Inspection on 15/01/09 for Saxonwood

This inspection was carried out on 15th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Saxonwood 04/09/07

Saxonwood 04/09/06

Saxonwood 01/11/05

Saxonwood 31/05/05

Saxonwood 14/12/04

Saxonwood 13/07/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Saxonwood Saxonwood Road Battle East Sussex TN33 0EY     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: Michele Etherton     Date: 1 5 0 1 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 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Saxonwood Saxonwood Road Battle East Sussex TN33 0EY 01424774336 01424774336 manager@saxonwood.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sussex Housing and Care care home 36 Number of places (if applicable): Under 65 Over 65 36 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 36. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Saxonwood is registered to provide accommodation for up to 36 older people and admits residents with low to medium dependencies. It is owned by a housing association, Sussex Housing and Care. Mr. David Short is the registered manager and has day-to-day responsibility for the home. The premise is a detached property situated in a quiet cul de sac in Battle. There are 36 single bedrooms situated on three floors. There are two shaft lifts to enable access to all floors. Eighteen bedrooms have ensuite facilities and 18 have a wash hand basin. There are four bathrooms one of which is assisted and another has a shower. The home has a large dining room, lounge with views across the gardens and activities room. The home is non-smoking. There are 3.5 acres of garden which are well maintained, accessible to residents and include Care Homes for Older People Page 4 of 34 Brief description of the care home lawns with some bench seating, established borders, a fish pond, patio area with seating, greenhouses, vegetable patches and fruit trees. There is a good-sized car park to the rear of the property. The home is situated within walking distance of the town centre, its shops and access to bus and rail routes. The staffing compliment consists of the manager, carers and ancillary staff. There is two staff on a wake night duty. The fees range from £340 - £533 per week. Additional charges are made for hairdressing, newspaper/magazines, telephone, transport and chiropody. Previous inspection reports are available from the Provider or can be viewed and downloaded from www.csci.gov.uk Care Homes for Older People Page 5 of 34 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: A key unannounced inspection of this service has been undertaken, this has taken account of information received by CSCI from and about the service since the last inspection and includes our findings of an Annual service review in 2008 and the completion of an AQAA (Annual Quality Assurance Assessment by the manager within the last twelve months. From the findings of our Annual Service Review we highlighted some areas of service improvement and as a result brought forward the inspection of this service. We have looked at the AQAA information provided by the home manager and consider this to have been completed to a reasonable standard providing us with some of the information we needed to know about the service this would have benefited from Care Homes for Older People Page 6 of 34 additional evidence to illustrate how the service has addressed previously identified shortfalls within the service and current and future plans. Our inspection of the service has included an unannounced site visit to the service on 15th January 2009 between 09:50 am -17:50pm. During this visit we undertook a tour of the premises, consulted with seven care and ancillary staff in addition to the manager, and spoke with and observed more than half of the current resident group either in private or in groups. Surveys were distributed last year to inform the annual service review and comments were received from residents staff and other stakeholders at that time that have contributed to our planning of the inspection and in the compiling of this report. All key standards have been assessed and the progress made by the home in addressing outstanding requirements, where we have observed outcomes for additional standards we have included these in our assessment. During our visit we examined a range of documentation including support plans, risk information, menu records, medication records and storage facilities, staff recruitment training and supervision records, complaints accident and health and safety information. In arriving at our overall judgment about the service we have tried to be proportionate in considering compliance with regulation and outcomes for the residents alongside the overall risks and impacts of identified shortfalls. What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 34 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 34 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. Information provided to prospective residents is in need of updating and should be available in more accessible formats. All prospective residents benefit from a full assessment of need prior to admission to the home and have opportunities to visit. Evidence: Many residents have come to the home because of its local reputation, through word of mouth or because they or their families and friends had prior knowledge of it, most said they had seen information but couldnt recall what, some residents indicated they or their families had opportunities to visit the home and residents experienced trial stays before making their decision to become a long term resident. We are advised that the statement of Purpose and user guide have not been reviewed for sometime and the current manager is undertaking to do so, consideration should be given to also making this information in more accessible formats to suit the needs of a range of residents, It is a requirement that the home makes avaialble to prospective residents Care Homes for Older People Page 10 of 34 Evidence: up to date information about the services offered which is in an accessible format to support and inform their decision making. Prospective residents benefit from an assessment of need prior to their admission carried out by an experienced member of the senior staff team, the format for this has recently been updated by the current manager and assessment information has been noted in the files of newer residents admitted recently, this information would benefit from more depth to the level of information collected and individual resident preferences in order to bettrer in form the development of the care plan. The home does not provide intermediate care Care Homes for Older People Page 11 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The general physical, emotional and health of residents is well maintained but would benefit from suggested improvements in care plan and medication arrangements Evidence: We looked at a sample of care plans for new and longer term residents we found these clear and easy to follow they gave a good level of information about residents needs and support that would benefit from improved detail in respect of individual residents personal preferences in respect of personal care and daily routines. We found some omissions in the content of resident files and in the detail of personal information recorded for individual residents and this needs standardizing. From our examination of care plans and daily records we noted in the case of two a disparity between what was recorded in the care plan and actual practice by staff and this needs to be addressed to ensure that staff practice is always supported by agreed methods of support and residents quality of life is not adversely impacted on. Staff were observed updating daily records and those viewed were found to be up to date. A Care Homes for Older People Page 12 of 34 Evidence: system is in place for the monthly updating of care plans but we found no evidence of regular annual reviews of the placement despite the AQAA telling us this is underway with more than half completed, we recommend that the provider addresses the suggested improvements to care plan informatuion and reviewing. We have noted that regular weight recording is undertaken but nutritional screening is not conducted routinely unless issues arise in residents eating routine. Care plans do not make clear if health conditions are impacting on the residents daily life and how.We found reference to health appointments and contacts with health professionals both in resident files and in daily records, residents we spoke with confirmed access to routine health care and some have been able to keep their own GP if they lived local to the home. Residents told us they feel well supported and cared for. All staff administering medication are now trained and this meets an outstanding requirement, competency assessments are now to be implemented. We found storage of medication to be good. Our observation of medication administration found this to be undertaken satisfactorily by the staff member concerned. We noted however, that some residents administered medication are not observed taking it although MAR records would seem to suggest this is the case, whilst we are satisfied that these arrangements are in keeping with the individual preferences of the resident, this is not made clear within their care plans as this does constitute partial administration and should be recorded appropriately to support staff practice, we would recommend that a risk assessment and a part administration procedure is developed for each affected resident and accessible to administering staff, recording on MAR charts should make clear the partial administration, and systems should be developed to ensure these arrangements are monitored and reviewed. General PRN guideline information has been developed for administering staff but we would recommend this is individualized to reflect personal preferences around administration that the home is already clearly respecting. The home manager has implemented weekly audits of medication and the MAR sheets to minimize the risk of errors occurring, this audit is currently being recorded onto the daily MAR sheet which is consequently becoming messy and difficult to read, this has been discussed with a senior staff member and agreed that audit information will in future be recorded separately. Good progress has been made in the use of photos on MAR records and on MDS systems to ensure the right resident gets the right medication, we noted refusals to medication for some residents on a regular basis but there is no evidence as to what action has been taken as a result of this or reference in care plans to refusals and how Care Homes for Older People Page 13 of 34 Evidence: this is to be managed, which should be in keeping with the homes medication procedure. We found the home is responsive to the personal preferences of residents around administration times of medication and this should be made clear within a medication profile for each resident. We would recommend the suggested improvements are implemented. Residents have commented through survey feedback that they feel their privacy and dignity is maintained always and have also reported that: Staff are nice and friendly staff are excellent they do things the way you want Im very happy I feel care for by the awareness and concern of staff, i feel they know what theyre doing Care Homes for Older People Page 14 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have enough activities which they like to do, they are able to maintain links with groups and activities in the community if they wish. Visitors are made to feel welcome and feel they are kept informed by the home staff. The majority of residents enjoy the variety and quality of food offered and feel consulted about what they eat and that their own special needs are catered for. Evidence: Residents we spoke with reported they had enough to do and liked the range of activities provided, a number continue with activities they enjoyed previously outside of the home, and there is some evidence that residents have influenced changes in the activities programme. We met several relatives and friends who visit regularly and commented positively about the home and the good communication maintained with them by home staff regarding their relative/Friends well being. Relatives and friends told us: I am a health professional myself and this is one of the best homes Ive come across Care Homes for Older People Page 15 of 34 Evidence: They respond to everything well I can see the care plan if i want to My relative really likes it there and seems well settled The manager advises that the home does not manage the finances of residents and does not retain personal allowances on their behalf. New residents are encouraged to bring their own personal possession to furnish their bedrooms and records of items are maintained, lockable facilities have recently been provided to residents to improve security for their personal possessions. Discussion with residents indicates that they do what they want to during the day accessing activities if they wish to do so, some go out from the home regularly to visit friends, the majority spoken with did not highlight any restriction on their daily routines although one person did comment they would like to have a bath more often but admitted that they had not actually requested this as yet. The majority of residents expressed satisfaction with the quality and variety of meals provided, they felt consulted about whats provided and indicated that they could request an alternative, residents felt that the cook and kitchen staff understood their likes and dislikes and were able to cater to any specialist diet they might have. Residents enjoy eating in a well laid dining area with picture windows overlooking the garden, two small kitchen facilities are located on each floor but these have been underused by residents for a number of years and are no longer equipped for residents to make their own snacks and drinks although could be if the demand for this increased. The majority of residents we spoke with seemed happy with the availability of food and drinks comments received are:Food is very good, get asked what likes and dislikes are My relative often complains that there is too much food and says not another piece of cake and tea The food is fine I am diabetic and they do the best they can with food to make sure this is catered for We received only one negative comment about food quality, the resident reported that: I feel there is too much pre-prepared food, not always freshly cooked and variety is Care Homes for Older People Page 16 of 34 Evidence: sometimes an issue for instance desserts are current buns, arctic roll, meringues not much imagination Care Homes for Older People Page 17 of 34 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. Residents feel confident about raising concerns and approaching staff although some residents are concerned these are not always welcome. Residents are generally safeguarded from harm but systems for their protection could be improved upon. Evidence: The AQAA tells us that the current manager has revised the complaints form format, we looked at the complaints record and noted four complaints received by the home in the last twelve months, the manager advised these had all been resolved but outcome of complaint investigations was unclear and there was no indication whether the complainant was satisfied or not. We have recommended that complaints are formally closed with a written response to all complainants, not just those who are not resident or staff within the home. the manager reports that he has introduced a system whereby either he or the deputy visit residents on a weekly basis to check how they are and to listen to any concerns they may have, this was also made known to resents in a residents meeting, Whilst all the residents and relatives spoken with felt confident of raising concerns if they had them a few residents indicated that they had gained the impression that in fact complaints were not welcome and had little faith in the management team at local or area level addressly comprehensively complaints made. Clearly the management team need to instill trust in the complaints process and that the views of residents are valued however often they might be received. Care Homes for Older People Page 18 of 34 Evidence: There has been one adult safety alert in the last 12 months which is now closed and has resulted in some improvements within the home to better safeguard residents. A serious incident involving a resident was reported to CSCI earlier last year but not raised as an alert this was discussed with the manager at the time. Staff training in adult protection is overdue for update. In our examination of records we noted a restriction placed on a resident by the home without wider consultation with health or social care professionals as to whether this complies with legislation around deprivation of liberty, whilst the resident in question has capacity to understand the reason for the restriction, all restrictive practices must be clearly documented with details of who has been involved in making decisions which should not be taken in isolation by the service itself. Such restrictions must be monitored for effectiveness and routinely reviewed and this is a recommendation. Recent improvements to ensure residents personal possessions can be better secured within their bedrooms has improved safe storage and personal allowances are not managed by the home, procedures regarding the management of user monies are like most of the home policies and procedures in need of update. Residents we spoke with said they feel safe and well cared for but we consider that shortfalls in staff recruitment,training and the lack of updated policies and procedures to guide and inform staff practice could undermine this. Care Homes for Older People Page 19 of 34 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. Residents enjoy living in a clean comfortable home that will benefit from some required and suggested improvements. Evidence: We found the home to be very clean and well maintained internally, with no unpleasant odors. The home employs a full time maintenance person to undertake internal repairs routine maintenance and decorative upgrading, and an internal maintenance plan has been developed. The home employs three cleaners, one of who advised that they work to a cleaning schedule to ensure that all areas of the home are routinely cleaned each week. The present manager has compiled a list of improvements he wishes to implement and has submitted a budget request to fund these. On our tour of the premises we noted that garden maintenance has been carried out to improve this area and this should be maintained for the benefit off residents, we also noted some external areas that are in need of repair, these being broken roof tiles affixed to a side wall at the front of the home and also the uneven front path to the home entrance which could be a hazard to elderly residents with unsteady gaits, we are advised that the repair to the tiles has been outstanding for 11 months, which is unacceptable, there is clearly a need for the system of reporting repairs and Care Homes for Older People Page 20 of 34 Evidence: processing their completion within an agreed timescale to be reviewed. Residents told us that call bells work most of the time and staff are prompt in responding however the system occasionally breaks down, because it is an outdated system repairs can only be made locally by the maintenance person who is currently cannibalizing the last supplies of spares to address any breakdowns, there is a need for the call bell system to be replaced with an updated version and it is important that plans to do so are appropriately funded and planned for in a timely manner so that residents are not left without the means to alert staff when in their rooms. Bedrooms are usually furnished with a range of basic furniture to give prospective residents an idea of what they can fit into the space provided, the majority of residents bring a selection if not all of their own furnishings and any shortfalls are supplemented by the home, there is a need for the home to ensure that furniture it does provide is suited to the needs of the resident group as we noted in one vacant room a very low bed that would be difficult for elderly residents to get in and out of easily and should only be offered to residents who have specifically requested a bed of this kind. The home is warm and well lit through both natural and domestic lighting We found fire extinguishers and alarm systems had been serviced, as had equipment used in the care of residents e.g hoists. Storage is clearly a problem within the home and we found areas of the home used by residents e.g the hairdresser salon a little cluttered from storage of hoist, Hoovers, carpet cleaning equipment. We also expressed concern at the routine storage of another hoist in a toilet, and have asked this be discontinued as it is open to cross infection and not compliant with infection control guidance. The Home is required to address the identified shortfalls. We found the laundry to be very well equipped but small with inadequate space for storing clean and dirty clothes and hanging clothes to dry that cannot be tumble dried, the lack of space could also pose a potential hazard when machine doors which are stacked on each other are left open. Residents we spoke with and complaints information we viewed indicates that there is a problem with laundry going missing and we would therefore recommend a review of the present laundry arrangements. In touring the building we have queried the necessity for every bedroom to have a clinical waste bin and a rack over the sink containing protective gloves aprons and alcohol gel, we feel this gives an unnecessary and unwarranted clinical impression to the residents care and impacts on the homeliness of residents personal space, this has been discussed with the manager and senior staff member and we would recommend a review of these arrangements to ensure a more discreet storage of these items in Care Homes for Older People Page 21 of 34 Evidence: bedrooms where they are needed. We examined a side door entrance into the home through the staff room that has highlighted a possible security issue, whilst this was locked and shut at our visit we heard anecdotal evidence that this may still not always be the case, a review of the door security is currently underway, and in his budget request the manager has sought an upgrade of the door to improve security and we would recommend that this is progressed to ensure resident safety is not compromised. Care Homes for Older People Page 22 of 34 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. There are enough trained staff, progress has been made to ensure staff recruitment is more robustly applied but will benefit from suggested improvements. A broad and varied programme of staff training is available but home records fail to evidence that staff have received all mandatory training and if not addressed could compromise the safety and welfare of residents. Evidence: The manager is using the staffing tool guidance to ensure enough staff are on duty during the day time shifts, on the day we visited there were five care staff on duty in addition to the manager and ancillary staff, we consider this level should be sustained if not increased to ensure that residents can be appropriately supported at all times particularly bearing in mind the number of residents and the sprawling nature of the building that means that staff can be out of sight for some while whilst attending to residents in their rooms, residents and staff thought the increase in staffing levels to be good. The manager has advised in the AQAA information that approximately 75 of staff are now NVQ2 training or are completing the training and are therefore to be commended. Care Homes for Older People Page 23 of 34 Evidence: We viewed four staff files and found that only one out of four contained identity all had CRB checks in place but only two had references. The absence of interview records meant that we are unable to establish whether gaps in employment hisotiores and verification from applicants of reasons for leaving previous care roles are explored, although we noted employment histories for more recently recruited staff are more complete and the overall content of their files more compliant with legislation. We noted that files all contained staff Photographs, application forms, and health declarations with contract information in three out of four files viewed. Whilst there are positive signs that a more robust recruitment process is being implemented there is still a need for the home to ensure the content of recruitment files is standardised and that verification of of reasons for leaving previous care roles should be clearly evidenced along with exploration of gaps in employment and this is a recommendation at this time. The manager is aware of the need for new staff to receive an induction in keeping with skills for care common induction standards and is now implementing these with new staff. Files of longer serving staff provided little evidence that they had received appropriate induction and discussion with several staff in post for more than three years confirmed this to be the case. The induction of staff must be evident across all levels and grades including the manager who felt his own induction had not been particularly well planned. We examined training records and found that there has not been a sustained programme of training in place that ensures all staff are updated in their mandatory training, including medication, training records indicate that the home has made good progress however, in training care staff in adult safeguarding. We require the provider to implement a training programme to ensure all care staff have completed mandatory training, and can evidence updates are provided at the required intervals, and records are maintained of this. Care Homes for Older People Page 24 of 34 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. On a day to day basis the home is well managed but residents would benefit from improved mechanisms for consultation and evidencing their views are important to service development, some identified shortfalls could compromise the health and wellbeing of residents if not addressed. Evidence: The present manager is experienced and appropriately qualified to fulfill the role, the manager demonstrates insight into shortfalls within the service and has made progress in the implementation of some improvements. There has been a great deal of change within the management structure at area level and the manager does not feel that he has always been appropriately supported during this time. Staff we spoke with commented positively about the manager, who they respect and find approachable, staff reported that they things have improved since the new manager came, whilst residents are generally happy in the home they expressed Care Homes for Older People Page 25 of 34 Evidence: mixed views in respect of overall management of the service. Residents said they did not always feel consulted, or kept informed. Some indicated that initially the manager had made clear resident meetings would be quarterly but these had drifted and only two were held in 2008, similarly planned weekly visits to meet residents individually by the manager or deputy had started off well but not been maintained. An Area Committee formed of friends of the Home meets quarterly to review service quality. We have been made aware of some stand alone mechanisms for auditing medication, health and safety and these are undertaken either weekly or monthly, but no single quality assurance programme is currently actively managed within the home to ensure the internal audit and review of service quality and incorporates resident feedback. Although residents are surveyed annually the analysis of this and how it influences service development is unclear and no report has been published of these findings. The service is required to address these shortfalls. Regulation 26 visits are happening but there has been some infrequency to these, examples of visit reports examined would benefit from improved detail and content particularly in respect of which residents and staff are spoken with at each visit to ensure that over a period of time all residents and staff are approached for their views. There is no overall service development plan but there is a local plan for improvements to the interior. The home does not manage the personal finances of residents but does maintain records of personal possessions brought into the home where these are made known. Staff we spoke with commented positively about the management team particularly the manager who they like and respect. They feel well supported by the local management and feel able to raise issues and express views, they have access to staff meetings and commented that they work well as a team. Staff reported that they do get to see the manager on a 1-1 basis but this is often informal and not recorded, there is a need for the manager to implement a system of formal supervision for staff to provide them with opportunity to discuss their personal development and training needs and for their performance to be formally monitored, an observational element to supervising should be incorporated also and this is a recommendation. Accident recording is happening but we are unable to gain a picture of the level of accidents occurring as these are filed directly into resident files, resident files examined evidenced a low level of accidents for those individuals. The AQAA tells us that the majority of policies and procedures in the home are out of date and show no evidence of review even where changes in some legislation that may impact on them has occurred, these are important reference material for staff to refer Care Homes for Older People Page 26 of 34 Evidence: to to ensure their are action appropriately in response to a situation and must be kept updated and reviewed regularly and this is a requirement. The AQAA tells us that all servicing and checks of equipment and services has been conducted and is up to date however after reviewing a sample to confirm this we found that the Gas supply has not been serviced annually as expected and is now overdue, the provider is required to ensure that the gas installation is serviced within the timescale given and thereafter serviced a minimum of every twelve months. Care Homes for Older People Page 27 of 34 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 28 of 34 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 1 4 Statement of Purpose and user guide information must be kept updated and routinely reviewed a minimum of annually, this must be available in a range of formats to suit the needs of residents e.g large print this will inform prospective residents about what the home offers and help with decision making. 20/03/2009 2 19 23 The provider must undertake to ensure that plans are in place for the replacement of the call bell system. The provider must ensure that a plan for the external repair and maintenance of the building is established and that the system for undertaking works once reported is reviewed to ensure all works are completed within reasonable 30/03/2009 Care Homes for Older People Page 29 of 34 timescales Broken tiles to the front of the premises must be replaced and a solution found to prevent repeat breakages from rubbish bin storage. A review of the pathway to the front entrance and surrounding area is undertaken. Equipment used for hoisting residents should not be routinely stored in toilets To ensure residents are not left without a means of alerting staff To ensure the area in Front of the home is free from hazards 3 30 18 The provider must provide a 28/06/2009 programme of mandatory training to all staff that ensures they have the necessary updated knowledge and skills to fulfill their roles safely and appropriately So that the health and welfare of residents is not compromised 4 33 13 The provider must ensure that staff practice is in keeping with updated policies and procedures and these must be reviewed regularly and reviewed to 28/02/2009 Care Homes for Older People Page 30 of 34 assess the impact of legislation changes So that staff practice is supported by agreed policy and procedure 5 33 24 The provider is required to 28/03/2009 implement and manage a system of quality assurance for the internal audit and review of systems, this must take account of resident feedback and influence overall service development. A service development plan should be established So that service quality can be routinely monitored and areas for improvement identified, that residents are able to influence the development of the service and their views taken account of 6 38 13 The Gas installation must be 28/02/2009 serviced and thereafter every twelve months as a minimum to ensure residents health and safety is protected Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans would benefit from improved detail inn respect of personal preferences around personal care and daily routines, being updated to accurately reflect staff practice Care Homes for Older People Page 31 of 34 in regard to support and should make clear the impact of health conditions on residents in their daily lives. Annual or six monthly reviews of residents placement should be made clear within resident files. 2 9 medication practice would benefit from the implementation of the following: routine competency assessments for administering staff implementation of individualized PRN guidelines for residents development of individual resident medication profiles The development of procedures and risk assessments for those residents deemed to be part administering, and this to be made clear in MAR records Evidence of actions taken in respect of refusals to be made clear. Cross reference to care plans and risk information where non compliance with medication is a regular occurrence. consents to medication administration should be in place for those with capacity who do not wish to self administer, and capacity assessments should support medication administration for those who lack capacity to administer safely. 3 18 Restrictions placed on residents must be clearly documented, not made in isolation by the home and should be subject to regular monitoring and review, all restrictive practices must comply with deprivation of liberty and mental capacity legislation. A review of storage facilities in the home is needed to ensure equipment is stored away from resident areas and that stored equipment is not subject to cross infection. The planned upgrade of the external door into the staff room should be progressed to better safeguard residents. 5 26 The Manager should review the necessity of every resident having a clinical waste bin in their bedroom. The manager should review the current arrangements for protective clothing for staff and alcohol gel to be openly displayed in racks on residents bedroom walls, and consider ways in which this can be more discretely stored. 6 26 A review of the laundry is needed to assess health and Page 32 of 34 4 19 Care Homes for Older People safety hazards due to the limited space available, the adequacy of storage for clean and dirty washing and analysis of the causes for laundry to routinely be mislaid 7 29 The provider should ensure that the service can evidence a robust assessment of new applicants and that all gaps in employment and verification of reasons for leaving previous care roles can be verified. The content of all staff files should be standardized and compliant with schedule 2 of the Care Homes regulations Care Homes for Older People Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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