Inspection on 09/12/08 for Seaway Nursing Home

This inspection was carried out on 9th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seaway Nursing Home 10/01/08

Seaway Nursing Home 19/04/06

Seaway Nursing Home 14/10/05

Seaway Nursing Home 05/05/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Seaway Nursing Home 33 Vallance Gardens Hove East Sussex BN3 2DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth Dudley     Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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 32 Information about the care home Name of care home: Address: Seaway Nursing Home 33 Vallance Gardens Hove East Sussex BN3 2DB 01273730024 F/P01273730024 ivar_sum@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Seaway Nursing Home Ltd Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home with nursing - (N) 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 Seaway Nursing Home is a care home providing care for up to twenty residents over the age of sixty-five Nursing care is provided at this establishment. It is located in a quiet residential area of Hove. Local amenities and the seafront are within walking distance of the home. There is nearby access to public bus routes. There is a smallconcreted garden area at the front of the home and a garden accessible to residents at the rear of the building. Rooms are located over three floors and are accessible by stairs or a passenger shaft lift is available for those unable to independently mobilise. Care Homes for Older People Page 4 of 32 Over 65 20 0 Brief description of the care home There are six shared rooms of which one has en suite facilities and eight single rooms with one having en suite facilities. There are three assisted bathrooms and two showers that are accessible for wheelchair users. There are six toilet facilities located throughout the home, not including the two en suite facilities. There is one communal lounge/dining area that residents use. There is no parking available at the home. Paid parking is available in adjacent streets and also at the nearby leisure centre. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on the 9th December 2008 over a period of six hours and was facilitated by the appointed manager Ms J Martin. Judgements made at this inspection were reached by methods which included touring the home, examining various records, which included care plans, medication records, personnel files, staff training records, health and safety documents and catering documentation. Interaction between staff and residents was observed and six residents, three visitors and five members of staff were spoken with. Care Homes for Older People Page 6 of 32 Residents’ views on the life at the home were generally good with residents saying that they liked the home and that The staff Come quite quickly when you ring your bell; You can have a cup of tea when you want one and staff are very kind. It’s as good as anywhere, plenty to eat and Im warm and comfortable. Very nice staff and manager, very nice indeed, and they look after us very well. Visitors said Excellent home, they look after my (resident) very well, she is well nourished and well cared for. I visit most days and my mind rests easy when I go home. The CSCI requires services to complete and return an Annual Quality Assurance Assessment; this identifies the current status of the home and the achievements of the home in the past twelve months and plans for the future. The Annual Quality Assurance Assessment received reflected the status of the home was accurate and told us what the home has achieved in the past twelve months and plans for the next year. Prior to the inspection, surveys were sent by the CSCI to residents, relatives and staff. Of these three were returned from residents and relatives and gave positive comments about the home. Two surveys were received from staff and views raised included: The home provides a good service but there is room for overall improvement, including more activities for residents and more choice of meals. Thanks are extended to those people who responded to these surveys as they provide valuable insight into the life in the home and are used as part of the inspection process. Fees charged by the home range from five hundred and eighty pounds to seven hundred pounds per week. Services such as hairdressing and chiropody are not included in the fees and the prices for these are available from the home. The last inspection of this home took place on the 10th January 2008. The residents, manager and staff are thanked for their help, courtesy and hospitality during the inspection. What the care home does well: What has improved since the last inspection? What they could do better: Whilst there are sufficient staff on duty over a twenty four hour period to meet the care needs of the residents, the numbers are insufficient in the afternoons due to the other tasks that staff are expected to undertake at this time of day. These currently include activities and kitchen duties. Staff said that the care needs of the residents left little time for activities. The provider and the manager gave assurances that these staffing Care Homes for Older People Page 8 of 32 levels would be reviewed. A structured programme of leisure activities should be put in place following consultation with residents and the manager should ensure that these are indicative of residents interests and abilities. Residents would benefit from more choice at mealtimes. Staff supervision should be given within the timescales directed by the National Minimum Standards. 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 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents receive sufficient information to enable them to make a decision over whether the home can meet their needs and expectations. Residents are only admitted to the home following a thorough and comprehensive assessment by the manager, this ensures that the home is able to provide the necessary skills and expertise to meet the needs of the individual. Evidence: The Statement of Purpose and Service User Guide accurately reflect the management of the home and the services offered. Each resident receives a copy of the Service User Guide following his or her admission to the home. Residents also receive a copy of the homes contract and Terms and Conditions of Care Homes for Older People Page 11 of 32 Evidence: Residence. Both these documents comply with the regulations. The manager assesses prospective residents prior to admission to ensure that the home can meet the residents needs and expectations. This assessment also provides information for the staff about any special equipment or skills that may be required. Two preadmission assessments were examined, these were comprehensive and contained sufficient details about the prospective resident to inform the staff and for the care planning process to commence. Residents receive written confirmation about the homes ability to meet their needs. Prospective residents and their relatives or friends are encouraged to visit the home before they make the decision over whether they wish to live there, this also gives them an opportunity to meet staff and other residents. The home admits residents for respite and permanent care but not for intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans identify the current and changing needs of the residents and identify the care required to meet these needs. Not all care plans have been formed in consultation with the resident or their representative. Residents may be put at risk by the practice of using only one bed rail. Residents receive care in a manner which is empathetic and respects their dignity. The standard of medication administration safeguards the residents. Evidence: Three care plans were examined in depth at this inspection. The standard of care planning was generally good, with all showing evidence of monthly review across all sections. They included risk assessments for bed rails and pressure damage, nutritional scoring Care Homes for Older People Page 13 of 32 Evidence: charts and continence care plans. Records of monthly weights and wound care charts were also present and some care plans included a social care plan. Care plans showed the current and changing needs of the resident and care given was reflected in the daily records. The inclusion of continence aid sizes, sling sizes for those residents who require hoisting, and night care plans which also show the preferred times of rising and retiring, would ensure that residents are receiving care which meets their assessed needs and is given in a manner which reflects their preferences. No care plans viewed showed evidence of being formed or reviewed in consultation with the residents or their relatives and this should be put in place, the manager gave assurances that this would be commenced. It is recommended that the required mattress pressure for those residents using electric pressure relief mattresses, is included in care plan. There was clear evidence of consultation with other health care professionals such as General Practitioners, Speech and language therapists, wound care nurse and the Nursing Home Support Team. A physiotherapist was visiting a resident on the day of the inspection. Residents appeared comfortable and well cared for. Nursing charts such as fluid charts and turning charts were up to date and kept with the individual resident which ensures they are accurately completed. Surveys distributed to General Practitioners as part of the homes quality monitoring system showed that the General Practitioners thought the care given by the home was good and that residents were comfortable. Three visitors were spoken with during the course of the day and their comments included: Excellent home, I am so pleased with the care, I visit every day and every day I leave with my mind at rest. They are very well looked after and my (resident) loves the food, and nothing is too much trouble for the staff. This is a very good home. Excellent, I would say, no problems, the care is very good, the staff are helpful and the manager is lovely. The food is good and my (resident) is very well nourished. I visit most days and I must say that I made a good choice for my (resident) in bringing them here. The majority of the residents are frail and require a lot of nursing input, many of them can only stay up for a few hours but they were brought down to the lounge where they could socialise with the other residents. The manager must avoid admitting more Care Homes for Older People Page 14 of 32 Evidence: residents with this level of dependency unless current staffing levels are increased over the full twenty four hour period. The home should concentrate on good mix of dependency levels in order to ensure quality of life for those residents currently in the home. Good interaction was apparent between staff and residents and residents were treated in a dignified and polite manner.Residents nursed in bed appeared comfortable and received frequent nursing intervention. It was seen that one bed had only one bed rail, the bed being pushed up against the wall to prevent the resident falling, this practice could put residents at risk and two bed rails must be used. The manager gave assurances that this would be put in place, therefore no requirement has been made. Residents in their rooms had their call bells within easy reach and residents said that their call bells were answered in a timely manner. Most residents had tables pushed right up to their chairs, but three residents spoken with demonstrated that they could move these tables at will, and two others said they liked the tables there because everything they needed was within reach. Staff were seen consulting with residents about where they would like the tables placed. A medication round was observed, this showed that all medications were administered in a safe manner. Medicines are administered from a drug trolley using the MDA (blister pack) system, and medications were signed following administration to the individual resident. All medications had been signed on administration and on receipt into the home. Controlled drugs were correctly stored and recorded and the temperature of the clinic room and drug fridge is recorded daily. It is recommended that when a resident is receiving PRN (as required medications) that a chart is kept for each individual, which identifies for what reason that medication has been prescribed. The home is not currently administering homely remedies, but will require permission from a General Practitioner should this commence. No residents self medicate at the present time. Medication policies were not examined at this inspection. Care Homes for Older People Page 15 of 32 Evidence: None of the staff have taken part in end of life care training. It is recommended that this takes place with a view to commencing the Liverpool Care Pathway and Gold Standard Framework (nursing tools for ensuring that residents at the end of their lives receive a nationally recognised optimum standard of care and pain control). Neither end of life care plans or details of preferred place for end of life care were in place, although residents wishes for resuscitation were recorded. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is scope for more activities to be provided and for a formalised activities programme to be put in place. Lack of staff in the lounge may put residents at risk. Whilst the meals provided are nutritious and well presented, choices available do not appeal to all of the residents and do not provide a sufficient variety to enable residents to remain interested and therefore ensure optimal nutrition. Evidence: There are some opportunities for residents to participate in leisure activities. Whilst there is no activities coordinator employed, the staff provide activities in the form of board games and quizzes when time is available. This is supplemented by visiting activities providers, who provide monthly keyboard, reminiscence, poetry readings and arts and crafts sessions. No outings are currently provided. Staff surveys identified the need for more leisure activities, stimulation and outings to be provided. Records are kept of the participation of residents in the activities provided. Care Homes for Older People Page 17 of 32 Evidence: Residents said that most days they talked to staff or had visitors, but said that they watch a lot of television or listen to the radio.One resident had been provided with a colouring book, but generally residents were sitting in chairs with no form of occupation. Residents spoke of how much they enjoyed the entertainers that were brought in and their appreciation of when staff had time to provide activities or spend time with them. Whilst it is recognised that the home has many very frail, very elderly residents, there is scope to provide more activities, and the provider should make efforts to address this. Residents both in the lounge and in their rooms may benefit from more sustained one to one interaction with staff. There is a need to provide a formal programme of activities following consultation with residents and to ensure that all abilities are catered for, this is an important part of the holistic are of residents in any age group.A requirement made at the last inspection required that the residents choices regarding activities were identified this has been done insomuch that individual leisure interests of residents have been recorded, but very little action has been taken to address these. In the afternoon few staff were around the lounge, residents often sitting on their own for long periods of time. There were no call bells available and therefore residents would not be able to summon help if required. The manager said that few residents would be able to ring a call bell, therefore emphasising the need for staff to be in the lounge. Requirements have been made around activities and provision of call bells, or a similar method for residents to be able to summon staff when in the lounge area. A minister of religion provides a monthly church service at the home and will come to the home as required. The manager said that ministers of other faiths could be contacted as the need arose. Visitors said that they can visit at any time and there were several visitors in the home on this day. All visitors said that they were pleased with the services the home provides, the catering and the care of the residents. One visitor said that more activities would benefit the residents. A monthly rolling menu is in place and although this affords two choices at lunchtime, a hot main meal and an alternative option, this option was invariably cold meat and salad. Salads also featured on the supper menu at regular intervals. The meal provided Care Homes for Older People Page 18 of 32 Evidence: on the day of the inspection was chicken casserole or salad, and the evening meal on this day, the choice was corned beef salad or sandwiches. Whilst residents said that the standard of catering was good and that they enjoyed the food one resident said it’s a good job I like salad. Another resident said The food is alright, quite varied and they provide me with a gluten free diet. Relatives spoken with said that the residents enjoyed the food. Pureed meals were of a suitable consistency and well presented. At the previous inspection it was noted that all residents in the home received their beverages in lipped plastic cups, this was noted again at this inspection, the manager said that the majority of residents preferred this as they could not manage cups and saucers. It was also apparent that all residents in the home were wearing cloth clothes protectors for meals and some thought should be given to the provision of napkins in order to allow residents to maintain their dignity. Hot drinks dispensers have now been provided and therefore ensure that residents drinks remain hot. There is no dining table available in the lounge and therefore residents have their meals served on small tables pushed up to their chairs or in their rooms. Staff were seen assisting with meals and were sitting down to do this, both in the lounge and in residents rooms, thus maintaining eye contact, and they were also interacting well with residents whilst giving this assistance. Fresh fruit was seen in the storerooms but staff were not sure of how this was provided to residents. The cook has the Food Hygiene certificate but has had no training in the dietary needs of the older person. The Environmental Health Authority awarded the home three stars on their Scores on Doors initiative. Surveys received from staff showed that care staff have to do the washing up and other kitchen duties, which takes them away from the care of the residents. The provider stated that more catering staff have now been recruited and that this will cease. Care Homes for Older People Page 19 of 32 Care Homes for Older People Page 20 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives are confident that any complaints or concerns they may have will be dealt with in an open and transparent manner. Staff are aware of their responsibilities in safeguarding those in their care. Evidence: The home has a complaints policy which is displayed in the main entrance hall and included in the Service User Guide. All of the visitors spoken with, and some residents, were aware of how to make a complaint. Five concerns have been received by the home since the last inspection and the CSCI received two verbal concerns, which were passed to the manager and provider. Records of these and the actions taken to address them were seen. There have been no adult safeguarding alerts and staff have received adult safeguarding training with the local authority. The manager was unable to get a place on any of these training schemes and intends to attend one in the next few months. Staff spoken with were aware of their responsibilities in safeguarding the residents and were aware of what constitutes abuse. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing decoration and maintenance ensures the home provides a pleasant environment for the residents. Residents on upper floors will benefit from the completion of the top floor bathroom. Evidence: Maintenance work and redecoration have taken place around the home in the past twelve months and the owner intends to provide some new carpets for the entrance hall. New carpets have been provided in the lounge and some of the residents rooms. The kitchen has benefited from the purchase of new kitchen units and a new fridge/ freezer. However there is scope for improvement. Some furniture requires replacing and other parts of the home require redecoration. Staff should ensure that unoccupied beds, especially in double rooms are kept in a made up condition to improve the perception of the room for the remaining occupant. Currently the home provides accommodation for twenty residents in six double rooms and eight single rooms. Communal accommodation consists of a lounge, which is not Care Homes for Older People Page 22 of 32 Evidence: large enough to accommodate a dining table and there would be insufficient space to accomodate all residents comfortably. There is also a rear garden which is accessible to all residents.The provider has previously requested planning permission to enlarge the lounge area and add some rooms to provide single rooms instead of double, but this has been refused. He is in the process of reapplying for this. All areas of the home are served by a shaft lift, although there have been some problems with this lift in the past year, it has been regularly serviced and maintained and is currently in working order. Residents private accommodation is homely, and double rooms are provided with screens and privacy curtains. All residents rooms have a wash basin and lockable drawers are provided for residents personal possessions. Temperatures of the hot water supply to residents outlets are monitored on a regular basis, records of these were seen and were within recommended parameters. There are three assisted bathrooms within the home, but currently only two of these can be used. A requirement was made at the last inspection to restore this bathroom for the use of residents; this has not been completed, but the provider gave assurances that this would be completed within the month. Two new beds and a number of high risk pressure mattresses have been purchased, and the home has a Stand aid hoist and full body hoist for those residents requiring assistance. All areas of the home were clean and free from odour. There are updated policies and procedures relating to the control of infection and the manager has attended courses in infection control and is now the Infection Control Champion for the home. This will result with her liaising frequently with the Health Protection Agency and cascading relevant information to staff, thus ensuring that residents benefit from infection control practices that are in line with current research and best practice. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a low turn over of staff, which ensures that residents benefit from continuity of care from people with whom they are familiar. Robust recruitment procedures safeguard the residents. Evidence: There are three care staff and one registered nurse on duty during the day and one registered nurse and two care staff at night. Staff appeared busy throughout the day but said that generally there were sufficient staff on duty. Surveys received from staff, and discussions with them showed that care staff have to do the washing up and other kitchen duties, which takes them away from the care of the residents. They also stated that it was difficult to provide activities and spend time in the lounge as the care needs of the residents did not allow sufficient time for this. Discussions were held with the provider and manager with the provider who gave assurances that this would be addressed. Over 50 of the care staff have attained their National Vocational Qualification level 2 or 3 in care, and all staff are encouraged to participate in ongoing training. However, the manager said that there is often difficulty in registered nurses attending courses Care Homes for Older People Page 24 of 32 Evidence: provided by the hospital due to the lack of places for nurses working in the care sectors. Staff receive mandatory training such as fire, moving and handling and food hygiene training, and recently have undertaken infection control training. Training on the mental capacity act is taking place and one member of staff has a National Vocational Qualification level in Dementia Care. It is recommended that more staff undertake training in mental health conditions of the older person in order to enable them to understand the needs of some of the residents in the home. The home has a low turnover of staff; consequently the manager has not yet had the opportunity to commence the Skills for Care, a recognised induction training, although this is in the home and ready for use. Formerly, staff induction training was through an induction package local to the home. Three personnel files of relatively new members of staff were examined. These contained all the information and checks required by regulation to safeguard the residents. The manager was unsure about whether all staff currently employed have received the General Social Care Code of conduct, but will ensure that this is rectified if necessary. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems in place ensure that the home is run in a manner which meets residents needs and expectations. Evidence: The manager is a registered nurse and has been in this post for twelve months and is in the process of registering with the CSCI. Discussions with the manager during the day showed that she was enthusiastic about the home and her abilities in working to ensure that the home attains a good standard of care and lifestyle for the residents. The majority of the staff have worked in the home for several years and were very aware of the needs of the residents and showed good interaction and empathy when working with them.Visitors spoken with were very pleased with the care given and the ambiance in the home. A visitor said I cannot fault the staff here, every one of them will go out of their way Care Homes for Older People Page 26 of 32 Evidence: to help both us and the residents, and both the manager and the owner are extremely helpful. Residents spoke of the kindness of staff and how well staff looked after and interacted with them. The Annual Quality Assurance Assessment (a document required by regulation which sets out what the home has achieved this year and plans for the next twelve months) was received when we asked for it and provided accurate and comprehensive information about the home. The manager has recently undertaken quality monitoring in the home, which took the form of residents, relatives, staff and health care professionals surveys. Information received from these is currently being collated. These showed positive comments and constructive information. Staff meetings have been held on a regular basis but relatives and residents meetings are not held as the manager sees all visitors on a regular basis. Surveys received by the CSCI were also very positive. Staff surveys said that the manager and owner were approachable and encouraged further training; and visitor and resident surveys identified that the care in the home was good, and the staff very caring. Residents were also very positive, although one resident had some issues around the meals provided. Information regarding the homes finances has been seen recently during the purchase of another home by the provider. The home does not keep any money for residents. Residents are provided with a lockable drawer to keep money for their personal use. Visits under Regulation 26 (monthly visits and reports about the home by the provider or their representative) take place. These were informative and identified issues in the home and how they have been addressed. Not all staff have received formal supervision at intervals directed by the National Minimum Standards, the manager gave assurances that this would be rectified. Policies, procedures and other records in the home have been reviewed regularly and Care Homes for Older People Page 27 of 32 Evidence: accurately reflected practice in the home. Evidence was seen that all equipment and utilities receive servicing and checks as required by regulation. All staff have received mandatory health and safety training and a fire risk assessment is in place. A robust risk assessment is required for the back staircase, this was a requirement at the last inspection which has not been met to a standard which will protect residents, the manager has given assurances that this will be put in place. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 That a programme of activities is drawn up in consultation with service users and that this takes into consideration their past and present interests. Leisure interests which meet the needs of the service users are an important part of holistic care. They give service users the opportunity for social interaction and mental stimulation. 16/01/2009 2 12 13 That the provider ensures that service users are able to summon assistance when in the lounge area. Staff are absent from the lounge for long periods of time and the service users are at risk if they are unable to call for assistance. 16/01/2009 Recommendations Care Homes for Older People Page 30 of 32 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 8 That mattress pressures required to correlate with the individuals weight are recorded in the care plan, and a system put in place for checking these at regular intervals. That two bed rails are used at all times to ensure that residents are fully protected. That clear information showing the instances when residents require the administration of PRN drugs is shown in the MAR charts. That the reasons for individuals requiring PRN drugs are recorded and kept with the individuals MAR charts. That staff receive training in end of life care. It is considered good dietary practice to include full fat milk, butter and cream in the diet for older people, unless this is contrary to an individuals medical need.This ensures that the relatively small dietary intake contains the maximum calorific value. That the cook undertakes training in the nutritional needs of the older person. That menus are reviewed to ensure that the service users have a variety of options at meal times which are appropriate to their nutritional needs and will stimulate their appetite. That the upper floor bathroom is maintained in a suitable state to be used by service users. That the manager reviews staffing levels with regard to the other duties that care staff have to perform and in relation to the dependency of the residents in the home. That a robust risk assessment is put in place relating to the back stairway, taking into account any risks that may be posed to individual service users on the upper floors 2 3 8 9 4 5 6 9 11 15 7 8 15 15 9 10 22 27 11 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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. 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