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Inspection on 20/11/08 for St Paul`s Care Home

Also see our care home review for St Paul`s Care Home for more information

This inspection was carried out on 20th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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

The Statement of Purpose and Service Users Guide provides a good level of information regarding the home and the facilities available. One new resident said the information given to her before visiting the home enabled her and her family to make an informed decision on whether to move in to the home. The atmosphere at the home was relaxed, with communication between staff, residents and visitors being positive, open and friendly. The activities meet the resident`s expectations at this time and it was stated that residents are involved in the planning of new activities. The home was clean and well furnished and residents were seen to have been supported and enabled to personalise their rooms with furniture and ornaments. All residents relatives, visitors and visiting professionals contacted as part of the inspection process confirmed a satisfaction with the home and its services. One resident saying; `its very nice here`, `nice staff and always good food`. The quality and choice of meals remain good and most residents spoken with were complimentary about the food. The training for staff is good and covers a wide variety of resident related conditions which give the staff an understanding of the residents needs. There is a robust recruitment process that protects the residents.

What has improved since the last inspection?

The statement of purpose and service users guide have been developed and now give the necessary information required for prospective residents to be assured that the home is the right home for them. There is a need to update certain areas as discussed during the site visit. The pre-admission assessments were seen to be more detailed and person centred. This documentation has recently been updated and improved. The care documentation including individualised care plans and risk assessments have been developed and improved to ensure residents receive appropriate and person centred care that meets their assessed needs and to minimise any risks. There is now a more formal activity programme in place and it was displayed in the home and in residents bedrooms.

What the care home could do better:

The appointed manager and the management team have worked hard over the past year and the improvements seen were noticeable, particularly in respect of the environment and the documentation.The care plans and risk assessments have some shortfalls and these were fully discussed and acknowledged. Due to the stable work force and the knowledge the staff have on the residents the shortfalls do not negatively impact on the outcomes for individual residents at this time, therefore a requirement was not made. An area that needs to be developed is the risk assessments for call bell accessibility and there is more detail needed regarding pressure relieving equipment and lifting equipment in the care plan and that it includes an action plan for staff to follow in meeting the service users needs consistently. Recommendations of good practice in the management of medications were made and are detailed in the report. There are portable heaters in use at this time and the registered person needs to ensure that there are appropriate risk assessed and reflected in the homes environmental risk assessments.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Paul`s Care Home 65 Albany Road St Leonards On Sea East Sussex TN38 0LJ     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: Deborah Calveley     Date: 2 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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 Paul`s Care Home 65 Albany Road St Leonards On Sea East Sussex TN38 0LJ 01424-425798 01424448170 stpauls@new-meronden.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Margaret Law Type of registration: Number of places registered: New Century Care (Hastings) Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Service users must be aged sixty-five (65) years or over on admission Service users with a physical disability can also be accommodated The maximum number of service users to be accommodated is twenty-five (25) Date of last inspection Brief description of the care home St. Pauls is a detached property that has been converted and adapted as a care home. It is owned by New Century Care Ltd and provides nursing and personal care for up to 25 residents of an older age, including those with physical disabilities. The accommodation is arranged over three floors, with a shaft lift providing access to all floors. There are three double bedrooms, two of which have en-suite facilities and nineteen single rooms, seven with en-suites. The home has hoists, bath hoists and an Care Homes for Older People Page 4 of 31 Over 65 25 0 0 25 Brief description of the care home assisted shower room, for those who are less mobile. There are also grab rails and disability aids in the bathrooms and toilets. A large spacious lounge/dining room, with access to a patio area outside, provides communal space and at the front of the home, there is a parking area for several cars. The home is situated in a residential area of St. Leonards on Sea and is on the bus route for the shops at Silverhill or for the town of Hastings. The home welcomes prospective residents or their representatives to view the premises, discuss their needs with the Registered Manager and spend time with the staff and residents. Information about the service is available on the organisations website (New Century Care) and from the homes Manager. 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at St Pauls Nursing Home will be referred to as residents. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 8 hours on the 20 November 2008 and a follow up meeting with the appointed manager. There were 18 residents living in Care Homes for Older People Page 6 of 31 the home on the day of which five were case tracked and spoken with. During the tour of the premises four other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff and the cook were spoken with in addition to discussion with members of the senior management team and the appointed manager. Telephone contact was made with visiting professionals following the visit and their views and comments are incorporated into the report along with the information received verbally during the site visit. An Annual Quality Assurance Assessment was received from the appointed manager completed in full prior to this key inspection. The response to surveys sent out prior to this key inspection was good and the comments received have been included in the inspection report. Fees currently range from 500 pounds to 700 pounds per week. Additional charges are made for individual newspapers, chiropody, hairdressing and physiotherapy. The latest edition of the home’s inspection report is kept in the reception area along with the latest in house newsletter. What the care home does well: What has improved since the last inspection? What they could do better: The appointed manager and the management team have worked hard over the past year and the improvements seen were noticeable, particularly in respect of the environment and the documentation. Care Homes for Older People Page 8 of 31 The care plans and risk assessments have some shortfalls and these were fully discussed and acknowledged. Due to the stable work force and the knowledge the staff have on the residents the shortfalls do not negatively impact on the outcomes for individual residents at this time, therefore a requirement was not made. An area that needs to be developed is the risk assessments for call bell accessibility and there is more detail needed regarding pressure relieving equipment and lifting equipment in the care plan and that it includes an action plan for staff to follow in meeting the service users needs consistently. Recommendations of good practice in the management of medications were made and are detailed in the report. There are portable heaters in use at this time and the registered person needs to ensure that there are appropriate risk assessed and reflected in the homes environmental risk assessments. 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. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission. Evidence: There is a range of well-documented information about the home and the services it provides. The home has a Statement of Purpose and Service Users Guide and a copy of this is available in the reception area of the home, along with previous inspection reports and a copy of the homes terms and conditions of residency. All the bedrooms have a copy of the Statement of Purpose along with the key worker diary. As discussed there are areas that need to be updated and this was discussed. It was confirmed whilst talking to residents that the contract arrangements were clear Care Homes for Older People Page 11 of 31 Evidence: and understood. There is a copy of the terms and conditions of residency included in the homes information documents. A review of the care documentation confirmed that preadmission assessments are completed by the manager. The last three admissions to the home were identified and the records relating to the admission procedures followed were reviewed. This confirmed that the pre admission assessments are completed and provide a clear assessment of prospective residents care needs. The ones viewed were more person centred than previously seen. These are completed by the manager and she confirmed that these are used to ensure new admissions to the home are appropriate and that the home have the staff equipment and environment to meet their care needs. Prospective residents are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. It was confirmed by the manager that the home confirms in writing with the prospective resident the outcome of the assessment and that the home can meet their assessed needs at the time of writing. The manager was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and ensures that the nurses and carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged. It was confirmed that residents are invited to a trial period to ensure suitability of the home this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. One resident recently came for a respite stay and made the decision to make it her home, Friendly staff so made the decision to stay, its marvellous here. Intermediate or rehabilitative care is not provided at St Pauls. 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. Care documentation provides a framework for the delivery of care, it has been developed to provide clear guidance to care staff on all the care needs of the residents along with robust systems for risk assessment to ensure individual person centred care is delivered. The homes practices in the main ensure residents medicines are stored and administered safely and residents are treated with respect and have their privacy and dignity maintained. Evidence: The care documentation pertaining to four residents was reviewed as part of the inspection process. These were found to include plans of care, nutritional assessments, personal histories and risk assessments. The residents that are diabetic, need a care plan in place to guide staff in meeting their individual needs and it is recommended that random blood sugars are taken at different times. As the shortfalls were fully discussed and acknowledged, a requirement has not been made at this time. Care Homes for Older People Page 13 of 31 Evidence: Since the last inspection the documentation has been developed and the care documentation demonstrated that the care was reviewed and evaluated regularly. Risk assessments for health needs and residents safety are included in the care plan system used by the home and in the main risk assessments were found to be completed competently. There are areas identified that need to be developed and these include: Call bell risk assessments to be introduced for those residents that are unable to use this facility to ensure the residents safety. Moving and handling assessments to include more details regarding the equipment used, e.g hoist and size of sling to ensure the residents safety and comfort. The pressure relieving equipment assessed as required, e.g mattress or seat used needs to be clearly documented within the risk assessment as to whether it is used or not and the evidence of consultation with a specialist health professional. It is acknowledged that the staff of the home have worked hard to improve the records and documentation since the last inspection and are continuing to develop the documentation The home operates a key worker system. Staff spoken with confirmed that they received a full report on each resident daily and complete the care diary that is kept in the residents bedrooms. They felt that their views were taken into account when planning residents care The surveys received from residents and relatives evidenced they were satisfied with the care provided at the home, comments received included ‘They are caring and friendly’ ‘ Always care with a smile’. Residents spoken with were complimentary regarding the care they receive and stated everybody is very kind. Records indicated that local Doctors are called regularly and are involved in the care of residents. The manager confirmed that specialist external advice is sought as necessary and included the Dietitian and regular visits from a privately employed Tissue Viability Nurse. A Registered General Nurse is the link with the Tissue Viability Nurse and takes the clinical lead for wound care in the home. The clinical room is on the second floor and whilst small was clean and well organised, the clinical fridge was clean and temperatures of the fridge and room are recorded daily. Staff were observed administering medicines safely and professionally. The records seen were found to be accurate and the storage areas were found to be appropriate and well managed. Some recommendations of good practice were made during the site visit and include: The expiry dates on stock items for emergency use need to be checked regularly, photographs of residents dated, the staff identity signatures need to be updated and current and topical creams in use need to be used Care Homes for Older People Page 14 of 31 Evidence: only for those it is prescribed for. Staff were seen to be kind and pleasant and atmosphere friendly and inclusive The residents spoken with confirmed that they felt that their privacy and dignity was respected. 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. Residents lifestyle within the home is their own choice and most residents are provided with sufficient stimulation to fulfil their interests and needs. Residents are offered a choice in meals to ensure preferences and nutritional value is catered for. Evidence: Care plans evidence residents past histories and social preferences and thought has gone into developing an activity programme taking into consideration peoples preferences. As discussed the activities in the home still need to be further developed to appeal to the younger people living in the home and provide a stimulating environment for the people living in the home. There are planned activities but not on a daily basis the sessions include arts and crafts, bingo, memory, reading and pet therapy every other week. The staff take photographs of the residents enjoying the pet therapy and other activities and these are displayed in the home and in the residents bedrooms. The manager confirmed that have received advice on activities and these will be further developed in the home. Care Homes for Older People Page 16 of 31 Evidence: Activities are taken by care staff and it was confirmed that time is spent with residents on a one to one basis and this include hand massages and manicures. Church services are held in the home for residents that wish to attend and and there is a church nearby that they can visit if they wish to. Resident’s rooms were found to be individual and personalised and each resident has their preferred term of address recorded in their care documentation and this preference was respected. It was found from talking to residents that during the refurbishment of bedrooms residents were not consulted on the their preference regarding the colour of their room, and some were not totally happy with the colour scheme chosen, it would benefit the residents if they had been consulted on the changes to their room. Residents are facilitated to maintain their independence for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the residents. There are communal areas throughout the home that are available to residents and their visitors for private meetings if required. Visitors spoken to were all happy with the visiting arrangements and how staff who were said to be ‘very welcoming’ received them. There are no restrictions on visiting times as long as consideration is shown to all the residents. Residents are facilitated to maintain their independence for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the residents. There are communal areas throughout the home that are available to residents and their visitors for private meetings if required. There is a small dining area which leads into the main lounge, the residents living in the home at this time prefer to eat at their own small table in the lounge or in their room. The menus demonstrated that the meals are varied and nutritious and are rotated four weekly. The midday meal was observed and was well presented and enjoyed by the residents. The menus are devised with consultation with residents and their preferences are taken into consideration, there is a list of residents likes dislikes allergies or any specialist diets, such as diabetes for the chef and kitchen assistants to follow. The chef visits the residents during the morning to discuss their choice for lunch, alternatives are always offered. Formal records of food eaten are not kept on all the residents only those that have been identified as at risk. Care Homes for Older People Page 17 of 31 Evidence: Care Homes for Older People Page 18 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. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive appropriate training to protect residents from abuse. Evidence: The home has a written complaints procedure and this is displayed in the home and provided within the Service Users Guide. The procedure followed on receipt of a complaint evidenced the investigation undertaken with an outcome recorded and the action taken. All records were clear and kept in a way that promotes peoples confidentiality. There have been no complaints received since the last key inspection. The appointed manager has an open surgery every Monday and operates an open door policy which enables residents, visitors and staff to raise niggles and deal with issues before they become a complaint. It was confirmed that this works well. Relatives and visiting professionals said that they were confident that the management of the home would respond positively to any concern raised. Everyone spoken to confirmed that if they had any concerns or complaints they would not hesitate in talking to either the manager or a senior staff member of the home. The home has relevant guidelines on the protection of vulnerable adults and staff have Care Homes for Older People Page 19 of 31 Evidence: received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. Care Homes for Older People Page 20 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. St Pauls provides a comfortable clean and safe environment for those living there and visiting. Residents and their families are enabled and encouraged to personalise their room and rooms are homely and reflect the residents personalities and interests. Evidence: The home has followed an improvement and refurbishment programme that has benefited the residents and visitors to the home and provides a welcoming and comfortable environment. The tour of the home evidenced that the work is now completed. The lounge and dining room area is combined and is spacious and plenty of natural light. It is pleasantly decorated and well furnished. The majority of the furniture in the home is of good quality. Residents who expressed an opinion spoke positively about the home, many residents have brought in their own possessions pictures and ornaments. The gardens are accessible and attractive There are adequate communal bathrooms and shower rooms in the home with specialist equipment, which enables frail residents and those with a physical disability to enjoy the facilities available. Specialised equipment to encourage independence is provided e.g. handrails in bathrooms, hoist, wheelchairs and lifts to all areas of the home. There is a call bell system that includes the use of a pendant so that residents Care Homes for Older People Page 21 of 31 Evidence: can move around and still call for assistance if required. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. Random temperatures were taken and were of the recommended level. It was confirmed in the Annual Quality Assurance Assessment (AQAA) that there are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. Records therefore were not checked at the site visit. Polices and procedures for infection control are in place and are updated regularly. The home was clean and fresh smelling. There are two sluice rooms, one on the ground floor and one on the second floor. The staff discussed procedures in place for the first floor usage of commodes, and these were seen to be appropriate and safe, though not ideal. The laundry room was seen to be functioning well and the residents confirmed their clothes were well looked after. Residents were appropriately dressed in clean clothes. Care Homes for Older People Page 22 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. Robust recruitment procedures are in place to protect residents and staff training ensures they are aware of their roles and are able to provide the support and care the residents need. Evidence: The staffing rota was viewed and for the 18 residents living in the home at present, there are three carers and one Registered Nurse (RNs) in the morning, three carers and one RN in the afternoon and one RN and two carers at night. Feedback from residents, staff and surveys indicate that there are sufficient staff to meet the needs of the residents from direct observation. There were no concerns felt at this time in respect of the staffing numbers and no call bells were unanswered. The appointed manager confirmed that that there is flexibility of the staffing levels especially if there is a resident that is receiving end of life care. From direct observation a resident was accompanied to a hospital appointment by a member of the staff team. Staff spoken to say that the levels of staff on duty were sufficient to give the care required. Four staff recruitment files were viewed and evidenced that the home management team follow robust procedures when employing staff. The application form has recently Care Homes for Older People Page 23 of 31 Evidence: been updated to provide space for previous employment history which was needed from ones previously viewed. The robust recruitment procedures in place protect residents and the staff training ensures they are aware of their roles and are able to provide the support and care the residents need. The induction training is thorough and staff are supervised closely during this period to ensure they are competent for job they are to undertake in the home. At present approximately 75 per cent of staff have a National Vocational Qualification or are currently enrolled on a course. Staff interviewed confirmed satisfaction with the training provided Staff and records seen confirmed that they had undertaken compulsory training such as manual handling, adult protection, first aid, food hygiene, fire safety and Infection control, there is a training matrix in place that evidenced that staff are due for updates and the appointed manager is planning courses. In addition specialist training such as equality and diversity palliative care, wound care and catheter care updates are also provided. 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. The overall management of this home is good with effective systems in place to protect residents. The ethos of the home is to focus on the residents and the staff were observed doing this and interaction was positive. Evidence: The appointed manager was previously in the role of deputy manager at the home and has worked for the organisation for approximately 3 years. She has the necessary experience and qualifications to manage the home and has completed the registered managers Award. The management of the home is strong and supportive and the improvements are noticeable. The staff spoken with said that they felt supported by the management structure of the home. Residents were aware of whom the manager is and of her role in the home. The Annual Quality Assurance Assessment (AQAA) was received completed in full in Care Homes for Older People Page 25 of 31 Evidence: August 2008 and demonstrated their strategies for continued improvement and clearly evidenced what they had implemented and achieved. The quality assurance systems in the home include questionnaires being sent out to residents, families and internal audits of all areas that had been identified as needing improvement. These include pre-admission assessments, care plans, medication, activities and the environment. Regulation 26 visits are undertaken monthly and are unannounced and written formally. The introduction of these formal quality assurance and quality monitoring systems has enabled the management to objectively evaluate the service and ensure it is run in the residents best interests. Residents and Relatives meetings/forums are held regularly. Quality assurance questionnaires are completed, any areas highlighted when the surveys are collated, are then actioned. The home hold an open door policy and provide a suggestion box encouraging feedback from residents and representatives, there is also open access for residents with the external senior management. Weekly surgeries are held by the appointed manager to facilitate guaranteed uninterrupted time for visitors, residents, relatives or representatives to discuss any issues, concerns or suggestions not discussed at any other time as a matter of urgency. The AQAA states residents are encouraged to be involved in the recruitment process. Staff supervision was discussed and staff supervision is in place and in the main upto date. Staff spoken with confirmed that they receive supervision and a plan of the years supervision sessions was seen. The manager confirmed that all staff are appropriately supervised until they have received the necessary training and induction. The health and safety policies and procedures and were viewed and it was noted that all these policies and procedures had been reviewed this year- 2008 All staff with exception of the newest recruits have undertaken moving and handling, fire safety, first aid, food hygiene and infection control training. Equipment used in the home has current service certificates. All staff receive health and safety induction and the inspector was shown evidence of this in staff personnel files and this was also confirmed by members of staff spoken to on the day of the inspection. The accident book was viewed and was found completed appropriately and there is an audit of falls completed at present yearly. Care Homes for Older People Page 26 of 31 Evidence: Good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents whilst being moved around the building. As discussed the portable heaters in place need to be appropriately risk assessed and included in the environmental risk assessments. 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 8 14 That the Registered Person 26/01/2009 ensures that risk assessments are in place for call bell accessibility, and there is more detail regarding pressure relieving equipment and lifting equipment in the care plan and that it includes an action plan for staff to follow in meeting the service users needs consistently. To ensure the residents safety. 2 38 13 That the registered person enures that all portable heating equipment is appropriately risk assessed and reflected in the homes environmental risk assessments. To ensure the service users safety. 26/01/2009 Recommendations Care Homes for Older People Page 29 of 31 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 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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