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Inspection on 10/12/08 for St Bernadette`s Nursing Home

Also see our care home review for St Bernadette`s Nursing Home for more information

This inspection was carried out on 10th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People are assessed to check what their needs are, and whether the home will be able to meet them, before a decision is made to offer them a place at St Bernadette`s. One person said `I like living at St Bernadette`s. It`s the next best thing to living at home`. People have very good care plans, which describe their care in a sensitive, individual way. People said staff were `caring`, and as a rule `very good`. Health professionals think the care is good. One said they thought St Bernadette`s was `the best nursing home in Scarborough`. Another said the home `provides an excellent service`. People are offered a range of activities, and more work is being done to make sure that these are appropriate to meet each individual`s needs. People made comments like `I enjoy the activities`. They said the activities co-ordinator was `really nice`. They said `she asks us what we would like to do and arranges people to come in and entertain us and take us out`. The staff know they must report any signs or allegations of abuse so action can be taken quickly to stop it. They have had training in this to keep them alert. And the registered manager tries to solve complaints that are brought to her attention. There are a variety of reminders around the home which offer the opportunity to complain formally. The home is warm, and there are no offensive smells. It feels homely. Everyone who returned their surveys agreed that the home is always fresh and clean. Staff receive compulsory training updates so they are reminded about how to provide care in a safe way. They also get training about specific conditions and needs, so they can reflect on this knowledge in their day to day caring role. The manager is keen to continue to improve the service that people get. She is asking their views about what could be made better, so that any changes are made with their interests in mind.

What has improved since the last inspection?

People are now all referred for a falls assessment, so any risk to them can be minimised. The hot water temperatures accessible to people are now monitored, and the results recorded, to make sure that people remain safe from the risk from scalds. People who have bed rails have an assessment to check they are safe. Staff now record to show that the rails have been checked on a regular basis to make sure they remain safe and fit for use.

What the care home could do better:

The fire alarm could be checked weekly, as is the policy of the home, to make sure it is in full working order.The pre admission assessment could include a section to remind staff to discuss the implications of people sharing their bedroom with another, where this is the case, so that this can considered formally as part of the moving in process. The use of people`s private space to carry out communal activities, such as the hairdresser`s visit, could be avoided, so this area remains their own to use at any time as their own private space. All concerns could be recorded in the record of complaints so that these are easier to keep track of, and audit, so that any similar trends can be identified quickly and action taken to rectify them. The tiles in the bathroom identified could be re grouted or replaced so they are easier to keep clean. A survey could be completed, which asks people and staff their views about the current staffing levels, and whether they meet people`s individual needs and dependency, and whether they allow staff to provide overall care in a flexible way. Changes to the way staff are allocated could be made depending upon the outcome of this survey. A more formal way of defining and recording who is responsible for supervising new starters until their full police check is returned could be organised, so this supervision is maintained at all times.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Bernadette`s Nursing Home 25-27 Trinity Road Scarborough North Yorkshire YO11 2TD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 1 0 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 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 31 Information about the care home Name of care home: Address: St Bernadette`s Nursing Home 25-27 Trinity Road Scarborough North Yorkshire YO11 2TD 01723366522 01723361325 roger.somauroo@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Complete Care Homes Ltd Name of registered manager (if applicable) Miss Ingrid Louise Campbell Richards Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Age Range 60 years plus Date of last inspection Brief description of the care home St Bernadettes provides nursing care and accommodation for up to 27 older people of either gender. The home is located in a residential area of Scarborough and the amenities and facilities of the town are approximately a mile away. The accommodation provided is in single and double bedrooms over 3 floors. There is ramped and level access to the home and two passenger lifts give access to the upper floors. There are gardens to the front and side of the house that are used by people living there and parking is available on the road. Current information about services provided at St Bernadettes are available in the form of a Statement of Purpose, service user guide and the most recent inspection report published by the Commission for Social Care Inspection, which are all available by contacting the home. The company now has a website where extra information is also available to look at. On Care Homes for Older People Page 4 of 31 care home 27 Over 65 27 0 Brief description of the care home the day of the site visit, the registered manager told us that the weekly fees for admissions to the home will be 525 pounds. The Registered Nursing Care Contribution is calculated seperately. People pay extra for newspapers, hairdressing, private chiropody, dry cleaning, aromatherapy and massage. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection took place on 8 January 2008. This key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave some numerical information about the service. Care Homes for Older People Page 6 of 31 Comments cards returned completed from nine people who live at the home, and four visiting health professionals. A site visit to the home carried out by one inspector over one day. The inspection began at around 9.30am, and lasted for approximately seven and a half hours. We have reviewed our practice when making requirements and recommendations, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only where it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The fire alarm could be checked weekly, as is the policy of the home, to make sure it is in full working order. Care Homes for Older People Page 8 of 31 The pre admission assessment could include a section to remind staff to discuss the implications of people sharing their bedroom with another, where this is the case, so that this can considered formally as part of the moving in process. The use of peoples private space to carry out communal activities, such as the hairdressers visit, could be avoided, so this area remains their own to use at any time as their own private space. All concerns could be recorded in the record of complaints so that these are easier to keep track of, and audit, so that any similar trends can be identified quickly and action taken to rectify them. The tiles in the bathroom identified could be re grouted or replaced so they are easier to keep clean. A survey could be completed, which asks people and staff their views about the current staffing levels, and whether they meet peoples individual needs and dependency, and whether they allow staff to provide overall care in a flexible way. Changes to the way staff are allocated could be made depending upon the outcome of this survey. A more formal way of defining and recording who is responsible for supervising new starters until their full police check is returned could be organised, so this supervision is maintained at all times. 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 31 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 31 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 responsibly assessed before they are admitted. Evidence: People are properly assessed, using information from a variety of professionals where possible, before a decision is made as to whether their needs can be met by the home. This information, together with information collected by senior staff during their own assessment of the persons needs, is discussed with care staff before the person arrives. This helps to make sure that staff know what care the person will need, and how they like to receive it, from the start. People are invited to visit the home if they would like to if it is possible, to see for themselves what it is like, and decide whether they would like to live there. They are also given a copy of the brochure which they can then look at in their own time. This Care Homes for Older People Page 11 of 31 Evidence: explains what services the home provides. The service users guide has been translated for those people whose first language is not English. This is a good example of how peoples diverse needs are being catered for. The pre admission assessment developed by the home covers all areas of the persons overall care. It has been improved since the last key inspection, and asks lots more questions about peoples overall health and well being, including, for instance, direct questions about allergies, peoples capacity to make decisions, and any problems the person may have with communication. There are a number of shared rooms at St Bernadettes. It would be good practice to include in the pre admission assessment information about how the person concerned feels about sharing. This would allow staff to think about whether there is anything they especially need to consider, and how the persons needs and day to day activities will match with the person with whom they will be sharing. The registered manager thought this would be a good idea, and agreed to implement it straight away. Everyone who returned their surveys agreed that they got enough information about the home before they moved in. Their comments included Thought the home sounded lovely. My family looked round, Quite happy with the home, I am very happy at St Bernadettes. Its the next best thing to living at home. Once admitted people get a contract which specifies how much their care will cost, who will be paying for each element of their care, and how much contribution they will receive following their free nursing care assessment. The contract also tells people what they will pay extra for, so they know what they may have to spend in addition to their fees. The home does not provide intermediate care. Therefore standard 6 is not applicable. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are understood and written down in a personal way which helps staff so see each person as an individual. Evidence: Staff have worked hard to complete new care plans for everyone. The majority of the information has now been transferred. Peoples care was written down in a very individual way, which really considered them as each having their own personal, social, psychological and nursing needs, as well as their likes, dislikes and preferences. Staff demonstrated that they knew people well, and the plans explained how best they could meet these needs. Entries like sleeps well without medication. Likes a drink of fruit juice, then tucking in really focus on that persons preferences before retiring. There were other examples where staff had thought about what would make the person feel more at home. Risk to people was also identified and calculated. This information was used when developing the care plan, in order to judge the safest way for each area of care to be Care Homes for Older People Page 13 of 31 Evidence: provided. Care is taken to try to keep risk to people to a minimum. For instance, everyone without exception has a special mattress to reduce the risk to them from pressure sores. And one professional commented that St Bernadettes are forerunners in developing a special tool which assesses risk to people from malnutrition. Staff had recalculated someones risk assessment for the use of bed rails, which were no longer needed. This is good, because it shows that changes in peoples health and safety are being monitored. But they had forgotten to update the persons night profile, which said they were still used. This was corrected on the day of the site visit, and the rails removed from the bed altogether. The registered manager has taken the time to provide extra information in peoples care plans about individual conditions that they suffer from. This is good, because it means staff can refer to it when they write about that persons care. Nine out of ten people said that staff listen and act on what they say. However, they made comments like They always try to do what they can, Most of the time, Yes. But not all of the time. These comments appeared to relate more to staff availability, so will be discussed further in the Staffing section. People were very positive about the way staff care for them, when they made comments like Staff are very good, and very caring staff. Five people said that they always get the care they need. Four people said this was usually the case. One person thought that they did not get enough care. On the day, peoples comments were very positive. One person who has recently come to live at the home said Ive progressed more in the last three weeks than I did all the time I was at hospital. They said all the staff are attentive, kind and nice. Another explained how staff are very sensitive to their feelings, stating that they try their best not to cause any embarrassment when providing personal care. Another said the home was perfect as far as they were concerned. A relative spoken with said that they were happy with everything. They said Ingrid (the registered manager) contacts us if there are any problems. Its a load off my mind - I am happy with the care. The records showed that people get attention from health professionals where this is needed. They commented in their surveys Excellent nursing staff. I feel this is the best nursing home in Scarborough....very impressed, Referral are always prompt and any concerns highlighted, Stimulates residents. Excellent sister Ingrid (the registered manager) manages the home well and extremely caring and emphatic to residents. The home has recently conducted a satisfaction survey which asked people, their relatives and visiting health professionals whether they thought peoples privacy and dignity was upheld by staff. The feedback was mainly positive, although there were Care Homes for Older People Page 14 of 31 Evidence: one or two areas where the registered manager and general manager wanted to make some improvements. This was around staff making sure that they knocked on doors before entering peoples rooms, and also ensuring that curtains were properly shut before personal care was provided. There were two observed occasions where staff forgot to knock during this site visit. It is important that staff remember to do so. Training has been organised for all staff to address this, to take place in the New Year, which will reinforce the importance of privacy and dignity. It was noted that people have do not disturb signs hanging from their doors. People could be encouraged to use these if they would like to warn staff not to enter their room if they do not want to be disturbed. Nobody at the home looks after their own medication. Everyone has been assessed as needing help from staff. Trained staff look after this medication, which is delivered monthly to the home, signed in by them, and a record kept by them every time any medication is administered to a person. The home has recently had a pharmacy inspection. Two recommendations were made following the visit. We were told that both have been addressed. An internal audit is also carried out by the registered manager. If she identifies any shortfalls, she tells staff straight away. This stops any errors from reoccurring, because they are identified quickly, and is good practice. All areas of the medication seen were managed well. Care Homes for Older People Page 15 of 31 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. Steps are taken to understand and meet peoples overall social wellbeing. Evidence: An activities person is employed four days a week. A member of the care team is about to cover a fifth day. The activities person is completing special assessments specifically about peoples social needs so she can tailor the activities to meet these needs as she develops the activities programme over time. For instance, she had discovered during this assessment that one person prefers individual activities, including hand massage, manicures, music and arts and crafts. There were lots of festive celebrations advertised for over the Christmas period, such as a carol service, Christmas party and nativity play. And information about the home, the local area, and local places of worship was available for people to read. This gives people new to the area a taste of what it has to offer them, and reminders to those who know the area of what there is to do. The hairdresser was spending the day at the home. She used someones bedroom as the hairdressing salon. This was raised with the registered manager, as using Care Homes for Older People Page 16 of 31 Evidence: someones room does not protect their privacy. She explained the bathroom was usually used, but because it had been used to store a delivery of boxes, it could not be used. She told us that the person is always asked if this is appropriate, and that they normally spend the day watching the activity as people come and go. However, this is not best practice. People and staff spoken with agreed that the routine at the home is flexible. This means that one day does not have to be the same as the next. It makes life at the home more interesting for people, because they can make choices about how to spend their time. Visitors are welcomed into the home until around 8pm. Everyone has been issued with new contracts following a recent residents and relatives meeting where this was agreed by the people present. We were told that people currently living at the home like to go to bed reasonably early, and that this arrangement allows their choice to be accommodated for. However, the registered manager did stress that there is some flexibility in this arrangement. We were told that people are offered three meals each day. They are also offered supper. Staff ask each day what people would prefer from the menu choice, so this can be prepared in advance to allow everyone to eat together at the mealtime. Fresh meat is delivered to the home daily, and fruit and vegetables twice weekly. We were told that the cook is not limited by a set budget, so she can order plenty of food to make sure people get a varied diet. In the kitchen there were details about likes, dislikes and also information about people who had special dietary needs. The menu displayed in the dining area showed the choices for the day, for each mealtime. The main meal of the day comprises of a three course lunch. Following a request at a recent residents meeting, spaghetti bolognese was on the menu for the first time. One person said later how tasty is was, and that the meal had been good fun. People who did not want this meal had an alternative. One person had a salad. Another had a vegetarian meal. The meal was relaxed and unrushed. People who needed help were assisted in a dignified manner at a pace which did not rush them. Comments about the food included Its really lovely, We always get plenty to eat, Nice home cooked meals. Two people who returned their surveys said the food was Not Bad, and It varies. Care Homes for Older People Page 17 of 31 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. Peoples concerns are listened to by staff and acted upon. Evidence: Six people who returned their surveys said they always know who to speak to if they are not happy. Two people were not sure. However, there are a variety of ways in which people are reminded about how to complain. For instance, the complaints policy is displayed in the main hallway, together with complaints and commendation forms for people to complete as they wish. People also have a copy of the procedure in their room. And advocacy services visit the home regularly to speak with people who may want their independent support. This is good practice. As an extra reminder, people could be refreshed about who to go to, and how to complain, at the next residents meeting. Any concerns raised with the Commission for Social Care Inspection have been discussed, considered, and, on one occasion, referred to the local authority so they could be appropriately investigated. The specific information passed on on this occasion was not upheld by them. Peoples complaints are taken seriously by the registered manager. One complaint was recorded in the records as having been made since the last key inspection. This was about the sun glare in the dining area. This was resolved quickly, and new blinds are Care Homes for Older People Page 18 of 31 Evidence: now in place. The registered manager said that concerns, where people have not said that they want to raise a formal complaint, are recorded in the persons care file. This makes it very difficult to audit complaints or concerns that are received over time. It is recommended that all this sort of information should be be together in the complaints book. This way, any emerging trends can be seen, and action taken following these collective concerns can be better monitored by the registered manager, but also by the general manager when she visits the home to oversee the way that the home is operating. The registered manager agreed to do this. Staff at the home have completed training about safeguarding. Everyone spoken with knew what to do if they witnessed or suspected someone was being abused, and took this responsibility very seriously. This helps to keeps people who live at the home safe. The abuse policy was amended on the day of the site visit to support the current agreed guidance, and the role of the local authority as lead investigators, although the immediate information for senior staff to follow was entirely correct. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a warm, comfortable environment. Evidence: The home was clean, warm and nicely decorated. There is car parking to the rear of the house which makes it easier for people to park when they visit. Recent damage to the roof following a snow downfall was being repaired promptly. There are two small sitting areas to choose from. People said they had their favourites. Some liked the quieter top lounge. One person said they liked to watch the staff activity so chose the sit in the other lounge, which looks onto the dining room and kitchen area. There are a number of shared bedrooms. One person said they did not mind sharing. They liked the person with whom they shared, and said that they had enough privacy, although were looking forward to the solitude of a single room once they had the chance to move rooms. Those rooms seen were homely, and contained peoples personal belongings. There is a cleaning programme in place. The housekeeper told us that she goes round the home to check that the cleaners have completed the jobs allocated to them. This Care Homes for Older People Page 20 of 31 Evidence: will help to keep the home clean and free from any unpleasant odours. There is a maintenance man who works between all four homes owned by the registered provider. He visited on the day of the site visit to replace some restrictors on two windows so they only opened a safe distance. He has glass ordered for a window which is cracked, but we were told that this has been made safe in the meantime. Some of the tiles around the bath in the first floor bathroom needed to be repaired so they can be kept clean easily. The registered manager said that she would organise for this to be done. The laundry facilities were appropriate for the home. There was protective equipment available for staff to use, and facilities available to promote good infection control. Staff have received infection control training to help keep problems to a minimum. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by staff who are encouraged to train to meet their individual needs. Although further work is needed to check that the current staffing levels provide consistent care for those living at St Bernadettes. Evidence: Peoples views about staff availability differed, although there have been no changes to the staffing levels since the last visit. Whilst we were told that the registered provider always works to previously agreed staffing levels, this is no longer the measure for deciding whether there are sufficient staff for people. This is now judged by peoples experiences, whether they have positive outcomes, and whether the number of staff meets peoples collective needs and varying levels of dependency. When asked about staffing, two people said that staff were always available when needed. They made comments like They try to be available. Sometimes they are busy but always get to me when they can, and Staff try to help. They sit and chat to us on an afternoon. Four people said staff are usually available. They commented Staff are sometimes very busy but always try to help, and Most of the time. Four people said that staff were available sometimes. A member of staff spoken with said that they do get short staffed sometimes, but that Care Homes for Older People Page 22 of 31 Evidence: it is normally OK, although they identified that more staff would be nice on an evening. They said that staffing was the only area where they thought the home could do better. They stressed that people still always get the care they need, but that sometimes the extras drop off, like social activities. However, they said that the registered manager does their best to cover. Another staff member thought that staffing during the day was normally satisfactory. They were pleased that they usually operate with a full staff complement. But they could imagine that extra staff would be better at night, when two staff provide cover. They recognised that peoples needs and dependency are increasing over time. These comments from people suggest that staff try their hardest. But it was agreed with the registered manager that a survey should be completed for people and staff, focusing on staffing, to pinpoint where there may be delays, and whether changes need to be made to make peoples experiences better, or more consistent. However on the day of the site visit, call bells were quickly attended to, and people did not have to wait long before staff came to assist them. The recruitment files of two new staff were looked at. These showed that the registered manager had interviewed them, obtained two written references, and had checked that they were not barred from providing care, before they were allowed to work at the home. The full police check had not been returned. This is acceptable in exceptional circumstances, which we were told was the case. However, until this is returned, such staff need to be supervised at all times. The system at the home was not robust enough to make sure that this happened consistently, although the staff concerned were pleased that they had been allocated a more senior member of staff to work with when they first started. These supervision arrangements need to be better for future new starters so every step is taken to keep people protected. The registered manager has just introduced the full Skills for Care induction, which the new staff were about to commence, having finished their in house induction. This will help them to provide good, consistent care, which meets nationally recognised standards. Staff get a range of training to help meet peoples differing and diverse needs. Visiting professionals offer training to staff in house. And training is sourced which meets the specific needs of people as they are admitted. We were told recent courses include tissue viability, communication and understanding continence. There is also an ongoing National Vocational Qualification training programme. Some care staff are training towards Level 3, which is a higher standard. This accreditation provides evidence that staff work to at least national minimum standards in care. This helps staff to meet Care Homes for Older People Page 23 of 31 Evidence: peoples needs in a more educated and informed way. Care Homes for Older People Page 24 of 31 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. People are considered and listened to by an enthusiastic manager who is looking at ways that the service can improve, based on their views. Evidence: Positive comments were made about the registered manager, who said how much she enjoys her job. She is spending more time now on her management role, so that responsibilities in this area do not fall behind. As part of this, she is in the process of completing a Leadership and Development diploma. This will help to underpin the skills she already has as an established manager and registered nurse. However, she still spends time each week providing direct care, as she believes this is the best way to check practice, and supervise staff. She and the general manager are looking at ways to seek peoples views about the quality of the service. The first surveys sent to people, their relatives and health professionals have been sent, and the results returned and collated. This survey, about Care Homes for Older People Page 25 of 31 Evidence: privacy and dignity, has highlighted one or two areas where the registered manager and general manager now want to make improvements. They have published the results, and intend to hold some further training for staff. This is good, and shows that the managers are making improvements based on peoples views. As suggested in Staffing, it is recommended that the next survey be specifically about staffing, so that any shortfalls recognised by people can be made clearer through a more focused survey, and acted upon. The home can look after peoples personal allowance if this is their wish. The records seen tallied with the money held. The person in charge has a key to the safe where the money is kept secure. This means that at any time, people can ask for some of their money, or check how much they have. This helps people to retain some control over their finances. Staff get a range of compulsory training so that they are kept up to date about how to provide care in a safe and lawful way. All staff receive this training. Gaps are being identified and are addressed, so that no one misses out on their updates. The one area identified where this had not been completed or organised for all staff was around Food Hygiene. Following discussion at this site visit, the registered manager has told us that she has already contacted the Environmental Health Department to see what level of training is expected for care staff. Someone from the department has agreed to come to the home in the New Year to provide staff with training which they believe will be satisfactory. Although the home felt warm, there was one halogen heater in the dining area, which the registered manager said was just used to warm up the conservatory. She stated that these heaters were not used anywhere else in the home. This was not guarded, nor risk assessed, and, on reflection, the registered manager decided that it was not needed, and that it would not be used any more. One persons door was held open with a stool. The registered manager said that this was their choice, and that the door was always closed at night. However, this does not protect the person in the event of a fire during the day, when the door would not close whilst held open in this way. The registered manager decided to keep the door shut, and has ordered a self closing device which will allow the door to close should the alarm go off. The policy of the home is that the fire alarms are supposed to be checked weekly. There were some gaps in the record which suggested that sometimes this was not done. Whilst the maintenance man has responsibility for this task, it is important that, Care Homes for Older People Page 26 of 31 Evidence: if he is not available, someone else is trained to carry out the check in his absence. The last check however had been carried out two days before, and the registered manager agreed to make sure that this was done weekly in the future. The information seen before and during the site visit showed that the major appliances in the building are kept maintained. The Environmental Health Officer has visited recently, and said they observed good cooking practice. We were told that the recommendations made by them have been addressed. Care Homes for Older People Page 27 of 31 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 31 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 38 13 Weekly fire checks must be kept up to date. This will meet the policy of the home, and will assure people that the equipment is in full working order, and will alert everyone should a fire break out. 17/12/2008 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 3 The pre admission assessment should include a section to remind staff to discuss the implications of sharing their bedroom with another person, where this is the case, so that this can considered formally as part of the moving in process. The use of peoples private space to carry out communal activities, such as the hairdresser visit, should be avoided so this area remains their own to use at any time as their own private space. All concerns should be recorded in the record of complaints so that these are easier to keep track of, and audit, so that any similar trends can be identified quickly and action Page 29 of 31 2 12 3 16 Care Homes for Older People taken to rectify them. 4 5 26 27 The tiles in the bathroom identified should be re grouted or replaced so they are easier to keep clean. A survey should be completed which asks people and staff their views about the current staffing levels, and whether they meet peoples individual needs and dependency, and whether they allow staff to provide overall care in a flexible way. Changes to the way staff are allocated should be made depending upon the outcome of this survey. A more formal way of defining and recording who is responsible for supervising new starters until their full police check is returned should be organised, so this supervision is maintained at all times. 6 29 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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