager said staff will be commencing distance learning courses in the next three months which will cover infection control and food hygiene. Some staff spoken with said that they have received fire safety training in the last year. However, one had not, and the records of others showed that they also needed an update. Discussion with the registered manager has agreed that further training will be organised and provided within the next two months, and, over the next two weeks, staff will be given an in house refresher so that people can be sure that staff know what to do to protect them in the case of a fire breaking out. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Hand written entries on peoples medication records must be completed properly and fully, checked by a witness, and countersigned and dated. This will reduce the risk to people from avoidable errors being made when they get their medication. 15/11/2008 2 29 19 Information, which tells the registered manager whether a prospective staff member is suitable to work with vulnerable people, must be thoroughly checked when it is received. This is to make sure that it gives the information needed to confirm whether the person has been barred from providing care. 15/11/2008 3 38 13 Fire safety training must be updated for all staff working at the home. 15/11/2008 Care Homes for Older People Page 31 of 35 This is so they are refreshed about what to do should a fire break out at the home. 4 38 13 A risk assessment must be completed to check what level of first aid is needed at the home. In the absence of a risk assessment, a qualified first aider must be available at all times. This will make sure that the right action is taken in an emergency situation requiring first aid attention. 5 38 13 People must be moved in a 15/11/2008 safe and proficient way by ensuring that staff put into practice the moving and handling training they receive, and that they follow the instructions in the persons moving and handling risk assessment. This will help to keep people safe and to feel secure when they are being assisted. 6 38 13 Bed safety rails must always 15/11/2008 be used in a safe way, which meets peoples needs. A check must be kept and recorded to show that they are safe and fit for use. This will reduce the risk of the check being forgotten, and will ensure that the equipment is safe and fit for use. 7 38 13 The service of the fire alarm must be kept up to date. 15/11/2008 15/11/2008 Care Homes for Older People Page 32 of 35 This will make sure that it works properly should a fire break out. 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 3 The profile used to record their needs when people have been admitted should be used when completing their pre admission assessment, because it asks better questions about peoples overall needs and the care they require. To give people better social stimulation, they should be asked more about what interests them. This information should be written down, and used to decide what individual and group activities should be offered each day. The menu should be reviewed, made more varied, and should consider peoples collective views, likes and dislikes. It should provide an advertised alternative so people can make a positive choice at each mealtime about what they would like to eat. People should be served one course at a time at mealtimes. This way, the meal will be more of a social occasion, people will not feel rushed, and their meal will be kept at the right temperature until they are ready to eat it. 2 12 3 15 4 26 The faulty valve should be repaired in the identified bathroom as soon as possible to get rid of the unpleasant smell. This will make the room more pleasant for people when they use the room for bathing. Those frayed and discoloured towels currently in circulation should be replaced with new ones, which look more pleasant to use. 5 30 To make sure staff are trained and confident to do their job, they should have an induction that meets with the skills for care specifications. Peoples views, those of their relatives/representatives, and also those of visiting professionals should be collected on a regular basis. The feedback should be collated and used to find out what the home does well, and where it needs to improve, based on their collective views. This information, and any action taken as a result should then be published, so people can see that their views are taken seriously and Page 33 of 35 6 33 Care Homes for Older People acted upon. As agreed with the commission, the registered providers should allocate a suitable person to carry out monthly unannounced visits to the home now that the registered manager is no longer able to do so. This will help to identify areas that have improved, and where further improvements are needed. Care Homes for Older People Page 34 of 35 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 © (2008) Commission for Social Care Inspection (CSCI). 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