Inspection on 12/11/08 for St Ronans Nursing and Residential Care Home

This inspection was carried out on 12th 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Ronans Nursing and... 13/11/06

St Ronans Nursing and... 15/12/05

St Ronans Nursing and... 07/06/05

St Ronans Nursing and... 05/01/05

St Ronans Nursing and... 13/07/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Ronans Nursing and Residential Care Home 23-27 St Ronan`s Road Southsea Portsmouth Hants PO4 0PT     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: Mark Sims     Date: 1 2 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. 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 33 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 33 Information about the care home Name of care home: Address: St Ronans Nursing and Residential Care Home 23-27 St Ronan`s Road Southsea Portsmouth Hants PO4 0PT (023)92733359 02392817738 info@st-ronans.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John Pattison,Ms Jane Helliwell Name of registered manager (if applicable) Ms Amanda Jayne Brett Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia dementia mental disorder, excluding learning disability or dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 33 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Care Homes for Older People Page 4 of 33 care home 33 Over 65 0 0 0 0 33 33 33 33 33 0 Brief description of the care home St Ronans is a care home providing nursing and personal care for 33 older people. The home is three large, four-story Victorian houses that were converted to a care home a number of years ago. The home is located in a residential area of Southsea in close proximity to the seafront and local shops and is in easy access to Portsmouth city and the local hospitals. The current providers are in the process of negotiating and planning extensive alterations to the home, to provide level access to all parts of the home and general refurbishment. Care Homes for Older People Page 5 of 33 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 quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was, a Key Inspection, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit to the site of the agency was conducted over 8.5 hours, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met service users, staff and management. The inspection process involves pre fieldwork activity, gathering information from a variety of sources, surveys, the Commissions database and the Annual Quality Assurance Assessment information Care Homes for Older People Page 6 of 33 provided by the service provider/manager. We also considered information provided by service users, staff and professional visitors to the home, who completed and returned surveys. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 33 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 9 of 33 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 who use the service and their representatives had the information they needed to choose a home that would meet their needs. Evidence: The manager states via the AQAA that: All information given to service users is in plain English, complete, comprehensive and available in different formats. An enquiry and welcome pack, which includes our brochure, terms and conditions of accommodation, schedule of fees, description of a typical day at St Ronans and our Service Users Guide, is given to all prospective residents. Prospective residents and their family / friends are encouraged to visit St Ronans and move in on a trial basis to ensure we are the right home for them, in an attempt to minimise the number of failed admissions. All residents have a copy of the homes Terms and Conditions. Residents are only admitted to St Ronans if the Registered Manager is confident that their needs will be met. Care Homes for Older People Page 10 of 33 Evidence: Our assessment tool quite often highlights residents whom we are unable to admit. The Home has an excellent assessment tool including a thorough nutritional tool, with attached guidance notes for assessors, which is constantly reviewed in light of best practise. A full care needs assessment is completed with the service user and relative / friend, as appropriate, prior to the service users care plan being drawn up and admission, in accordance with our Statement of Purpose, either in their own home or their current abode. When a Care Management assessment / Care Plan is made available from the referring Care Manager, the information provided is included in the plan of care for daily living; in the event of an emergency admission, this is required information, and we will not admit a resident without it. All assessors are fully trained and are competent to undertake a comprehensive care needs assessment. The Registered Manager has achieved her Registered Managers Award and disseminates all appropriate information to her staff. For those residents who may be admitted on a short term contract, all person-centred, rehabilitative care if required, to maintain their level of independence will be given. Staff are fully trained to provide all care, external agencies will be contacted if specialist care is required. Regular reviews and surveys are undertaken to ensure quality standards are met and continually improved and to discuss any comments or suggestions. Eight surveys were returned to us (the Commission) by people residing at the home. Four surveys were ticked yes in response to the question: did you receive enough information about this home before you moved in so you could decide if it was the right place for you, whilst two people could not remember and the final two people ticked no in response to the same question, although one of the two added: because of the nature of the transfer from Kingshaven Rest Home, we did not receive a lot of information but what we did receive was positive. Another comment: I had to rely on my boy but he brought me back a pack about the place. Supports the managers statement made within the AQAA, as identified above, that: An enquiry and welcome pack, which includes our brochure, terms and conditions of accommodation, schedule of fees, description of a typical day at St Ronans and our Service Users Guide, is given to all prospective residents. During the visit to the home information for use by the residents, their visitors and prospective service users was notice on display within the front hallway. Amongst the various leaflets and brochures were copies of the homes statement of purpose, service users guide and the last inspection report. Care Homes for Older People Page 11 of 33 Evidence: The AQAA is used to inform us that: Our assessment tool quite often highlights residents whom we are unable to admit. The Home has an excellent assessment tool including a thorough nutritional tool, with attached guidance notes for assessors, which is constantly reviewed in light of best practise. A full care needs assessment is completed with the service user and relative / friend, as appropriate, prior to the service users care plan being drawn up and admission, in accordance with our Statement of Purpose, either in their own home or their current abode. Four care plans were reviewed during the visit, each containing information gathered by the manager during a pre-admission assessment, although these were not always signed and dated, which was discussed with the manager. The information gathered was clearly being used in the development of the persons care plans, as personal information was being transferred between the relevant documentation. Three staff surveys generally support the AQAA statement, as two of the three people to complete the survey ticked yes in response to the question: are you given up to date information about the needs of the people you support or care for, the third person ticking sometimes and commenting: if we have a new service user admitted the we are never told enough information about the person and that can be quite difficult to give the service user the care they need. On balance however, the home appears to provide people with sufficient pre-admission information and to undertake assessments aimed at identifying peoples immediate care needs, which help in the production of the persons initial care plan. The home does not provide an intermediate care service and so this standard is not applicable. Care Homes for Older People Page 12 of 33 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. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practise. Evidence: The manager states via the AQAA that: The person-centred care plans and associated risk assessments, are drawn up following the admission of the resident in conjunction with the resident, relatives and friends (as appropriate) and all information gathered in the initial care needs assessment. Included within the initial assessment is a nutritional screening tool. The care plan is signed by the resident, relative and/or friend once it has been agreed. Residents care plans, including the nutritional tool, are reviewed at least once a month, identifying and reflecting their changing needs. All residents are weighed on admission and monthly thereafter; the home has normal scales, sit on scales, wheelchair platform and hoist scales to enable all residents can be weighed. The home uses a computerised care planning and recording system, which is made Care Homes for Older People Page 13 of 33 Evidence: accessible to the staff via terminals at the nurses station and the main office. Access to the system is restricted as a password is required to gain entry to the system and a automatic logging off process has been initialised to ensure terminals left unattended for more than thirty seconds close the open window. Four plans were read through during the fieldwork visit, with large amounts of information found to be stored on each file, including monitoring and assessment tools, waterlow and nutritional screening tools. All changes made to the care plans are saved by the system, with previous information stored in a read only format, which prevents over-writing and the loss of important data. The qualified nurses do need to remember when updating residents wound plans that alterations to the products being used need to be documented in both the running record and the care plan itself, as the latter should be the principle source of information for the next person undertaking the wound dressing. Information taken from the service user surveys, indicate that people are generally happy with the care and support provided at the home, with comments like: I can do things for myself but when I need the girls and male carer help me and the people here are perfect. They have always been good to me. I think to myself theyve got a job and half, they even cut my nails. The staff surveys create a little bit of a confusing picture with two people indicating that they receive adequate guidance on how to support the residents, with one person adding: Being given up to date information helps us, as carers, meet the needs of each service user, which then give us a better understanding of the service user, whilst a third employee felt they did not always receive the information required, commenting: if we have a new service user admitted then we are never told enough information about the person and that can be quite difficult to give the service user the care they need. It is the opinion of a visiting health professional, who kindly completed and returned a survey that: some residents have multiple, complex needs as well as mental health issues, which sometimes limits the care the staff are able to provide but they always endeavour to meet the needs of the residents. The health professional also stated: very good senior staff and management, know the residents very well and call for medical help appropriately. Carryout instruction and make changes to care reliably. Care Homes for Older People Page 14 of 33 Evidence: The records maintained within the home support the view offered by the visiting health professional with detailed entries made on each residents files when they are involved with a health or social care professional, both within the home and/or at clinics or outpatient visits. The staff also ensure that correspondence, relating to peoples ongoing health and welfare is appropriately filed and that appointments are documented and arrangements for attending clinics, etc, confirmed. A review of the homes present medication management system is required, as a number of issues were identified during our checking of the system. Co-codamol, Paracetamol and Movical were all found in the medication trolleys not in their original packaging and therefore with no prescription instructions or satisfactory/safe method for identifying who the medicine had been prescribed for. Medication, arriving midway through a month was not being appropriately checked into the home: an example being a prescription for Cefalexin which had not signed in by the receiving nurse before being given. Medication was also not being re-ordered in time for it to arrive before the preceding dosage had run out, two examples were documented including codeine, which ran out seven days prior to our visit and still had not arrived and a prescription for finistraide, which again had not been available for seven days. Medication administration records (MAR) were not being accurately maintained, the staff making inappropriate use of the codes available to denote why a medication is withheld or omitted; an examples being the use of the letter N to explain why a regularly prescribed medication had been withheld, when the advice given at the bottom of the MAR sheet indicates that an N is a refusal of a PRN (as and when required) medicine. The home also has no PRN protocols in place, these protocols used to advice staff on how and when to use a medicine prescribed on an as and when required basis, i.e. a sedative for a person when the become or are becoming agitated, the protocol describing how the person presents so the staff use the medication at the appropriate and optimum time. Insulin and eye drops, which were in use, were still being stored in the fridge despite the manufactures guidance clearly instructing that once open the medication should be Care Homes for Older People Page 15 of 33 Evidence: stored within a cool place and no longer required refrigerated storage. As mentioned above the homes care plans are stored using electronic databases, which are only accessible to people if they have a authorised password, which ensures that the information maintained is kept private and secure. The view of the visiting health care professional indicates that issues of privacy and dignity are also considered during professional visits: always take patients to their rooms to been seen and examined. The general view of the service users is that the staff treat them with respect, people returning their surveys indicating that the staff both listen to what they have to say and acted upon it appropriately. Care Homes for Older People Page 16 of 33 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 who use the service are able to make choices about their life style and are supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. Evidence: The service tells us via the AQAA that: Before admission, residents are given information, which gives them an outline of activities, facilities, visitation times and the guidelines to what happens day-to-day. Once residents are admitted their social, cultural, religious and recreational interests are identified, recorded and updated in their social care plan by our social activities’ coordinator, who also develops and updates their personal history profile. Once their preferences have been established, the Home makes arrangements for facilities to be provided if they so wish. The Home arranges regular visits by Vitalize, an exercise company, Patey Day Centre activities, one-to-one social and emotional visits by a domiciliary care company and regular one-to-one sessions with our Social Activities Co-ordinator. Musical entertainment, bingo, cabaret singers, theatre Care Homes for Older People Page 17 of 33 Evidence: production companies, harpist, Millars Ark Farm Zoological visits, themed parties and trips out to the theatre and shopping. Forthcoming activities are listed in our bimonthly newsletters and monthly events displayed in the communal areas, which are available in alternative formats if required. The view of the service users is clearly that activities are provided and that people can choose to participate in the organised events if they please. The responses to our survey including: I dont want to, I like it in my room, They are very good. I like a good sing song and I prefer the music as i get funny eyes so i cant see much. Whilst looking around the home a group of service users were observed playing bingo, which was being arranged and provided by an external agency. It was also noticed whilst looking around the home that activities schedules were on display both within the main lounge areas and within the main entrance hallway. The AQAA is used again to explain that: The Home has an open door visiting policy where visitors are welcomed at any time residents wish; areas for private visitation are available on request. The above statement was confirmed during the fieldwork visit when we arrivied at the home at the sametime as a visitor who discussed his regular visits to see his relative. Other visitors were also observed arriving and leaving the home throughout our time in the home, there is also a visitors book, which people are asked to sign on entering and departing the building, which provides evidence of the numbers of people to visit the home and the varying times these visits occur. Details of the homes visiting arrangements are contained within the Statement of Purpose and Service Users Guide documentation, which is made available to people within the home. The care planning records, as discussed earlier in the report reflect peoples choice over rising and retiring times, their terms of address and generally their wishes with regards to the delivery of personal care. A look around the home established that people were using personal items to individualise their bedrooms and thus creating a sense of ownership and belonging. Information, taken from the residents surveys, indicate that people generally feel they receive both the care and support they require and that the staff are available to help them when required, listen to their requests and respond appropriately. Care Homes for Older People Page 18 of 33 Evidence: The look around the home, discussed earlier, enable us to visit the kitchen, dining room and food storage facilities, where time was taken to speak to the cook. She discussed the menus and showed us the records she maintains in respect of the food served and the equipment checks undertaken, etc, she also stated that at the last Environmental Health visit the kitchen had been considered satisfactory. The food storage facilities were appropriate and provided sufficient dry, cold and frozen food stores and there was a range of catering and/food items available. Observations made during lunchtime, established that mealtimes are largely social occasions and that sufficient staff are around to support the service users eat their meals. The catering and care staff also demonstrated an awareness of how meals should be served and presented with soft/liquidised meals looking appealing and well presented. Observations also suggested that the people eating the meals were enjoying what they were served, as people required little or no prompting to eat their food, although the staffs interaction with residents were positive and appropriate throughout. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. Evidence: The AQAA states that: We have a comprehensive complaints procedure, which is simple and clear. This is given to all residents, their relatives and friends at admission. In addition to this, a comments and suggestions box, with forms, is located in the front lobby in plain view and is checked regularly. We encourage residents, relatives and/or their friends to bring any concerns to the attention of the Registered Manager as soon as possible so they can be resolved as quickly as possible. In the event of a formal complaint being made it is dealt with by the appropriate person promptly and responded to within 28 days. A complete record of any complaints received, including investigations made and subsequent actions taken is held in a secure environment. Details of the homes complaints process are contained within the service users guide and statement of purpose literature and these documents are made accessible to service users and their representatives. The dataset, which forms part of the AQAA documentation, confirms the existence of the homes complaints and concerns procedure, which was last reviewed and updated Care Homes for Older People Page 20 of 33 Evidence: in the March of 2008. The dataset also contains information about the homes complaints activity over the last twelve months: No of complaints: 1. No of complaints upheld 0. Percentage of complaints responded to within 28 days: 0. No of complaints pending an outcome: 1. Information taken from the service user and staff surveys indicate that people moving into the home are aware of the homes complaints process and whose attention complaints should be brought to, whilst the staff indicate that they are aware of how to support people raise concerns or complaints. During the visit the Manager produced copies of the homes training record, which indicates that all staff have completed ‘safeguarding adults’ training, this corroborated the information contained within the AQAA. The homes tells us, via their AQAA and dataset, that policies on the protection of service users are in place, ‘Safeguarding adults and the prevention of abuse’ and ‘Disclosure of abuse and bad practice’, these policies reviewed in the August and March of 2008, respectivley. The dataset also establishes that over the last twelve months one safeguarding referrals have been made to the Local Authority, a statement support by a review of our database, which did establish that one alert had been brought to the Commission’s attention. The evidence indicates that this incident was appropriately handled by the service and has now been satisfactorily resolved. Care Homes for Older People Page 21 of 33 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. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: The Provider Organisation is planning to increase the current homes capacity providing further communal and private accommodation within the existing property/grounds. This was discussed with the manager and administration manager, as delays in gaining planning permission and/or in commencing the development work have an obvious knock on with regards to the maintenance of the existing premise. During our look around the home a number of areas, where some small repairs or redecoration were required were brought to the managements attention, it is these small areas, which can often be overlooked when planning a larger redevelopment, however the manager and adminstation manager were quick to deny this was the case and gave assurance that an ongoing programme of maintenance was in place and that any areas that required attention, were receiving it. Care Homes for Older People Page 22 of 33 Evidence: To this end the manager has stated via the AQAA: The Home continues to meet, as a minimum, all standards as were applicable on 31st March 2002 for communal, bedroom and sanitary facilities. The Home is kept well-maintained by an excellent team of subcontractors and housekeeping team. The Homes in house maintenance department regularly inspect the fabric and décor of the premises, including the outside grounds, keeps a log of all findings and has a programme for regular renewal. The Home was awarded some funds from the governments capital grant to improve the gardens and make them more accessible and interactive and able to meet the needs of all residents, including those in wheelchairs or with other mobility problems, sensory and cognitive impairments. Residents, relatives and friends are delighted with the new garden and are planning to grow lots of things in the summer. During our look around the home the facilities were found to be spacious and well set out, with the choice of lounge providing a variety of environment for the residents, whilst the bathrooms and toilets are large and accessible amenities. In discussion with residents and their relatives the external areas of the home were acknowledged, the garden and the patio areas being well set out and accessible by ramp. The look aound the home also established, as mentioned earlier in the report, that the rooms visited contained items of an individual nature, pictures, ornaments, pieces of furniture, etc, which had been used by the occupant to personalise their room. Information taken from the dataset, which forms part of the AQAA documentation, establishes that domestic appliances and personal equipment is regularly maintained and serviced by external agencies / bodies. Including the homes stairlifts, which had only recently been serviced according to the managers who accompanied us on the tour around the home. Information taken from the service users surveys indicate that people feel the home is generally fresh and clean all eight people ticking always in response to the question raised. Domestic staff were observed during the visit undertaking their duties. The home was noted to be free from odours and clean and tidy throughout. Communal toilets and bathrooms were noted to contain liquid soaps, paper-towels and bins for the disposal of waste. All chemicals were stored in accordance with the Care Homes for Older People Page 23 of 33 Evidence: Control Of Substances Hazardous to Health (COSHH) regulations. The laundry is located within the main building and the staff are responsible for laundering residents clothing and returning this to the client room. Clothes are labelled to reduce the possibility of lose or the item being returned to the wrong person. Care Homes for Older People Page 24 of 33 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. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Evidence: A copy of the homes duty roster was seen during the fieldwork visit and indicated that sufficient care and domestic staff are on duty to meet the needs of the service and the service users. Information taken from the AQAA indicates that: The staff rota, which is displayed in a secure case to prevent unauthorised changes being made, identifies staff duties both day and night and is readily available for staff to consult. Staffing rotas are drafted weekly, and displayed a week in advance. Allocation lists are given to staff before their shift commences so they are aware of residents and tasks allocated to them. Observations made throughout the day support the fact that sufficient staff were employed at the home and that the needs of the service users were being meet, with care staff, domestic and catering staff all seen around the home during the fieldwork visit. Care Homes for Older People Page 25 of 33 Evidence: Information, taken from the residents surveys, indicate that people generally feel that they are receiving both the care and support they require and that the staff are available to help them when required. Details of the home’s staffing arrangements and the skills and experience of the staff are set out within the ‘statement of purpose’ document, which as mentioned is accessible to people within the home. Information taken from the staff surveys indicates that the staff are being provided with access to relevant training and development opportunities, all three people to reply ticking yes when asked: are you being given training which is; a). relevant to your role; b). helps you understand and meet the individual needs of the service users and c). keeps you up to date with new ways of working. Training records are available, which record both the training sessions completed and the dates that updated training sessions are to be undertaken/completed. The training records identified that the staff have completed courses of both a mandatory nature, food hygiene, fire safety, moving and handling and skills development courses, mental capacity act, safeguarding awareness training, etc. The also manager states via the AQAA that: A comprehensive training programme of self-development, which not only meets the NTO targets, but also incorporates skills for care knowledge sets and wide range of relevant and topical subjects is co-ordinated by our Training Co-ordinator and supported through our mentor system. Training is delivered in-house and from external accredited providers and is available in a diverse range of subjects and delivery. Staff receive at least 3 days paid training a year; the majority of staff significantly exceed this, as St Ronans invests in our staff and is Investors in People accredited. Information taken from the National Minimum Dataset indicates that currently the home employs 23 Nursing and Care Staff. Ten of the sixteen care staff have completed a National Vocational Qualification (NVQ) at level 2 or above and this gives the home a percentage of 62.5 of its care staff possessing an NVQ at level 2 or above. Information contained within the dataset establishes that a recruitment and selection strategy/procedure exists to support the management staff when employing new staff. It also indicates that all of the people who worked in the home over the last twelve Care Homes for Older People Page 26 of 33 Evidence: months had undergone satisfactory pre-employment checks. On reviewing the files of four newly recruited staff all of the required checks were in place, Criminal Records Bureau (CRB) checks, Protection Of Vulnerable Adults (POVA) checks and two references. The files also contained completed application forms, health declarations, photographs of the employee, interview summaries, personal information and information used to support the CRB application process. Feedback provided by the staff, through the surveys, establishes that they feel they had completed a thorough recruitment process before starting work at the home. Care Homes for Older People Page 27 of 33 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 management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. Evidence: The AQAA states that: Our Registered Manager is a Registered Nurse 1, Register Managers Award qualified, National Vocational Qualified Assessor, D32 & 33, MSc in Gerontological Practise, and has been the Registered Manager since 2000. The Registered Manager is supported by a good complement of Registered Nurses and Business Manager. The Registered Manager is one of the appointed first aiders for the home and undertakes the Homes training and development programme as well as her personal professional profile. All Registered Nurses’ PIN numbers are checked with the Nursing and Midwifery Council to ensure they are on the current register; expiry dates are flagged up on our easy log computer system. Care Homes for Older People Page 28 of 33 Evidence: The evidence contained throughout this report indicates that the home is being well run and that the manager has introduced a number of management and communication tools to ensure the smooth running of the service, including service user and staff meetings, newsletters and supervision and appraisal sessions for staff. Information taken from the staff surveys indicate that the staff find they are reasonably well supported by the management, whilst the professional survey praises the management and organisation within the home. The service states via the AQAA that: The company is Investors in People accredited, ISO 9001 (QMS) accredited and uses Croners to monitor all health and safety activities. The proprietors are actively involved in the running of the business and visit the home weekly, often, several times weekly. They are executive members of the Registered Nursing Home Association, Hampshire Care Association (HCA), local representatives for the Alzheimers committee, stroke committee, nursing committee, falls prevention committee, local joint commissioning group, local HCA & Primary Care Trust (PCT) representative and Mental Capacity Act and DOLS lead. The service does not arrange service user or relative meetings but has introduced a comments box, which is accessible within the front hallway for people to make comments upon any and all elements of the service. Surveys are used to gather information, annually from residents and relatives, this information is used by the administration manager and registered manager to review the quality of the care provided. The home state via the AQAA: The Home has no involvement with residents personal financial affairs. A safe is available in the event of the Home storing residents’ valuables. An inventory is kept of all residents’ belongings at point of admission and receipts given for possessions handed over to the Home for safekeeping. The service tells us, via the AQAA and dataset information that health and safety policies and procedures are made available to the staff and that domestic appliances and personal equipment is regularly maintained and serviced. Health and safety training is made available to staff, with the training records and staff comments providing evidence of the courses attended: Health and Safety, Moving and Handling and Fire Safety. The look around the home identified no immediate health and safety issues, and the Care Homes for Older People Page 29 of 33 Evidence: environmental risk assessments consider both potential areas of harm and how these can be managed. The presence of the maintenance person means that any immediate hazard or risks to people can be addressed without delay, whilst routine maintenance is undertaken to ensure the environment remains fit for purpose and safe. Care Homes for Older People Page 30 of 33 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 31 of 33 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 9 13 The manager must review the homes management of service users medications. Medications must be appropriately documented, stored and administered. 08/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 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. 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