Inspection on 06/11/08 for St Benedict`s Nursing & Residential Home

This inspection was carried out on 6th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Benedict`s Nursing &... 08/05/08

St Benedict`s Nursing &... 09/05/07

St Benedict`s Nursing &... 06/06/06

St Benedict`s Nursing &... 24/01/06

St Benedict`s Nursing &... 16/08/05

St Benedict`s Nursing &... 20/01/05

St Benedict`s Nursing &... 16/04/04

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Benedict`s Nursing & Residential Home St Benedict Street Glastonbury Somerset BA6 9NB     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: Justine Button     Date: 0 6 1 1 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 30 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 30 Information about the care home Name of care home: Address: St Benedict`s Nursing & Residential Home St Benedict Street Glastonbury Somerset BA6 9NB 01458833275 01458833402 stbenedictsnursinghome@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr David Edwin Wills White Type of registration: Number of places registered: care home 39 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 who can be accommodated is 39 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home St Benedicts Care Home provides nursing to older persons over the age of 65 yrs. It has been developed from a large domestic dwelling house with a purpose built extension. It is within easy walking distance from the town centre of Glastonbury, although up a slight hill. Accommodation is on two floors, with a four-person lift. There is a level patio area approached from the lounge and there is a garden area to the rear. There are 26 single rooms and 6 double rooms. 29 rooms have en-suite facilities. The home provides nursing care for up to 30 people and personal care for up to 9 older Care Homes for Older People Page 4 of 30 Over 65 39 0 Brief description of the care home people. Experienced nursing and care staff deliver the care. The accommodation is maintained and experienced staff provide a full catering and domestic service. The current fees are from #487 to #535 per week Care Homes for Older People Page 5 of 30 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 Key unannounced inspection was carried out over one day by one inspector. The interim Manager was available on the day of the inspection. The inspectors would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: excellent, good, adequate and poor. These judgment descriptors for the seven chapter outcome groups are given in the report. Care Homes for Older People Page 6 of 30 Records examined during the inspection were five service user care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. The current fees range from 487 to 525 pounds, which does not include hairdressing, toiletries, dental care, optician, physiotherapy, newspapers, transport or chiropody. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the care home does well: What has improved since the last inspection? At the last key inspection significant shortfalls in the standard of care provided were identified. Following the last inspection additional concerns were raised with us. These concerns have been investigated in conjunction with the local social services office, who have the lead in safeguarding matters. As a result of the concerns raised the home has not been open to new admissions until the care and support provided at the home improved to acceptable levels. As a result of this inspection it is envisaged that admissions to the home will recommence in the near future. As a result of these issues and the last inspection report the home owner, also known as the provider, has recently reviewed the managerial structure to help identify and resolve the issues raised and improve the quality of care provided at the home. This has had a significant positive impact on the care provided. Improvements have been observed in staff recruitment, safeguarding policy and procedures, quality assurance, staff training and induction, care planning and personal care delivered to people living Care Homes for Older People Page 8 of 30 at the home. The number and severity of wounds and pressure damage (pressure sores) has reduced. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to enable them to make an informed decision about moving to the home. The home ensures that people are appropriately assessed before a placement is offered. Evidence: Care homes are required to have information available to individuals with regard to the care and services that are provided at the home. This information is called the statement of purpose and service user guide. At the last inspection conducted in May 2008 it was reported that information available to people was not up to date and was no longer relevant. Since the last inspection the Statement of purpose and service user guide have been up dated. Relevant information is now available both to people thinking of moving to the home and to those already living at St Benedicts. Care Homes for Older People Page 11 of 30 Evidence: At the last inspection it was reported that: All people living at the home are provided with a copy of the terms and conditions of their stay. The terms and conditions however do not state the room to be occupied nor do they clearly state the services to be provided with in the fees paid. Due to this they do not comply with the guidance issued by the Office of fair trading. The contracts were not viewed on this occasion so it has not been confirmed if this document has been updated nor if new contracts have been given to all necessary individuals. Extra charges are met by service users for newspapers, hairdressing, trips, outings, personal toiletries items and special requirements. Readmission assessments completed for people moving into the home by a senior member of the nursing team. The inspector was able to see evidence that prospective service users were fully assessed prior to being offered a placement at the home. Completed pre-admission assessments were seen to be in place in service user care plans examined. Care Homes for Older People Page 12 of 30 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. The care planning process at the home has improved although additional developments are required. The health care needs of people living at the home are met for most of the people living at the home. The storage and documentation of medication has improved in line with manufactures and good practice guidelines. Evidence: Two people living at the home were case tracked at this inspection. This involved meeting with the individual, examining care and related records and viewing their bedrooms. Additional care plans and bedrooms were viewed and individuals spoken to. At the last inspection it was reported that the care planning process was inadequate as the plans did not give clear guidance to staff on the needs of the individuals living at Care Homes for Older People Page 13 of 30 Evidence: the home. Since the last inspection the staff have worked at reviewing and developing the care planning process. This has also been confirmed by other professionals who have been visiting the home to review the care of individuals as part of the recent concerns. Some of the plans viewed however require ongoing and additional development. For one individual, staff had commenced a social assessment however this was not yet fully completed. This is important as it gives the staff an over view of the person including their likes dislikes and daily routines. The individual had recently lost some weight. A care plan was in place for this aspect of the individuals needs however the plan contradicted other information contained in the dependency tool. Information in the plans and assessments needs to be consistent to ensure that staff deliver the care and support to the individual in a consistent way and to ensure that care needs are met appropriately. The care plans for the individual were not always specific and were ambiguous in places. Again the plans need to give clear guidance to staff to ensure that care and support is delivered appropriately. This individual had some tissue damage. A care plan was in place for this aspect of the individuals needs. This include the use of photographs. This is an improvement on the findings of the last inspection. The bedroom for this individual was viewed during the inspection. This showed that appropriate pressure reliving equipment was in place. The equipment in use was in line with the care plan. During the course of this inspection this individual was supported to change position on a regular basis in line with the care plan. A change of position is required to help in the prevention and the healing of any pressure damage. For the second individual who was cased tracked some shortfalls were noted. The care plan described in one area, on the body mapping form, that the individual had some pressure damage in two areas. There was a clear care plan in place for one of the wounds noted however there was no care plan for the other area of pressure damage. During the inspection it was noted that this individual did not have a regular change of position. As previously stated a regular change of position is required to help in the formation of and healing of pressure damage. The care plans were again ambiguous and contradictory in places. For example in one part of the assessment it stated that the individual required all support from staff when eating and drinking. In another part of the plan it stated that the individual was fully independent in this area. This would not provide clear guidance to staff particularly staff from an agency or those who did not know the individual well. This individual has a urinary catheter. For people with this catheter it is important that an adequate amount of fluid is taken each day to help in the prevention of infections. The plan for this area of the individuals care was not clear and did not state the amount of fluid the staff should be supporting the individual to have on a daily basis. This individual, although not under weight, had lost some weight over the preceding weeks. Nutrition is also important in the healing of any Care Homes for Older People Page 14 of 30 Evidence: tissue damage. Despite both of these facts staff had not considered implementing an nutritional care plan so it could not be confirmed how staff were going to monitor any additional weight loss or ensure that a diet appropriate for the needs of the individual was provided . The care of other individuals at the home was observed during the inspection, although not in as much detail of those people who were cased tracked. For these people staff supported the individuals appropriately to change position. Fluid and positional change charts had been completed when required. Some of the concerns that have been raised with regard to the care and support afforded to people living at the home relate to the support given to maintain hygiene needs. On this inspection everyone at the home looked clean tidy and well kempt. The care plans are now being developed to ensure that individual preferences and choices are documented. This will help to ensure that staff deliver care in the way in which individuals living at the home would prefer. Feedback from people included I am very happy here, The care is excellent, Staff are lovely. On this inspection all people had excess to fluids at all times and appropriate snacks and supplements were available to those with swallowing difficulties or who had some weight loss. The care plans seen confirmed that people living at the home have access to a range of health care professionals. This included input from district nurses, GPs, Social workers & palliative care specialists. At the last key inspection concerns were noted with regard to the storage and recording of medication. The home uses the monitored dosage system (MDS) with preprinted medication administration records (MAR). The registered nurse on duty administers medicines. Medicines were found to be securely stored on this visit. Excess and out of date stock seen at the last inspection has now been disposed of. Creams and lotions stored in peoples bedrooms now relate to the individual to whom they are prescribed and have a date of opening. This is required to ensure that creams and lotions are not used after the expiry date or shelf life. At the last inspection the storage of insulin for people with diabetes was found to inadequate. This has now been addressed with insulin now stored in line with the manufactures guidelines. This will ensure that the effectiveness of the insulin is not compromised. Medication requiring refrigeration is now stored at the correct temperature. At this inspection it was noted that the home kept a stock of oxygen. It could not be confirmed that this was prescribed for any individual at the home although staff stated that this was used on an occasional basis for one individual. If this is the case then the use of oxygen should be prescribed by the GP. If it is not prescribed then the oxygen Care Homes for Older People Page 15 of 30 Evidence: should be returned and not stored at the home. People who were able to express a view and relatives were very positive about the care they received.This was confirmed both during the inspection and in the surveys received. Staff interactions with individuals were noted to be very warm, professional and respectful. Interventions were observed to be unhurried. Staff were heard explaining interventions to service users before carrying out. Service users appeared relaxed and comfortable throughout the day. Care Homes for Older People Page 16 of 30 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. Choice is available at some times with regard to meals although this needs to considered at all times. Meals and mealtimes are a pleasant experience for people living at the home. Activity provision is currently limited although this may improve in the near future Evidence: Lunch was viewed during the inspection. The meal consisted of braised steak with vegetables and potatoes or Curry and rice. One person who is vegetarian was seen to have stuffed peppers. Feed back from people living at the home stated that a choice is not always available however an alternative is offered by staff. One relative stated that his wife had a very small appetite. He continued to state that staff work hard at trying to tempt his wife to eat. Staff came in every day to ask her what she would like to eat. During the serving of the meal staff were observed offering people choices about the type and amount of vegetables that they would like and if they would like gravy. A soft diet was available for those people who required it due to difficulties in chewing Care Homes for Older People Page 17 of 30 Evidence: or swallowing. Interaction between individuals and staff were seen to positive and appropriate particularly for those people who required staff assistance. The meal was nicely presented and smelt appealing. The tables were nicely set and the lunchtime experience was pleasant. Staff should consider making condiments such as salt and pepper available on the tables. It was noted that all people who ate lunch were wearing aprons to protect their clothes. This gave a rather institutional feel to the meal and staff should consider how this impacts on peoples dignity and self esteem. A more person centred approach should be used. At the last inspection it was reported that There is currently no activities organiser employed by the home although one has been recruited and is due to start work in the very near future. Due to this in house activities have been limited over the last few months. Two activities had been arranged and this included a visit by some birds of prey on the day of the inspection visit. Additionally a clothes sale had been organised for the 24/05/08. During this inspection a sing along had been organised on one afternoon. It was apparent that the opportunities to undertake activities remain limited currently. Feed back forms received from people living at the home continue to confirm this. During the second visit on the 19/11/08 no activities were on offer as the staff member responsible for organising these was completing care duties due to staff shortages. People living at the home stated that they appreciated the care and support afforded to them by the staff at the home. Comments included the staff here are marvelous and they work so hard As previously stated however the care planning process needs to be developed to ensure that a person centred approach is adopted by all staff. This will ensure that care and support is delivered in a way that they would prefer and taking into account their individual wants and wishes. Care Homes for Older People Page 18 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure in place.The home has systems in place to reduce the risk of harm or abuse to the people living there. Evidence: Since the last inspection we have received a number of concerns and complaints about the care and support afforded to people living at the home. These complaints have been investigated in conjunction with Somerset Social Services under the safeguarding policy. An additional concern was raised with us with regard to staffing levels and as such the second visit to the home was conducted on the 19/11/08. All complaints have been investigated with the full cooperation of the home/provider. The home had a complaints procedure, which was available to service users, staff, and visitors. It forms part of the Service User Guide and is detailed in the Statement of Purpose. People who were able and staff spoken with informed us that they would not hesitate in raising concerns if they had any. Feedback forms received also confirmed that people would not hesitate to raise concerns and were clear who they would speak to do this. A number of staff spoken during both visit stated that they felt that the standard of care and support was improving at the home. Care Homes for Older People Page 19 of 30 Evidence: Three staff were spoken to during the visits and asked what they would do if they suspected abuse was occurring at the home or if they saw another staff member acting inappropriately. Two of the staff gave clear answers whilst the remaining staff member was unsure what she would do. Staff training in this area is being organised currently. Since the last key inspection staff recruitment procedures have been reviewed and are now robust . This protects the People living at the home. The home is currently undergoing an extension and as such workmen from outside contractors are undertaking this work. Some members of this workforce were seen freely wandering around the home during the inspection. Contractors may not have had appropriate Criminal Record Bureau Checks. This may put the vulnerable people living at the home at risk. This was discussed with the manager on the day of the inspection who agreed to review this practice as a matter of urgency. Care Homes for Older People Page 20 of 30 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. The focus at this inspection was to review the progress toward meeting requirements made at the last key inspection which was conducted on the 08/05/08. As no requirements were made for this outcome group at the last inspection these standards were not assessed on this occasion. At the last inspection it was reported Some parts of the building are looking tired and worn but it is understood that this will be rectified once the new building has been completed. There has been an increase in the number of adjustable beds although not all people with nursing needs have this equipment. People are able to individualise their private rooms. People are able to have access to a garden although this is currently restricted due to construction of a new building. The cleanliness of the home was good. It should be noted on this inspection the number of adjustable beds had continued to increase. Care Homes for Older People Page 21 of 30 Evidence: At the last inspection it was reported. A new building is in the process of being developed at the site of the home. This will be completely separate registration from the existing service with its own manager although the two homes will be linked via one corridor. Services such as the laundry and kitchens will be shard by both the homes and as such will be upgraded in the near future. The new service will provide dementia care. A tour of the building was conducted during the inspection. There are a range of communal areas including 2 large lounges, two dinning room. This space complies with the requirements of 4.1sq m per service users. The furnishings and decoration are all homely and varied although tired looking in parts. Although some of the bedrooms in the existing service have been redecorated and modernised the owner of the home stated additional refurbishment will occur once the dirty work form the new building is completed including the link corridor. There is a range of specialist equipment including air mattresses and cushions used to help in the prevention of pressure sores. People who are frail and nursed in bed for long periods should be provided with an adjustable bed to reduce the risk of back injury to staff. The home does not currently provide all people with nursing needs with this equipment. The number available has increased since the last inspection however. The home does provide access to outdoor space in the form of a garden and patio area. The access to this space is currently limited due to the building works that are being completed. Parking is also restricted at this time. The home was clean and tidy on the day of the inspection with the exception of the drug room as discussed earlier in this report. The AQAA sent to us following the previous site visit confirms that all necessary maintenance is completed. Care Homes for Older People Page 22 of 30 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. Staff training has been reviewed and training has been organised. This has yet to be completed in all areas. The Registered Nurses may not have the skills and competencies to meet the needs of the people living at the home. Staffing levels have been reviewed and now appear adequate to meet the needs of the people living at the home. These need to kept under review. Staff recruitment is now robust. Evidence: As previously stated social services and ourselves have received a number of concerns over the last few months with regard to the care and support afforded to people living at the home. Included in these complaints were concerns with regard to the skills and competencies of the staff working at the home. At the last inspection it was identified that not all staff had received all necessary training in line with their job role. Since the last inspection the management have identified one staff member who will now be responsible for the identification and organization of training. This staff member has developed a training matrix. This matrix has identified some staff that have not undertaken all necessary mandatory training. Thus training has now been organized although not all has been completed. During the concerns raised with regard to the Care Homes for Older People Page 23 of 30 Evidence: home it has become evident that some of the Registered nurses may not have the skills and knowledge to meet the needs of the people living at the home. Tools are available to help assess Registered Nurses skills. The management should identify and use one of these tools to ensure that the nurses have up dated their training and have the necessary skills to complete their job role. The Registered nurses also need to be reminded of their accountability under the Nursing and Midwifery Council code of practice. This code states that you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions. Following the last inspection the induction of new staff has been reviewed. The new induction now complies with good practice guidelines. New staff now complete two days training and then shadow senior staff for three shifts prior to working unaccompanied. This was discussed with the individual responsible for training and it was agreed that this may need to be reviewed Dependant on the skills of the new staff member. This is important especially for those people who have not worked social care previously. During the second visit on the 19/11/08 it was clear that the staff member who was responsible for completing activities with people living at the home was in fact completing care duties due to staff shortages. The management need to ensure that the quality of life for people living at the home is not compromised by poor staffing levels. The concerns also related to the numbers of staff available to offer care and support to the people living at the home. The new manager has stated that she has reviewed the staffing numbers and shift patterns. As a result of this review the shift patterns worked are due to change. The manager also discussed staffing numbers. On the day of the inspection 29 people were residing at the home. Staffing levels are expected to be, from 08:00 until 14:00 six care staff will be available. From 14:00 until 20:00 five care staff will be available. From 20:00 until 08:00 two care staff will be available. A registered nurse will also be available at all times. The home manager will be working a full time 37 hour week. Given the geographical layout of the home and the dependency of the individuals (it being over two floors) these staffing levels need to be kept under review. This is particularly important as the numbers of people living at the home increases. At the last inspection it was identified that recruitment procedures were not robust and as such may not protect the people living at the home. The recruitment procedures have been reviewed and are now robust. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A new manager has been recruited. The manager must now submit an application to be registered with us. Evidence: These standards were not assessed in full. A new manager has been recruited to the home. This is in addition to two Registered Nurses who will take the clinical leads for the two areas of the home, once the extension has been completed. The new Manager Ms Watkins has had previous experience in managing care services. Ms Watkins is yet to submit an application to be registered with us. Managers are required under the Care Home Regulations to be registered with us to ensure their suitability for the role. An application, therefore, needs to be forwarded to us. Since taking up her position as manager Ms Watkins has reviewed and made some significant changes at the home. Ms Watkins has agreed that there is still alot to do until the home would be providing the level of care and support that she would like. Care Homes for Older People Page 25 of 30 Evidence: The considerable changes at the home have caused some disruption to staff however this would not be unexpected in a home undergoing change. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 31 8 (1)9(1) You must make application 30/07/2008 to register any person appointed to manage the home to comply with Section 11(1) of the Care Standards Act 2000. Care Homes for Older People Page 27 of 30 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 It is required that the 06/01/2009 development of the care plans continued to be developed to ensure that the plans give clear and unambigious information on thr care needs of the indivduals living at the home. To ensure that staff are aware of the care needs of the people living at the home. 2 18 13 Outside contractors should not be freely able to be in the home where individuals are living unless they are accompanied by a member of staff or have a completed record bureau check. to safeguard people living at the home. 26/12/2008 3 30 18 It is required that staff training is completed. This should include the assessment of the skills and 07/01/2009 Care Homes for Older People Page 28 of 30 competencies of the Registered Nurses To ensure that staff have the skills and competencies to meet the needs of the people living at the home. 4 31 9 The manager should submit an application to register with us To ensure that the manager has the skills ad competencies to complete the role 15/01/2009 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 9 It is recommended that the storage of oxygen is reviewed and if not required then this should be returned. If the oxygen is required for one individual then this should be prescribed by the GP and documented on the Medication Administration Record. It is recommended that staffing numbers continued to be reviewed to ensure that there are sufficient staff to meet the needs of the people living at the home. 2 27 Care Homes for Older People Page 29 of 30 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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