Inspection on 18/09/08 for Sherwood House Care Centre

This inspection was carried out on 18th September 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

Sherwood House Care Centre 18/09/07

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sherwood House Care Centre 209-211 Maidstone Road Rochester Kent ME1 3BU     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: Eamonn Kelly     Date: 1 8 0 9 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 29 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 29 Information about the care home Name of care home: Address: Sherwood House Care Centre 209-211 Maidstone Road Rochester Kent ME1 3BU 01634843132 01634311485 sherwoodhouse@blueyonder.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Hapee Care Ltd Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 30. 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) Dementia (DE). Date of last inspection Brief description of the care home The service is for people with dementia and other health issues. Accommodation is provided over four floors each of which is served by a passenger lift. The premises have a mixture of single and shared bedrooms some of which have en-suite facilities. Fees and other charges can be obtained from the manager and information about services and facilities are contained in a written guide to the home.. 30 Over 65 0 Care Homes for Older People Page 4 of 29 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: The inspection was carried out on 18th September. It comprised discussions with the manager, members of staff on morning and afternoon shifts, visitors and residents. All parts of the premises were visited, residents were met at lunch-time and other times, and records relating to, for example, care plans and risk assessments, staff rota, menus, medication records, staff and training files were checked. Key Lines of Regulatory Assessment (KLORA) have informed the judgements contained in the report. Information relating to this procedure may be viewed on the Commissions website. The report also contains references to the AQAA (annual quality assurance Care Homes for Older People Page 5 of 29 assessment) completed by the manager and submitted to the Commission. Information about this document may also be viewed in the Commissions website. Checks were made on information about the service that is known to the Commission, for example, notifications about incidents and accidents affecting residents or adult protection referrals since the previous inspection of the service. Five requirements were contained in the previous inspection report. Good progress has been made in addressing these issues. This report contains requirements in respect of hairdressing facilities, the need for an action plan for the renewal and replacement of furniture and facilities for residents to be able to enjoy external facilities easily and safely. The report contains some recommendations that the manager has agreed to consider particularly at this time when major alterations to the premises are thought to be imminent. What the care home does well: What has improved since the last inspection? What they could do better: This report contains requirements as referred to above. It contains recommendations relating to the need to make other improvements. For example, bedroom doors need to be fitted with appropriate locks, bedrooms should have carpets unless there is a particular need for alternative covering which is described in the residents care plan, showers in en-suite facilities should be in working order and not used for general storage and bedrooms should have the level of furnishing as recommended in national minimum standards. There is a need to update the smoking policy and procedures followed by staff to enable residents who wish to smoke to do so. In the interests of equality and diversity, for example, the homes policy on this issue should be clearly stated in the Statement of Purpose and a designated area should be identified and stated in the Statement which is the written guide to the homes facilioties. Although the manager said that the restrictions are for the safety of residents, there Care Homes for Older People Page 7 of 29 should be reflection on the potential deprivation of liberty for residents as they are subject to considerable restriction of movement throughout the premises. The manager should apply to the Commission for registration as the manager of the service. The provider should advise the Commission that the registration certificate should be amended to reflect the fact that the separate premises in the grounds of the home are no longer used for resident accommodation and that the maximum number of residents to be admitted is 27 and not 30. Members of staff should be supported by an experienced activities organiser. There should be improvements to the storage of continence aids and personal toiletries particularly in shared bedrooms in the interests of residents dignity and privacy. The bedroom of a resident should not be used for general hairdressing purposes. 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 29 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 29 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 are assessed in detail to enable a decision to be made as to whether suitable support can be given. Prospective residents and their supporters receive good information, written and verbal, about services and facilities. Evidence: The service provides good information for prospective residents. Written information about services and facilities is likely to be helpful for prospective residents and, according to the manager, will be updated soon. The information covers activities available, type of accommodation, staffing and complaints procedure. It was recommended, for example, that the homes policy on assisting residents who wished to smoke to do so safely and in comfort without adversely affecting other residents be clearly shown on the statement of purpose. All new residents receive a copy of a personal contract and a copy is retained on their Care Homes for Older People Page 10 of 29 Evidence: personal file. There is good evidence that the manager carries out pre-admission assessments to determine if the service can meet the needs of each prospective resident. The assessments seen contained relevant information such as medical history, moving and handling needs, nutrition, pressure areas audit, medication and dependency levels. Residents and relatives are encouraged to visit prior to making a decision about taking up residency. As some residents are admitted from hospital, it is often their relatives who make the major decision for them. Admissions are for an initial trial period for the sake of both parties with a review at the end of this time to assess the suitability of the placement. Care Homes for Older People Page 11 of 29 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. Each resident has a care plan that sets out the planned support for his/her medical, personal and social needs. Residents are treated with respect based on good knowledge by members of staff of their support requirements. The safety of residents is assisted by good medication procedures. Evidence: The premises have a friendly and welcoming atmosphere. Visitors confirmed this and said that staff provide them with helpful information about residents disposition and health. Residents are able to bring in some personal possessions when they take up residence or at a later stage subject to some conditions. A property list is retained in their personal file. There are limitations on the extent to which residents are able to move about the premises (for example, use of barriers at doors and stairs). The manager said the devices are for the continuing safety of vulnerable people due to the age and complexity of the layout of the building and based on an appropriate risk assessment Care Homes for Older People Page 12 of 29 Evidence: in each case. The recommendation was made that the manager should continuously assess the support requirements of residents and have the numbers of staff on duty to enable the needs of residents to be met including the continuing ability of residents to move about the premises with suitable assistance. During the mid-day meal, residents received pre-agreed choices of meals based on staff knowledge of residents likes and dislikes, allergies and health requirements. Some residents were assisted with their meal and there was evidence of other assistance, for example, availability of food supplements. Visitors spoke well of the quality of food provided. Care plans seen during the inspection visit contained information relating to these topics. In the sample of care plans seen, there were details about medical and personal support. Care plans included information about identified risk assessments, for example, in respect of pressure area damage, moving and handling, nutrition and continence management. There was evidence of risk assessment of safety issues relating to prevention of falls, need for bedrails, and whether the person can use a call alarm. Daily reports are maintained. Staff demonstrated how particular information is identified and recorded in this format, for example, residents diets and any need to make special arrangements where residents food and fluid intake was causing concern. The manager is extending the care plan process for residents with dementia and mental health needs. Several examples of this development were discussed and there was evidence that the needs of people with changing support needs are identified so that their new needs are addressed. Where residents need wound care, good documentation is maintained including details of progress and a body map. Nutritional needs are well documented and weights are recorded monthly or more often as necessary. There was evidence of interventions from various health professionals including district nurses. The manager said that these referrals are being further developed and extended. The manager outlined how she ensures that nurses and care staff are informed of specific needs of new residents. These issues were outlined in the examples of care plans seen during the inspection. There is a well organised medication room with fridge Care Homes for Older People Page 13 of 29 Evidence: temperatures recorded, records of medicines coming into the premises and those disposed of recorded. MAR charts (medication records) were in order and records of controlled drugs are maintained. Visitors expressed confidence in the ability of staff to look after residents well. They spoke positively of support given to residents. There was evidence that staff treated residents with respect and understanding. For the purpose of residents continuing dignity, it was recommended that, in shared bedrooms, arrangements are made that clearly identify which toiletries and towels belong to which resident. It was also recommended, for the same purpose, that continence products are not left on display but discreetly stored. Care Homes for Older People Page 14 of 29 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 a range of activities and outings but they would benefit from increased assistance in this respect, for example, through the use of an experienced activities organiser to supplement current initiatives. Evidence: All staff involved with food preparation have received training in food hygiene. Residents received different meals depending on the information known about their likes and dislikes and health requirements. Visitors spoke highly of meals provided by the service. An activities organiser is not employed. This was previously recommended by the Commission but further progress has not been made in recruiting such a person. Members of staff seen on both the morning and afternoon shifts worked well with residents and members of staff had a good knowledge of residents disabilities and support requirements. The recommendation is that an experienced activities organiser is employed to complement the good efforts currently made by the manager and care staff. Care Homes for Older People Page 15 of 29 Evidence: Members of staff and visitors spoke highly of the current efforts of staff in helping residents to remain physically and mentally fit. Reference was made to a recent boat trip organised for residents. Three said they thoroughly enjoyed the experience. A number of external entertainers visit and staff, residents and visitors spoke highly of these visits. The AQAA refers to plans to increase the level of support for residents to remain more mentally and physically fit and the manager said the services of an activities co-ordinator would help with these plans. There is a great deal of space in the communal areas for residents to walk around and this is clearly of benefit to them. Residents may bring some personal possessions with them when they take up residence. In most instances, they have independent financial and legal advice. Where residents who might previously have been able to look after their own legal and financial matters and are becoming less able to do so, the manager takes steps to enable residents to obtain independent advice. Care Homes for Older People Page 16 of 29 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 live in a service where they are protected from abuse. Evidence: The manager said that the service has developed a good relationship with local authorities, care managers and Safeguarding Adults teams. She believes she and members of staff are fully aware of adult protection procedures and procedures followed by Social Services teams in this respect. The manager said that POVA (protection of vulnerable adults) training attended by all staff has provided them with suitable knowledge on identifying potential and active cases of exploitation or abuse. Members of staff met during the inspection confirmed that they have received this training and would not hesitate to report issues that concerned them. A complaints procedure is included in the homes information guide. There are currently no adult protection procedures underway. The homes recruitment procedure including receipt of CRB/POVA checks contribute to the safety of residents and prevention of abuse. Care Homes for Older People Page 17 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe environment. Some bedrooms and communal areas are in need of attention in respect of repairs and redecoration. Evidence: All areas of the premises were seen during the inspection. There were no offensive odours in any location and domestic staff were carrying out set tasks to maintain the levels of cleanliness required by the manager. There are three dining/lounge areas that enable residents, staff and visitors good space in which to move about. Since the previous inspection some internal decorating has taken place. The large premises need a high level of upkeep. The manager said that a substantial extension will soon be built. It is recommended that the existing premises be improved before and during this project for the benefit of residents. A number of areas needing improvement were noted during the inspection and discussed with the manager. Some bedroom and bathroom doors are fitted with locks that are not openable easily from both sides. All bedroom doors should be fitted with suitable locks for residents privacy and the fact that these are openable from both Care Homes for Older People Page 18 of 29 Evidence: sides would help prevent people from being locked in. The manager said she would bring this to the attention of the owner. In two bedrooms there is no carpetting and this is not related to the specific support needs of the residents. Suitable carpetting is expected in residents bedrooms and, in addition, there should be consultation with residents and/or their representatives as to the preference of flooring in these rooms. In shared bedrooms/en-suites, resident dignity is not helped by the absence of a facility to separate their toiletries and continence products. In some areas of the premises, continence products are stored communally and on open display. Some showers have not been properly maintained and some are used for storage. a residents bedroom contains facilities for general hairdressing: the manager said this is because there are no other suitable facilities available. The hairdresser also uses this residents bedroom for general hairdressing. It was recommended that alternative facilities should be identified as it is not appropriate for a residents bedroom to be used as a communal hairdressing room. This report contains a requirement for changes to be made in this respect. Most but not all bedrooms have an en-suite facility. Some bathrooms are maintained to a good standard. Others are in need of repair. The manager said she is aware of the level of attention needed to areas throughout the premises and will discuss these further with the owner. Two residents were smoking in a dining/lounge area. Staff said that this was because there were no other suitable facilities available. The recommendation earlier in this report is that the statement of purpose clearly outlines the homes policy and identifies a designated smoking area for residents. The manager said she was aware of the need to progress these arrangements. In some locations, residents hairbrushes and toothbrushes were unkept. The manager said that this issue of resident care and dignity would be addressed. The staff room is small and was very hot and without ventilation. In some bedrooms including shared rooms, the furniture does not comply with national minimum standards. This has previously been brought to the owners attention and the recommendation was re-iterated. This report contains a requirement relating to the need for an action plan for renewal and replacement of furniture. Access to the rear garden is difficult for residents. The manager said that residents sometimes sit in the front garden because of this difficulty. She said that it would be appropriate to incorporate good access for all residents to the rear garden into the Care Homes for Older People Page 19 of 29 Evidence: major extension planned. Currently, the lack of easy and safe access to the back garden restricts peoples rights to enjoyment of the external environment. There are many door/stair gates throughout the premises that limit the access of residents without staff accompaniment to their bedrooms and other areas of the premises. The manager said that this is for the safety of residents. Earlier in this report, recommendations were made in respect of use of this type of equipment and the need for adequate numbers of staff to be in attendance to meet the current and changing needs of residents. The premises have a passenger lift to all four floors. The laundry service, under the supervision of the housekeeper, is situated in an airy and spacious location and is well maintained. Following the inspection visit, the manager advised the Commission that an action plan is in place for the renewal and replacement of furniture which will be carried out at the same time as the new extension is built. This will involve a complete refurbishment. At this time, the external environment will be brought up to standard. A hairdressing room will form part of the refurbished premises. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not benefit from sufficient staff numbers to fully meet their social and psychological needs. Whilst residents were looked after by members of staff when issues arose that needed attention, residents must be accompanied on a one to one basis throughout the premises due to the presence of physical restrictions and are left in communal areas unattended for long periods. Evidence: The manager is on duty during weekday working hours and is on-call at other times. During the inspection, two domestic workers were at the premises. There was also a housekeeper and administrator. The number of residents who may be admitted (27) need a high level of observation, care and support and all have received a diagnosis of dementia. Three carers are on duty each night (awake). Three carers were on duty from 7.30am to 1.30pm. Three carers were on duty from 7.30am to 7.30pm with another carer on duty between 1.30 and 7.30pm. There was evidence that residents were left unattended for relatively long periods of time during the inspection. An observation exercise during the inspection indicated that residents were not benefitting from being left unattended for such long periods of Care Homes for Older People Page 21 of 29 Evidence: time. Members of staff looked after them when issues arose that needed attention. An activities organiser is not employed to provide assistance to staff that would be of direct benefit to residents. The manager referred to the agreement she has reached with the owner that she can increase the numbers of staff to meet the present and changing needs of residents and that she is doing so. She said a barrier to this improvement is difficulty in employing staff but that she is successfully overcoming this barrier. Members of staff indicated that they were concerned at some aspects of their employment contracts: the manager said she would look closely at how well European Union directives on employment matters were being followed. The evidence at the time of the inspection was that there were great pressures on the small number of staff on duty in meeting the needs of residents as outlined in their care plans. Because of the physical restrictions on residents in moving about the premises they require individual staff assistance when they, for example, wish or need to visit their bedroom. There was evidence from staff files and the managers description of recruitmment procedures that members of staff receive good training and support. Two references are obtained for new members of staff. The recommendation was made to obtain full information about referees on application forms (eg. address, occupation of referee, postcode) to enable references to be obtained because there were discrepancies in some staff files checked. The manager said she would improve the recruitment system in this respect. She added that Mental Capacity Act training for staff is being arranged and that she is considering how best to implement legislation covering Deprivation of Liberty (DoL) which will come into force in April 2009. Members of staff and providers are likely to find further exploration of these topics beneficial particularly in view of the examples shown in this report where residents needs should be met in specific ways. The administrator showed how CRB/POVA-first checks are undertaken and the files checked indicated that the process is followed for potential members of staff. Evidence of an effective formal staff supervision procedure was seen. This involves monthly (formerly 6-weekly) recorded staff supervision. The manager said that she believes this is a necessary procedure to enable staff to carry out their work effectively for the benefit of residents. The manager has made significant progress in facilities for staff development and support during the past year. The previous high level of adult protection interventions by Social Services when the service was conducted by former owners has been replaced by a long period when no adult protection referrals have been made. This is Care Homes for Older People Page 22 of 29 Evidence: one indication of the progress made at the home that has benefitted residents and their families. The induction procedure introduced by the manger meets and probably exceeds Skills for Care (the relevant training organisation for the care sector) recommendations. All members of staff have either completed or are completing an NVQ course. Mandatory training is also taking place for all staff. This includes the certificate in dementia care, infection control, medication and equality & diversity which are undertaken over a 3-month period and involve reflection and competency checks. Members of staff said they feel well supported by the manager in respect of the support they receive in personal development. The AQAA refers to the developments over the past year in introducing better staff training and provides details of the plans to extend this over the next twelve months. Care Homes for Older People Page 23 of 29 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 of the service has improved over the past year and the manager is committed to ensuring that the service is conducted in the best interstes of residents. Members of staff receive good support and are well supervised in the interests of resident safety and comfort. Residents health, safety and well being is promoted and protected. Evidence: The registration certificate currently in place includes three residents in the detached house at the end of the garden. This house is now used for accommodation of staff. The house and part of the garden has been separated by new fencing. The manager said she would write to the Commission without further delay and request a new certificate of registration that showed the correct registration details. The manager said she would progress her registration as manager with the Commission with further delay. The manager has experience and qualifications in Care Homes for Older People Page 24 of 29 Evidence: managing a residential home for older people with high support needs including dementia. Good quality monitoring procedures have been introduced by the manager as part of improving general standards and improving conditions for residents and staff. Regular audits are carried out of different aspects such as medication administration, residents skin integrity, falls and accidents, nutrition and complaints/compliments. Visitors referred to the good support given to their relatives by staff. Regular visits are made by the owner but the evidence is that he does not carry out formal recorded supervision of the manager. It is recommended that he carries out this important process because there are issues (referred to in this report) that need to be discussed with the manager, formally agreed and then addressed. The manager said that residents financial and legal affairs are conducted by people other than those accociated with the business and, after initial assessment and admission, advice is given where necessary in obtaining independent advice. The administrator manages smaller amounts of monies on behalf of residents and records are retained for all transactions. With the current pressures on staff, continuing lack of an activities organiser, implications of the Mental Capacity Act, implementing the expansion and refurbishment programme and need to make the improvements referred to in this report, the manager is committed to ensuring that the service is conducted in the best interests of residents and their families. Staff files contained records for staff supervision, carried out monthly for all staff by the manager and senior carers. This provides staff with opportunities to discuss progress, their training needs, the care needs of residents and developments at the home. Staff spoke highly of the benefits of the procedure. The manager does not receive, as described above, this level of formal support from the owner. The recommendation was made that the owner provides formal supervision and that the outcomes are recorded. The manager makes every effort to ensure that health and safety guidelines are adhered to, that staff receive suitable training and that risk assessments are in place and updated as residents support needs change. She reported in the AQAA that all maintenance and service requirements are up-to-date. Care Homes for Older People Page 25 of 29 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 26 of 29 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 19 16 There should be an action plan for the renewal and replacement of furniture. The report outlines examples where national minimum standards in this respect are not being met. These improvements should be made before, during and after planned major renovations for the benefit of existing residents. 30/01/2009 2 19 23 Residents should be able to enjoy the external environment in an easy and safe way. Traditionally residents have been helped to use the front garden because of the difficulties in accessing the back garden. Whilst this facility is reasonable, easy and safe access to the rear garden is a right that should be provided to them. 30/01/2009 Care Homes for Older People Page 27 of 29 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 20 Suitable facilities should be provided for hairdressing and the bedroom of a resident should not be used for this general and communal service. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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