Inspection on 01/12/08 for Southgate Beaumont Nursing Home

This inspection was carried out on 1st December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Southgate Beaumont Nursing Home 17/06/08

Southgate Beaumont Nursing Home 23/10/07

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Southgate Beaumont Nursing Home 15 Cannon Hill Old Southgate London N14 7DJ     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: Susan Shamash     Date: 1 2 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 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: Southgate Beaumont Nursing Home 15 Cannon Hill Old Southgate London N14 7DJ 02088829222 02088865381 barbara.rees@barchester.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Barbara Lyn Rees Type of registration: Number of places registered: Barchester Healthcare Homes Ltd care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Rooms 1;7;20;27 & 40 may not be used by heavily dependent persons. Date of last inspection Brief description of the care home The Southgate Beaumont is a care home registered to provide nursing care for up to 52 people over the age of 65. A section of the first floor has been converted into a residential unit for seven service users who do not need nursing care. The service is provided in a listed building, which has been converted for use as a care home. There are five communal lounge areas, a dining room and a hairdressing salon. All bedrooms have en suite facilities. The home is owned and managed by Barchester Healthcare Homes Limited. The home is located close to public transport links and is walking distance to Palmers Green and Southgate. The stated aim of the home is to create circumstances in which residents can maintain their dignity, identity and independence and also to provide an environment for individuals that supports their physical and mental well being. Weekly fees as at December 2008 are 750GBP - 1200 GBP for Care Homes for Older People Page 4 of 34 Over 65 52 0 Brief description of the care home nursing care. The most recent CSCI inspection reports can be obtained from the managers office or at www.csci.org.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: This inspection lasted approximately seventeen hours over three days, including an evening visit lasting until approximately 9.30pm and a medication inspection undertaken by Lawrie Allum (CSCI pharmacist inspector). Two of the three visits were unannounced with the last visit, being prearranged in order to incorporate a feedback session. On the first day of the general inspection visit, the interim manager, Benet Ormerod (Operations Manager) was having his last day at the home, and the newly appointed manager, Eve Talmor was still within her first few days of employment. I had the opportunity to meet with both of them, and both offered every assistance with the inspection. A regulation manager from Barchester, nurse consultant, and senior Care Homes for Older People Page 6 of 34 manager were all available for feedback at the end of the inspection, alongside the new manager. I also had the opportunity to speak to residents, nurses and careworkers on each unit, and the activities organiser and maintenance man, in addition to joining residents for an evening meal in the James Walker Suite. Approximately ten residents, two relatives and eight staff members were spoken to independently during the inspection. A tour of the building was conducted and residents and staff members records were inspected in addition to a number of maintenance and health and safety records. What the care home does well: What has improved since the last inspection? What they could do better: There is room for improvement in the flexibility of care and catering provision within Care Homes for Older People Page 8 of 34 the home, and communication regarding these areas. All residents should be offered dentist appointments on a regular basis, and there is a need for more regular care profile reviews involving residents and/or their representatives to ensure that they are consulted about the care provided. People who are not able to leave their rooms are still not receiving sufficient social, emotional and intellectual stimulation. Staffing on the residential unit at night should be reviewed to ensure that residents needs can be met promptly. Improvements are also needed in monitoring training and supervision for the staff team. All serious incidents affecting residents must be reported to the CSCI so that these can be monitored. 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 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 10 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. Peoples needs are assessed before they move into the home, so that they can be assured that their needs will be met appropriately. They have the opportunity to visit the home or have relatives/friends do so on their behalf, in order to make a more informed decision about whether to move into the home. Evidence: Five peoples care files were inspected and these all contained comprehensive preadmission assessments of their needs. Peoples signatures indicated that prospective residents or their representatives were involved in undertaking these assessments. There were also dates and signatures indicating that the care plans were being reviewed at least monthly. Care Homes for Older People Page 11 of 34 Evidence: The management advised that people continue to be visited in their own homes, or at hospital (depending on their circumstances) in order to carry out an initial assessment of the homes ability to meet their needs. Staff members told me that prospective residents or their family members are invited to visit the home and provided with information about the home to aid their making a decision about whether to move in. Interviews with people living at the home indicated that their needs were generally being met in accordance with their choices, and that they had been involved in the initial assessment procedure. In the majority of cases it had been their relatives who had visited the home to gain an impression of it prior to their admission, as they had been unable to do so themselves due to ill health. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home generally feel that they are treated with respect by the staff team and that their privacy is maintained. Improvements have been made in the way residents health, personal and social care needs are addressed in care plans, however there remains room for improvement in a some healthcare records to ensure that their healthcare needs are fully met. Significant improvements have been made in the area of medication administration, so that people can expect that their medication needs will be met effectively, with room for further improvement in this area. Evidence: Residents spoken to confirmed that their privacy was being maintained and that staff addressed them with respect at all times, and this was confirmed by observations of interactions between staff and residents. Although most residents indicated that they were satisfied with the care and support receive, several residents spoken to indicated Care Homes for Older People Page 13 of 34 Evidence: that they had little control over the time at which they got up or had breakfast in the morning. One person told me that they got up at 7am but sometimes had to wait until 9am before receiving breakfast. Another told me that they would understand if the staff would only let me know if they are running late - for example if someone has an accident. Of course I would understand, and then I could phone my relatives and ask them to come later, instead of being left waiting indefinitely. Inspection of a sample of the care plans for residents on each unit in the home (five care plans in all) showed that peoples health, personal and social care needs are recorded and most had been signed by residents or their advocates where appropriate. New more detailed formats were being used to record evidence of meaningful reviews on a monthly basis, and this represents a significant improvement in the quality of monthly reviews. However the care profile reviews had not been completed recently in the majority of files inspected. These are usually undertaken in conjunction with residents and/or their relatives, in line with the provider organisations policies, and are necessary to show consulation with residents and/or their representatives where possible. Records showed clear details of when people had received healthcare professional visits such as chiropodist, physiotherapy, and optician appointments. As required at the previous inspection people were being offered opticians appointments, however inspection of files and discussion with residents indicated that few people had seen the dentist within the last year. Nutritional and Waterlow assessments (regarding tissue viability used for the prevention of pressure sores) remain available for each resident. As required previously inspection of peoples weights were being recorded at least monthly including the date on which they were weighed. Records showed that staff were noting any significant changes in peoples weights and seeking medical advice accordingly as necessary. A small number of people had pressure areas/ulcers, and appropriate care plans appeared to be in place for them. Directions regarding the care and treatment of pressure ulcers were generally clear and detailed, and records indicated that these were being followed as appropriate. Overall I noted an improvement in the care plans for people with pressure areas, with the majority having current photographs and wound assessment records in place. However in the sample of files inspected, one person (who did not have any pressure area or history of such) had a Waterlow assessment from approximately six months previously, indicating that this was not being reviewed monthly in line with Barchesters policies. Another person who was receiving treatment for a pressure area did not have a current photograph of the Care Homes for Older People Page 14 of 34 Evidence: wound on file. There is therefore still room for improvement in the recording of treatment for pressure areas. I was provided with records of peoples Influenza or other recent vaccinations as required at the previous inspection, and records of all vaccinations were being recorded on peoples files as appropriate. Inspection of the medication storage, administration and disposal within the home was undertaken by Lawrie Allum - CSCI Pharmacy Inspector on a separate visit to the home on 01/12/08. All three of the homes units had commenced the first day of a new 4 week cycle of dispensed medication. Audits of medication were therefore only based on a single days use and random checks reconciled medication records with medication available. Viewing the medicine administration records (MAR) for the previous cycle ending 30/11/2008 indicated where the non-administration code F required defining for 2 residents on Grove unit. Also on Grove unit the GPs authorisation to administer medicines via non-oral administration into the stomach (PEG) did not include the CoCareldopa tablets. On James Walker unit, lactulose liquid was prescribed to be taken as directed without documented guidance provided on the doctors intended requirements. Lockable storage had not been provided for the secure storage of medication where it is kept in residents rooms. I was informed that although purpose designed storage cupboards had been delivered they were installed in the apartments of residents in the non-care home wing in error and a repeated order would be arranged. On James Walker unit medicines were stored on the open top shelf of a fridge without a lock. None of the medicines stored in the fridge required cold storage and were transferred to secure medicines storage at room temperature. Finally the recommendation made to include details for contacting NHS Direct in the homes policy & procedure for dealing with errors in the administration of medicines, when staff are unable to immediately contact a residents GP, had not been implemented. Care Homes for Older People Page 15 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. People living at the home are encouraged to maintain contact with their family members and friends, and a programme of activities is provided at the home to address social, cultural and recreational needs. However residents do not always have adequate stimulation at other times of the day. Residents are given limited choices about the way in which their care is provided. The standard of food served to residents in the home remains high but there is room for more choices and flexibility in the homes catering. Evidence: There is a varied activities timetable and residents continue to speak highly of the support provided to them by the activities organiser. The management advised that it was also intended for another part-time activities worker to be employed at the home. Activities available to residents continue to include film nights, toasted sandwiches evenings, entertainers, light exercise, Booze mornings, flower arranging, arts and crafts, cookery and occassional trips out of the home in the van. However staff advised that having a physiotherapist in on the weekend to take an exercise class has proved Care Homes for Older People Page 16 of 34 Evidence: very popular with residents. In addition a large plasma screen TV is being purchased for the home to make film events more accessible, and a newsletter has been piloted for the home including information on whos who, upcoming events and other articles of interest to residents and their relatives. Some residents spoke enthusiastically about recent events held at the home such as a fancy dress party and fireworks for Guy Fawkes night, Saint Andrews Day Celebrations including a Pipe Major piping in the Haggis, a casino night, and a mystery entertainment evening during which a number of exotic animals were introduced to staff and residents at the home. Animals visiting the home had included an Indian fruit bat, a skunk, a 12 foot python, an armadillo, a chinchilla, a barn owl, eagle owl and a very large spider, and apparently the evening was a huge success. Staff advised that there are also occassional outings from the home including trips out to local parks, restaurants and the pub. Staff advised that there was still an issue of having sufficient care staff on duty to assist with such trips, so the activities organiser tends to take small numbers of people out herself on each occasion. One person living at the home continues to arranges regular book club meetings and others assist in arranging card groups. A school choir had attended shortly before one of my visits to the home, and relatives spoke highly of the impact of members of the choir visiting people in their own rooms (when they were unable to attend the main performance for health reasons). At a previous inspection it was recommended that the care staff at the home be encouraged to be more involved in meeting social, religious and recreational needs of residents, including greater flexibility in the staffing rotas so that they can take individual residents out in the local area. This remains recommended. Staff and residents spoken to confirmed that care staff still do not have much time to provide residents with support to be stimulated and engage in activities within the home, particularly those who are unable to leave their rooms. The activities organiser visits all residents at least once weekly and although care staff are spending some quality time with residents during the day, this is not being recorded, making it very difficult to monitor. It remains required that residents must receive sufficient stimulation on a daily basis for their social, intellectual and emotional wellbeing. Regular residents meetings and relatives meetings have been held at the home, and there appeared to be improved communication between staff, management and residents. A new Catering Committee is being established including residents from all areas of the home. Care Homes for Older People Page 17 of 34 Evidence: Church services are provided in-house for those who wish to attend. The Jewish Womens League and two bridge clubs hold regular meetings at the home, which residents may also attend if they so wish. The menu for the home offers a choice of meals including special diets and the majority of residents spoken to advised that the food is of a satisfactory standard. Asian food options are available for an identified person if they wish, however although there are several Jewish residents in the home some, but a limited number of cultural alternatives were being offered to these residents. Hostesses are employed to serve the food to residents on each unit, and also provide feedback to the chefs regarding residents satisfaction with each meal. I had the opportunity to join residents for the evening meal in the dining room which is maintained and decorated to a high standard. The meal was tasty, with three courses, however there was no specific vegetarian option available on the menu, so I had to chose between sandwiches, an omelette or a salad for the main course. Discussions with other service users indicated that several of them were vegetarian or frequently preferred to choose vegetarian options. Staff supported residents appropriately although those having their meal in the dining room were generally able to manage independently. Residents receiving meals in their own rooms advised that they had little control over the times that meals were served. Several people advised that breakfast was frequently served late, and many felt that they did not have an option to ask for food in between meals. Care Homes for Older People Page 18 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. People generally feel that there has been an improvement in the way in which their informal concerns about the home are addressed. Staff training is in place to ensure that the risk of residents being abused is minimised. Evidence: There is a complaints policy in place that has all the required information, and the record of complaints is maintained appropriately. Several residents spoken to told me that they felt they were listened to, and that their concerns were addressed appropriately. They noted that the interim manager has been very approachable, and made an effort to see them all. All residents spoken to felt that they could speak to someone at the home if they were unhappy with their care. Concerns about the staffing numbers within the home had considerably reduced since the previous inspection, with higher morale amongst both staff and residents. I received communications from two complainants about some longstanding issues which had not yet been settled with the home, and passed these onto the management for resolution. At the previous inspection it was required that all concerns brought to the attention of Care Homes for Older People Page 19 of 34 Evidence: staff members should be recorded, alongside action taken to address them, to evidence that the home takes all concerns seriously. Feedback from staff, relatives and service users indicated an improvement in the handling of concerns, and the management advised that the protocol was for staff to record the concerns on the progress and evaluation sheets for each service user. This appeared to make it difficult to monitor the numbers and patterns in concerns raised, and it remains recommended that a more rigorous system be implemented. Although complete records were not available for all staff regarding training undertaken, evidence was seen at the previous inspection confirming that the vast majority of staff members had undertaken training in adult protection as appropriate. The home has a copy of the adult protection policy for the local authority, in addition to its own adult protection policies and procedures. Staff spoken to were confident about action to be taken in the event of a disclosure or suspicion of abuse, and confirmed that they had undertaken training in this area. Care Homes for Older People Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and pleasant environment that is consistently decorated to a very high standard, well furnished, clean and hygienic. They have comfortably furnished individual rooms and access to a range of inviting communal areas both inside and outside of the home. Evidence: On all three days of this inspection the home was cleaned and decorated to a very high standard with no offensive odours and the large garden areas were well maintained. The housekeeping staff are commended for the high standards of cleanliness that have consistently been maintained in the home. The home has sufficient communal areas that remain furnished and decorated to a very high standard. In addition to en suite toilets for every bedroom, there are also adequate shared bathroom and toilet facilities, which are kept clean and in a good state of repair. Residents had personalised their own rooms, which were well furnished and decorated. Keypads are installed both inside and outside of the main entrance to the home and an Care Homes for Older People Page 21 of 34 Evidence: increased presence in reception ensures adequate but safe access for people in and out of the home. New larger plasma screen televisions had been ordered for the home, which will make communal viewing more accessible for residents, and a new wireless call system had been installed throughout the home. There are large garden areas outside the home, however as noted at the previous inspection, the majority of the gardens consist of clear lawns which are not easily accessible to the majority of residents. It remains recommended that further ways in which the gardens might be used for the recreation of service users, should be considered. As required previously, lockable drawers had been provided on each nursing stations, so that residents files can be locked away when the nursing stations are unoccupied, to protect peoples confidentiality. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home operates safe recruitment practices and staff receive training to ensure that they carry out their roles competently to meet residents needs. More rigorous monitoring is, however, needed to ensure that there are no gaps in staff members training that might place residents at risk of harm. Improved staffing levels within the home, generally ensure that there are sufficient staff available at all times to meet peoples needs. Evidence: At the previous key inspection it was required that staffing levels within the home be reviewed, following feedback from staff, service users, and relatives. Staff and residents were noticeably more positive about staffing levels since they had been reviewed, although an issue was raised regarding staffing at night on the James Walker Suite (residential unit) due to increased levels of dependency on the unit. The hours between 9-10pm, in particular were highlighted as being very busy as medication is administered at this time, many residents wish for support to go to bed, and close care service users must also be attended to at this time. This issue was raised with the new manager at the end of the inspection, so that it might addressed swiftly. Care Homes for Older People Page 23 of 34 Evidence: Feedback from residents indicated that they were generally satisfied with the support of nurses and care staff, descibing them as helpful and respectful to them, although there remain some frustrations around waiting times for care support. Morale amongst the staff team appeared to have improved noticeably under the interim management arrangements since the previous inspection. Inspection of the staffing rotas, indicated that these are now maintained accurately, and indicate which staff are working in particular areas of the home on each day. A sample of four staff employment files were inspected. Each contained the required level of Criminal Records Bureau (CRB) disclosure checks, references, recent photos and evidence of each staff members eligibility to work, as appropriate. Evidence of current pin numbers were also available for all registered nurses, and there were details of their immunisations. It was, however, not always clear how references had been verified. Approximately two thirds of care staff have an NVQ level two qualification or higher, which exceeds the national minimum standard of fifty percent trained staff. Discussion with staff indicated that they had received a wide range of training, however a new system of recording staff training had only recently been commenced, and therefore whilst computerised training records indicate training undertaken, the certificates and staff training profiles for each staff member were not yet complete. The trained nurses are also qualified first aiders, and at the previous inspection it was noted that a large number of staff had undertaken training in adult protection and in person centred dementia care. At the current inspection I saw evidence that further staff had undertaken manual handling, infection control, health and safety, person centered dementia care, customer care, fire safety and first aid training. However without all current certificates available for each staff file it was not possible to verify that all staff have the required mandatory training. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate interim management arrangements were made for the home, resulting in improved performance. It is too early to assess the impact of the newly appointed management style. There are forums for residents and their advocates to express their views about the home, and people are more confident that their concerns will be addressed. Service users finances are safeguarded appropriately however gaps in staff supervision, which may impact on the quality of care experienced by residents. There is a high standard of health and safety procedures to protect residents, visitors and staff from risk of harm. Evidence: Since the previous key inspection, the manager of the home had left employment with Barchester, and an interim manager (Benet Ormerod) had been in place. I had the Care Homes for Older People Page 25 of 34 Evidence: opportunity to meet the newly appointed manager for the home, Eve Talmor, on both days of the general inspection of the home, and met the interim manager who had handed over to her on the first day of the inspection. Feedback from staff and service users indicated that the interim manager had made a positive impact on the home, raising morale within the staff team, and assisting in the arrangement of a wide range of social events and activities within the home. The home had been through a very difficult time following a large number of changes to the management arrangements, poor morale within the staff team, and enforcement action taken by the CSCI regarding medication and staffing issues. It appeared that the interim manager had provided a period of stability for the home, however staff and residents were clearly apprehensive about having a new manager start. The new manager had been given one of her interviews by selected residents from different areas in the home, and I had the opportunity to speak to some of those present about their experience of the interview. Residents involved in this process felt valued and empowered by their involvement in the recruitment process and the home is commended for this practice. Discussion with the new manager indicated that she was appropriately qualified and experienced for the role. She was enthusiastic about the role whilst being realistic about the challenges ahead. She advised that she would shortly be applying for registration with the CSCI as registered manager of the home. A deputy manager has yet to be appointed to assist in the running of the home. The interim manager had held two resident meetings and a relatives meeting since the previous inspection, and instigated the formation of a catering committee for the home. Staff meetings had also been held, and strict sickness, punctuality and attendance procedures had been put into place. Regular unannounced visits to the home are undertaken by the responsible individual, with reports sent to the CSCI outlining the findings. The Annual Quality Assurance Assessment was provided prior to the previous inspection, and there has been significant support provided to the home by a range of personnel from the provider organisation, particularly with regard to compliance issues raised by the CSCI, indicating that these are being taken very seriously, and resulting in significant improvements. Residents administer their own finances, with no monies being held on behalf of any people accommodated. Care Homes for Older People Page 26 of 34 Evidence: Staff supervision records were available, indicating that some supervision was in place, however there remain considerable gaps in many staff members supervision, falling well below the expected frequency of at least six times annually. Records within the home were generally maintained to a satisfactory standard as appropriate for the protection of people living at the home. However I was concerned to see an incident report regarding a medication error, which had not been notified to the CSCI as is required. Health and safety documentation was inspected in detail and was maintained to a high standard. Appropriate safety certificates and monitoring records were available for relevant equipment including current satisfactory gas safety, portable appliances testing and emergency lighting certificates. I was provided with evidence of work being undertaken to meet the requirements made during the last electrical installation inspection, including works to a large number of flats within the home which received unsatisfactory electrical installation certificates. Further work was also being undertaken to replace emergency lighting fittings throughout the home. A detailed fire risk assessment was available for the home alongside an appropriate emergency plan. Weekly fire alarm call point tests were also being undertaken as appropriate, and there were records of regular fire drills. A recommendation is made regarding fire alarm call point testing. 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 7 15 The registered person must 27/02/2009 ensure that regular care profile reviews are conducted as outlined by Barchesters own policies, so that residents and/or their relatives are consulted with regarding their changing needs and the way that their care is delivered. . 2 8 12 The registered person must ensure that Waterlow assessments for pressure area care are reviewed monthly (even when there are no pressure sores/ulcers). Records of treatment for pressure areas/ulcers must include current photographs of the relevant area, so that progress can be monitored to ensure that treatment is effective as possible. . 30/01/2009 Care Homes for Older People Page 29 of 34 3 8 12 The registered person must ensure that people living at the home are supported to attend regular dentist appointments, in the interests of their oral hygiene. . 13/02/2009 4 9 13 The registered person must 16/01/2009 ensure that medicines prescribed without specific directions for administration, e.g. to be taken as directed or when required, are accompanied by documented guidance, available with the medicines administration record (MAR) chart, to ensure medicines are correctly and safely administered. Previous timescale of 28/08/08 not fully met. 5 9 13 The registered person must ensure that medicines and any other substances within the COSHH that are kept in residents rooms are kept in locked storage, for the safety of residents and to meet legal requirements. Previous timescale of 23/09/08 not fully met. 16/01/2009 6 12 16 The registered person must 27/02/2009 ensure that service users receive sufficient stimulation on a daily basis for their social, intellectual and emotional wellbeing, and Care Homes for Older People Page 30 of 34 that this is recorded so that it can be monitored. Previous timescale of 25/07/08 not fully met. 7 15 16 The registered person must 30/01/2009 ensure that people are able to make choices about the times of their meals, drinks and snacks during the day, and that more choices of cultural foods, or vegetarian foods are offered to people, to ensure that they receive a sholesome appealing balanced diet at times convenient to them. . 8 27 18 The registered person must 08/01/2009 ensure that staffing at night on the James Walker Suite (residential unit) is reviewed in the light of current levels of dependency on the unit, particularly between the hours of 9-10pm, to ensure that residents are supported appropriately. . 9 30 18 The registered person must 27/03/2009 ensure that training files for individual staff members contain current certificates for all training undertaken, and that a training matrix is completed for the staff team indicating training undertaken or required by each staff member, so that mandatory training can be prioritised accordingly. Care Homes for Older People Page 31 of 34 . 10 36 18 The registered person must 27/02/2009 ensure that there are no gaps in regular staff supervision sessions provided. These must be provided at least six times annually to ensure that people living at the home are supported appropriately. Previous timescale of 08/08/08 not met. 11 37 37 The registered person must ensure that all serious events affecting any person living at the home are notified to the CSCI without delay, so that they can be monitored for their protection. . 09/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It is recommended that the delivery of care in the mornings be reviewed in order to incorporate residents preferences for getting up early or late, and that communication be improved so that residents are notified if their care is to be delayed, so that they have more control over their morning routines. It is recommended that the prescribers written authorisation be obtained for administering medicines outside the licensed conditions, e.g. when crushing tablets for administration by feeding tube to the stomach. It is recommended that details for contacting NHS Direct should be included in the homes medication policies and procedures, in order to avoid any unnecessary delay in obtaining a health professionals advice following a Page 32 of 34 2 9 3 9 Care Homes for Older People medication error. 4 12 It is recommended that the management and care staff at the home be more involved in meeting social, religious and recreational needs of residents, including greater flexibility in the staffing rotas so that they can take individual residents out in the local area. It is recommended that more rigorous mechanisms be put in place for monitoring all concerns brought to the attention of staff members, and that these are recorded, alongside action taken to address them, to evidence that peoples views are being taken into account. It is recommended that further ways in which the gardens might be used for the recreation of service users, should be considered. It is recommended that the way in which staff references have been verified should be recorded in individual staff files, to ensure that recruitment procedures are as rigorous as possible for the protection of people living at the home. It is recommended that fire alarm call points should be tested in order to ensure that no call points are missed out, for the protection of staff, residents and visitors to the home. 5 16 6 19 7 29 8 38 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). 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