Inspection on 10/02/09 for St Marys Care Home

This inspection was carried out on 10th February 2009.

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

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

Other inspections for this house

St Marys Care Home 18/09/08

St Marys Care Home 19/06/08

St Marys Care Home 30/10/07

St Marys Care Home 20/02/07

St Marys Care Home 15/06/06

St Marys Care Home 24/01/06

St Marys Care Home 14/11/05

St Marys Care Home 09/02/05

St Marys Care Home 21/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Marys Care Home The Old Vicarage Main Street Blidworth Nottinghamshire NG21 0HQ     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: Karmon Hawley     Date: 1 0 0 2 2 0 0 9 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 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: St Marys Care Home Main Street The Old Vicarage Blidworth Nottinghamshire NG21 0HQ 01623795231 01623795231 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Broadoak Group of Care Homes care home 23 Number of places (if applicable): Under 65 Over 65 23 22 dementia old age, not falling within any other category Additional conditions: 0 0 The Home is registered to provide personal care for service users of both sexes Whose primary needs fall witin the following categories Old age, not falling with in any other category (OP) (23) Dementia - Over 65 years of Age (DE[E]) (23) Date of last inspection Brief description of the care home St Marys Care home provides personal care and accommodation for 23 older people. St Marys Care home is owned by the Broadoak Group that is a company which provides care for older people in Nottinghamshire and some of the surrounding counties. St Marys is a large converted vicarage situated on the main road in the village of Blidworth Nottinghamshire, fairly close to local amenities. All the bedrooms are furnished in a similar style and well appointed, many of these are well personalised. Six of the bedrooms have en-suite facilities. Most of the rooms have views over the rolling countryside. The lounge areas are situated on the ground floor of the home both lounge areas overlook the garden areas. Care Homes for Older People Page 4 of 34 1 9 0 9 2 0 0 8 Brief description of the care home Car parking is available. The current weekly fees range from £290 - £344 per week depending upon individual needs, these do not include hairdressing and chiropody fees. This information is made available on the point of enquiry. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people living at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service delivery that needs further development. A review of all the information we have received about the home was considered in planning this visit and this helped decide what areas were looked at. Two regulatory inspectors conducted the unannounced visit over 1 day, including the lunchtime period. Care Homes for Older People Page 6 of 34 The main method of inspection we use is called case tracking which involves selecting the care plans of four people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. As some people living in the care home have dementia care needs this has limited the number of their views and opinions that have been included in this report. We therefore used a specialist tool called Short observational framework for inspection (SOFI) this is a methodology we use to understand the quality of the experiences of people who use services who are unable to provide feedback due to their cognitive or communication impairments. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. Two hours were spent observing the care given to a small group of people. All observations were followed up by discussions with staff and examination of records. The acting manager and three members of staff were spoken with during the visit. Five people using the service were also spoken with during the visit to gain their views and opinions of the service. We also undertook a full tour of the care home, which included looking at the bedrooms of those people who we case tracked and communal areas of the home. What the care home does well: What has improved since the last inspection? What they could do better: Plans of care must be in place for all peoples identified needs. This will ensure that peoples needs are fully met. Risk assessments must be in place for peoples identified risks.This will ensure that people are protected from risks. Care Homes for Older People Page 8 of 34 It must be ensured that staff do not treat people using the service in an infantile manner. This will ensure that peoples right to dignity is maintained. All staff must be trained and understand their roles in safeguarding people using the service. This will ensure that people using the service are protected from abuse and any allegations are investigated appropriately. It must be ensured that the premises are kept in a good state of repair both internally and externally. This will ensure that people using the service live in a well maintained environment. It must be ensured that all parts of the care home are kept reasonably decorated. This will ensure that people using the service live in a well maintained and comfortable environment. Evidence to demonstrate that all new staff have undertaken an induction is needed. This will demonstrate that all new staff are aware of their roles and responsibilities in caring for people using the service. All staff must receive training in all mandatory areas and at a minimum training in dementia care and dealing with behaviour that may be challenging. This will ensure that people using the service are supported appropriately at all times. Appropriate risks assessments must be in place in regard to the radiator surface temperatures. This will ensure that people using the service are protected from scalds. The acting manager must apply to the Commission for Social Care Inspection to become the registered manager. This will ensure that people using the service live in a care home that is well run and managed. The quality assurance systems must continue to be developed. This will ensure that people using the service are able to express their views and opinions about the service. Arrangements must be made for the safekeeping of peoples money. This will ensure that peoples money is safeguarded. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that their needs will be assessed before they make a decision to move into the care home. The service does not offer intermediate care. Evidence: The acting manager visits people within the community to carry out a preadmission assessment to see if the staff can meet peoples needs before they move into the care home. We saw evidence of these assessments taking place within the case files that we examined. People may also visit the care home and spend some time there to get a feel for what it would be like to live at the service. Staff spoken with told us that they are informed of the needs of people before they Care Homes for Older People Page 11 of 34 Evidence: enter the care home. One person using the service told us that they are currently staying in the care home on respite and that they had looked around before they came to stay. The service does not offer intermediate care. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite the manager making progress with plans of care and risk assessments, peoples needs may not be fully met and they may not be protected from all highlighted risks due to the development still required. Evidence: The acting manager is currently developing plans of care; therefore the ones in use are at different standards. Plans of care that have not been updated do not contain specific plans of care or risk assessments for some peoples identified needs, such as diabetes mellitus, falls and dementia. Nor are these personalised in respect of peoples individual preferences, despite this information being available within the assessments that have taken place. The new plans of care are done via a computerised system. The care plans that have been completed by this method are more personalised and contain more detailed Care Homes for Older People Page 13 of 34 Evidence: information about the help and support people may need. However we found that some statements within these contradict each other, for example within one plan of care it stated that a person could move without aids, it then went on to say that the person could not move independently. The acting manager stated that she would bring these issues to the attention of the computerised systems manufacturer. Despite statements being entered such as people needing supervision to leave the building, plans of care do not consider the impact of the Mental Capacity Act nor the Deprivation of Liberty to ensure that peoples rights are maintained. In the new care plan format risk assessment are in place, however some of these only contain limited information, for example in regards to abuse, it did not provide any detail on what training staff had or if people are aware of how they can make a complaint. Staff spoken with are able to discuss the help and support that people need, however they are not aware of the Mental Capacity Act and how this may guide them in ensuring peoples best interests are maintained. People using the service said that staff are kind and caring and their needs are met. We saw staff support people when needed throughout the visit and offer reassurance to people as required. People using the service are supporting in accessing specialist services when required and we saw within plans of care that peoples health care needs are maintained. One person using the service stated that they can see the doctor at any time they needed, staff spoken with confirm that this is the case. During our specialist observation we saw a manual handling procedure take place where staff supported someone to stand by placing their arms under theirs; which is not good practice. The manager stated that she has also seen this practice on one occasion and that is why all staff are to be retrained in manual handling. For those people who are unable to weight bear a hoist is available for use, however we saw that one person using the service had been left sitting on the sling that is used for this and they told us that they were uncomfortable. On speaking with staff they removed the sling and stated that this was not a normal occurrence and they are Care Homes for Older People Page 14 of 34 Evidence: aware of the reasons why this should not happen. Staff who administer medication have been trained to do so and medication practices observed show that staff are following good practice recommendation. The medication records show us that people using the service are getting their medication as prescribed. Temperatures of the room and fridge where medication is stored is monitored as needed, there was a period where the room temperature was showing as too high, however a new thermometer has rectified this. Staff spoken with are able to discuss how they ensure that they maintain peoples dignity and treat them with respect. During our visit we saw that on occasion staff treat people in what could be called an infantile manner by the way in which they speak to them, nevertheless staff are kind and caring at all times. The acting manager has recruited a member of staff to become the dignity champion who will attend meetings especially arranged for this, she feels that this will address any issues of concern. Staff spoken with confirmed that this has taken place. People using the service told us that staff are kind, caring and respectful. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported to maintain contact with people that are important to them and participate in several activities should they wish. Some people would however welcome more activities if they were made available. Some remarks made by staff may be considered by others to be derogatory and disrespectful. Evidence: The acting manager has spent time talking with people using the service to ascertain what kinds of activities that they want to do. The service is currently advertising for an activities coordinator to deliver activities in the afternoons. Whilst waiting for this post to be filled staff are supporting people with activities when able and a voluntary worker also comes in once a week. There is a list of activities displayed on the notice board, which state that activities such as a stroll around the village, knitting, manicures, crosswords and puzzles, beanbag games, dominoes and a book club are on offer should people wish to join in. During our specialist observation we saw staff supporting people using the service Care Homes for Older People Page 16 of 34 Evidence: knitting. There is evidence of a good rapport during these times as one person who was having difficulty with their knitting was laughing and joking with the staff. Staff were happy to help and assist when necessary to maintain the activity. One person using the service said, I have friends here, I join the others for the knitting club, I am knitting a scarf at the moment. Another person using the service told us, I am settled here, I havent seen any real activities, I am not really that bothered but I would join in them if there were some. I often go for a wander around to see whats going on. Staff spoken with felt that there is enough for people to so as not everyone concentrates for a long period of time. We saw staff encourage people to sing war time songs and a few joined in, however staff also spent time talking between themselves and not to people using the service; talking over them and making remarks such as, it is funny that they cant say a sentence but they can sing a song. So that people can maintain contact with those that are important to them there are no restrictions on visiting. People using the service told us, my wife comes to see me whenever she can, it makes me feel a bit better, and my family can come whenever they like and they are made welcome. Staff spoken with confirm that there are no restrictions on visiting and people may see their family in private if they want to. Staff spoken with are not aware of the mental capacity act and why this is in place, however they stated that they make sure that people are supported in making their own decisions as able and they can spend their time as they wish. People using the service said that the routine of the care home is generally flexible and they can do as they want to. The menu on offer offers people using the service a traditional type menu with choices available at each meal. New charts have been completed, which are stored in the kitchen to inform staff of peoples likes and dislikes and whether they need assistance to eat, to ensure that their needs are met. Special diets such as diabetic diets are also catered for and staff spoken with are able to discuss the needs for these. Two people using the service told us that the food is Care Homes for Older People Page 17 of 34 Evidence: good and there are choices at each meal. During our observation we saw the tea trolley arrive and drinks were given to people, however no biscuits were offered at this time even though staff were seen eating them. The manager stated that this was not a normal occurrence and that people using the service are usually offered biscuits when given a cup of tea. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are assured that their complaints will be listened to and acted upon, however they are not fully protected from abuse. Evidence: So that people know how to make a complaint the complaints policy is on display in the main entrance. Prior to the inspection one relative spoken with stated that they do not feel that complaints are dealt with quickly enough. The service has received one complaint since the previous inspection in regard to a persons glasses. There is evidence that this issue was investigated and resolved quickly. Staff spoken with told us how they would deal with a complaint to make sure that this is resolved. People using the service did not express any concerns during the inspection and told us, I can talk to the staff, they listen and are respectful, and I am very happy and settled here, I am well looked after. Care Homes for Older People Page 19 of 34 Evidence: Some members of staff have received training in safeguarding adults, however there is still five members of staff who have not completed this training. On speaking with staff they are aware of the different kinds of abuse and how they should care for people, however one senior carer was not aware of their responsibilities in making safeguarding alerts to the local authority and relevant others should abuse occur to make sure that this is investigated appropriately. We referred one allegation of physical abuse to the Local Authority, which is currently being investigated. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate 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 satisfactory environment which is clean and tidy, however this is detracted from due to the additional maintenance work still required. Evidence: The maintenance records examined show us that ongoing maintenance continues to take place and during our visit to the service we saw maintenance people working on the roof and guttering. Although work is taking place, there are still some areas that look like they need attention. The varnish on the outside of the windows is now flaking and some peoples bedrooms are also in need of redecoration. The acting manager stated that there are plans to redecorate bedrooms and also turn the upstairs bathroom into a wet room, however she was unable to provide us with evidence to when this work would commence. During the tour of the care home we saw that there are some chairs in the main lounge that have tears in the arms and the side tables varnish is worn away. Following concerns expressed by the Local Authority about the laundry procedures, additional information has been made available for all staff so that they know what Care Homes for Older People Page 21 of 34 Evidence: temperatures to wash peoples clothes at, to make sure that infection control procedures are adhered to. The washing machine has also been repaired and a new laundry sorting system is in place to make sure that people using the service get their clothes easily. During the tour of the care home we saw that all areas of the care home are clean and tidy. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by sufficient numbers of staff, however not all staff have received the necessary training they need to care for people with dementia. Evidence: The duty rota shows us that there is one senior carer on duty during the day, with two care assistants in the morning and one to two care assistants in the afternoons. There are two care assistants on duty during the night. So that more staff are available to support people using the service, the acting manager has increased the amount of staff that are on in the morning and is looking to also do this for the afternoons. Staff spoken with confirm that the staffing levels in the morning has increased and they feel that this has made things better as they now have more time to spend with people using the service. People using the service told us, the staff look after me, I can use the call bell when I need them, they come reasonably quickly, and I dont have to wait, the girls are very good, they know how to look after me. Care Homes for Older People Page 23 of 34 Evidence: A number of staff have attained the National Vocational Qualification (a nationally recognised work and theory based qualification, which is designed to enhance knowledge and skills in caring for people) and some staff are working toward this. One staff member spoken with told us that they had completed this training and that it had given them more confidence in caring for people. So that new staff members are aware of their roles and responsibilities when they first start employment, it was stated that they undertake an induction. On speaking with staff they are able to confirm this, however not all documentation is in place within staff files examined to fully evidence this. Staff files examined show us that all the required documentation by law such as references, proof of identity and a criminal record bureau check (a police check to see if an individual has a police record or caution) are in place to ensure that people using the service are protected from unsuitable people being employed. One member of staff spoken with confirmed that they had undertaken a criminal record bureau check before they began employment. The acting manager stated that she is in the process of looking at individual staff and any shortfalls in their practice so that additional training can be arranged if necessary to ensure that they have the necessary knowledge and skills to care for people. The acting manager showed us evidence that further training courses in fire and manual handling have been booked for all staff. Within staff files examined we saw that staff are in the process of completing an infection control course and that they are undertaking mandatory training. There are however ten members of staff who have not undertaken training in dementia care and dealing with behaviour that may be challenging. On speaking with staff they stated that they felt the training offered is at a good standard and that they had the necessary knowledge and skills to care for people using the service. They are able to discuss how they would support people who may exhibit behaviour that is challenging, however one member of staff felt that additional training in this area would help them in their job role. As the service accommodates people with dementia care needs we asked staff about the Mental Capacity Act to make sure that peoples rights and choices are maintained. Staff spoken with were unaware of the Act and could not discuss this, they did state though that they support people in making their own choices as able. Care Homes for Older People Page 24 of 34 Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are plans for development, people using the service are still given little opportunity to formally express their views and opinions about the service. People using the service are not able to access their money held in safe keeping at times that may be convenient to them and the safe keeping of this may also be compromised due to the current practices in place. Evidence: There is a new acting manager in place. She has previous experience in managing a care home and been working at the care home for three weeks. She is aware that many improvements are required and she has begun to develop plans of care. She states that she feels supported by the provider and area manager and is currently working on a supernumerary basis to ensure she has time for management and administration. Care Homes for Older People Page 26 of 34 Evidence: Staff spoken with told us, Rachael has made some good changes, she is approachable and comfortable to be with, and Rachael is lovely, she is getting it sorted, she is defiantly approachable, as a senior carer I feel involved in the changes. The acting manager has sent out a newsletter to people using the service and their relatives so that they remain up to date with events that are happening in the care home. She has also begun holding managers surgeries where people can drop in to have a chat should they wish. We saw evidence that one relative has so far accessed this and their concerns were addressed and resolved. Other areas in regard to quality assurance have not changed since the previous inspection and people using the service are not given the opportunity to complete questionnaires or attend meetings to express their views and opinions. However the acting manager stated that she has sent out a letter to relatives asking them if they would be interested in setting up a group so meetings can take place. People using the service are able to have their personal money kept in the care home safe should they wish. As only the acting manager has access to this money, she stated that should any one need money whilst she is not there plans are usually made for this. However on speaking with staff, they stated that they would have to ring the acting manager if anyone wanted money out of the safe and she would have to come in. One senior member of staff also stated that as they do not have access to the safe, if a relative brings in any money this has to be locked in the medication cupboard. We examined four peoples personal allowances, which show us that receipts are available for all transactions and the money in each account corresponds with the accounting sheet. The fire records examined show us that the emergency lights have been tested as required by the fire authority, however there is a gap in the testing of the weekly fire alarm systems to ensure that this is in good working order. There is evidence that some staff have attended a fire drill, the acting manager stated that some staff are unaware of the fire procedures and the action to take in the event of a fire, therefore fire training has been re-booked for all staff. The electrics, hoist and lift certificates show us that these have been serviced as required to make sure that they are in good working order. Accident records examined show us that staff have been logging accidents on pieces of Care Homes for Older People Page 27 of 34 Evidence: paper as the accident book was full. Although these show us that there are minimal accidents occurring, this method does not follow good practice recommendations and also some of these pieces of paper could be mislaid. The acting manager has now started a new accident book to remedy this. A new risk assessment folder has been introduced for staff to read to make sure that they are aware of risk management. This folder covers general risks such as bedrails, the environment, wheelchairs and storage and using sharps. We saw that staff have signed a form to state that they have read this new document. During the tour of the care home we observed that two radiators in the main corridor leading to the bottom lounge and one radiator in the bottom lounge are very hot to the touch. There are no radiator guards in place to make sure that people using the service are protected from burns. We left an immediate requirement form so that a risk assessment could take place immediately to ensure that people using the service are protected. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 38 13 You must ensure that 10/02/2009 appropriate risks assessments are in place in regard to the radiator surface temperatures. This will ensure that people using the service are protected from scalds. 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 13 All staff must be trained and 20/05/2009 understand their roles in safeguarding people using the service. This will ensure that people using the service are protected from abuse and any allegations are investigated appropriately. 2 7 15 Plans of care must be in place for all peoples identified needs. This will ensure that peoples needs are fully met. 10/04/2009 3 7 15 Risk assessments must be in 10/04/2009 place for peoples identified risks. Care Homes for Older People Page 30 of 34 This will ensure that people are protected from risks. 4 10 12 You must ensure that staff do not treat people using the service in an infantile manner. This will ensure that peoples right to respect is maintained. 5 12 12 You must ensure that staff conduct themselves in a manner which respects dignity of people using the service. This will ensure that peoples right to dignity is maintained. 6 19 23 You must ensure that all parts of the care home are kept reasonably decorated. This will ensure that people using the service live in a well maintained and comfortable environment. 7 19 23 You must ensure that the premises are kept in a good state of repair both internally and externally. This will ensure that people using the service live in a well maintained environment. 8 28 18 You must ensure that there is evidence to demonstrate that all new staff have undertaken an induction. This will ensure you can Care Homes for Older People Page 31 of 34 27/03/2009 20/03/2009 05/05/2009 05/05/2009 06/05/2009 demonstrate that all new staff are aware of their roles and responsibilities in caring for people using the service. 9 30 18 You must ensure that all staff receive training in all mandatory areas and at a minimum training in dementia care and dealing with behaviour that may be challenging. This will ensure that people using the service are supported appropriately at all times. 10 31 8 The acting manager must apply to the commission for social care inspection to become the registered manager. This will ensure that people using the service live in a care home that is well run and managed. 11 33 24 The quality assurance 05/05/2009 systems must continue to be developed. This will ensure that people using the service are able to express their views and opinions about the service. 12 35 16 Arrangements must be made for the safekeeping of peoples money. This will ensure that peoples money is safeguarded. 05/04/2009 05/04/2009 06/05/2009 Recommendations Care Homes for Older People Page 32 of 34 These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Ensure that plans of care do not contain conflicting statements so that staff are appropriately informed of peoples needs. People who use the hoist are not left sitting on the hoist sling when this is not in use. This will ensure that they are protected from developing pressure sores. Continue to develop activities that are available to people using the service so that these suit the needs of everyone living in the care home. Ensure that people using the service are offered a biscuit when drinks are given if staff are eating these in front of them. Ensure that all staff are fully aware of the mental capacity act and that they ustilise this in their working practices. Arrangements should be made to ensure people have access to their money at any time they wish.This will ensure that people can access their money at any time should they wish to. Ensure that the fire alarm system is tested as required by the Fire Authority. 2 8 3 12 4 15 5 6 30 35 7 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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