Inspection on 19/02/09 for Stainton Way Care Home

This inspection was carried out on 19th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stainton Way Care Home 15/03/10

Stainton Way Care Home 02/11/09

Stainton Way Care Home 10/03/08

Stainton Way Care Home 26/02/07

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Stainton Way Care Home Stainton Way Hemlington Middlesbrough TS8 9LX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Katherine Acheson     Date: 1 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Stainton Way Care Home Stainton Way Hemlington Middlesbrough TS8 9LX 01642599157 01642596481 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: North East Care Homes Ltd care home 67 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 67 The registered person may provide the following category of service only: Care home only - Code PC 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 - Code OP, maximum number of places: 49 Dementia - Code DE, maximum number of places: 18 over age of 55 years Date of last inspection Brief description of the care home Stainton Way is a purpose built care home in the village of Stainton on the outskirts of Middlesbrough. The home is registered to provide care to a maximum number of 67 older people, 18 of whom may have a dementia.The home is divided into four units. Each unit has lounge, dining facilites, toilets and bathing facilities. Bedrooms are single Care Homes for Older People Page 4 of 32 Over 65 0 49 18 0 Brief description of the care home in nature and have ensuite toilet facilities.A Passenger lift enables accesss to the first floor. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is one star. This means that people who use the service experience adequate quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous inspections reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. This unannounced key inspection took place on 19th February 2009 and lasted for eight hours and forty minutes. A Manager completed and returned an Annual Quality Assurance Assessment, (AQAA). Care Homes for Older People Page 6 of 32 The AQAA is the services self assessment of how they think they are meeting national minimum standards. This information was received before the inspection and was used as part of the inspection process. The reason for the inspection was to see how good a job the home does in meeting the national minimum standards set by the Government for care homes. Numerous records were examined including care records of people living at the home, medication records, risk assessments, complaints and staff recruitment and training files. People living at the home, relatives and staff working there were also spoken to. Before the inspection surveys for people that use the service and surveys for staff were sent out for the manager to distribute accordingly. Surveys sent to people that use the service were asked to comment on care received. Surveys sent to staff were asked to comment on what it was like working for the home and training provided. We received fourteen surveys from people that use the service. We received five surveys from staff. Comments in surveys received can be read in the main body of the report. The cost of care at the time of the inspection visit ranged from three hundred and fifty five pounds a week to four hundred and thirty five pounds a week. What the care home does well: What has improved since the last inspection? What they could do better: Care plans for people that use the service need to be developed to include more detail. Care plans should clearly identify the problem or need and detail care, assistance and treatment required. Care plans should state what the person can do for themselves and the help that they need. Some improvement is needed in respect of medication systems. Hand written Medication Administration Charts should be signed and checked by two members of staff to make sure that correct information is recorded and people get their medication as prescribed Medication carried over from one month to another should be recorded on Medication Administration Charts to ensure accurate recording, that people are getting their medication and enable auditing. The homes complaint procedure should be updated to include names and contact details of who to complain to. This will help to ensure that any complaints are dealt with promptly and appropriately. The homes adult protection procedure needs to be reviewed and staff need to attend adult protection training on a regular basis to prevent people that use the service being Care Homes for Older People Page 8 of 32 harmed and ensure that staff are aware of what to do if abuse is suspected. All new staff who are not qualified to NVQ level 2 in Care or equivalent must complete an induction that meets with the required standard. The Manager needs to continue to work towards achieving an NVQ level 4 in Care and Management or equivalent to ensure that she is appropriately qualified to run the home. Concerns have been raised that on occasions there has not been any hot water. The Provider must continue with the action to address this problem. The recording system of money held for people using the service is not robust. This should be improved to safeguard all. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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. Assessments of people who are to use the service are carried out before they move into the home to ensure all needs can be met. Evidence: The Manager said that people who are to use the service are assessed before coming into the home. They firstly receive an assessment from a Social Worker. This assessment is forwarded to the home for the Manager to review and determine if needs can be met at Stainton Way. The Manager said that where possible senior staff will then visit the person at home or in hospital to carry out a further assessment. This further assessment allows staff at the home to introduce themselves and enables people to ask questions about Stainton Way. If a person is funding their own care an assessment is usually only undertaken by senior staff working at Stainton Way. Care Homes for Older People Page 11 of 32 Evidence: People are encouraged to visit the home before they move in. This gives the opportunity to meet staff, other people living at the home and have a good look round. A survey received from a person that uses the service stated, The home was recommended, we had a tour and felt that the establishment would be suitable One person spoken to during the inspection said, I had a look round before I came in here its a nice place Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are happy with the care that they receive. Improvement is needed in respect of care planning. Insufficiently detailed plans of care could impact on care given. Evidence: The files of four people that use the service were looked at during the visit, two from the dementia unit and two from the older persons unit. Files contained an assessment of the persons needs which included evidence of personal choice. An example of this is that one person liked to have a coffee at night before they went to bed. Plans for those people who use the service from the dementia unit also contained a life history of the person. This contained important and interesting information about the person including school years, working life, family, likes and dislikes and significant life achievements. Following assessment a plan of care is developed. Care plans examined during the visit were not specific to the person or include enough information. An example of this Care Homes for Older People Page 13 of 32 Evidence: being, one person was identified as having short term memory loss. This plan of care did not state the level of the memory loss, how this problem affects the person e.g. do they know staff can they find their way around the home, what they can do for themselves and what help is needed. This same person had a care plan for attending to personal hygiene. This care plan stated Allow the person to do as much as they are able, but does not say what the person is able to do and what help is needed to maintain a level of hygiene that is acceptable to the person. Staff had observed and highlighted for one person reasons and triggers as to why they became aggressive, however had not developed a plan of care on how to manage the aggression. Staff had commented in one file looked at that the person was losing weight, and contacted the GP. The GP had prescribed food supplements, however staff at the home had not developed a plan of care in respect of this. A plan of care looked at did contain some good information. This plan gave detailed information on dietary requirements for a person who suffered from stomach problems. Care plans looked at were evaluated on a monthly basis, however evaluations did not include any deteriorations or improvements made. A long discussion took place with the Manager regarding care planning. She said that she had already highlighted the need for reviewing care plans updating them to include how care needs are to be met and to make them more personal. There is clear evidence of the involvement of GPs, District Nurses and other health care professionals such as chiropodists. People living at the home confirmed that if they were feeling unwell, the GP would be called. One person said, They always phone the doctor if I am under the weather. People spoken to during the visit and surveys received in general were complimentary about life in the home and care received. Comments made included, The home is lovely and staff always say hello It is very good, I have nothing to complain about. I am well looked after and if I am the others will be Care Homes for Older People Page 14 of 32 Evidence: I am happy here during my respite stays. Staff are pleasant and caring and know me well Care and support in some areas could be improved e.g eating and drinking and general attendance to residents needs During the inspection arrangements for receiving, storing, administering, recording and disposing of medication on the dementia unit were observed and examined. In general record keeping was good and medicines were appropriately stored. The Manager said that it is the responsibility of senior care staff to give out medication. Prior to giving out medication all staff complete a Safe Handling of Medication Course and have their competency checked. The Manager thought that staff who administer medication have their competency checked on a regular basis there after but said she would need to check up as she had only been in post for a few weeks. The Manager said that the home were in the process of changing their supplying pharmacy and that medication refresher training is to be provided in the next couple of weeks and then on a yearly basis. On a monthly basis staff keep a record of medicines coming into the home and the amount received. The amount of medication received is recorded on the Medicine Administration Chart of the person using the service. Sometimes a new supply of medication may not need to be ordered as there is sufficient left over from the previous month. When this is the case staff should record the amount of medication carried over to the next month to ensure accurate recording and to enable auditing. It was observed that hand written Medication Administration Charts were signed but not countersigned to confirm that two staff had been involved in writing up the medication and checking that it was correct. This issue was highlighted at the last inspection of the service. It was identified at the last inspection that home must develop a protocol for homely medicines and dealing with Medical Device Agency alerts, this had been actioned. Care Homes for Older People Page 15 of 32 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 that use the service lead fulfilling lifestyles through exercising choice and control over how they spend their day. Food provided has improved and is now enjoyed by people that use the service. Evidence: The Manager said that the home employs two Activity Co-ordinators to plan, arrange and take part in activities for people that use the service. The Activity Co-ordinators work Monday to Friday with one of which or occasionally both being on duty from nine in the morning until four in the afternoon. On the morning of the inspection the home were hosting a coffee morning. Activities taking place on a daily basis include crafts, dominoes, knitting and musical bingo. In musical bingo people are given a card with song titles on it and when they hear the song played they mark it off, the first person to mark off all the songs on their card is the winner. One staff member spoken to said that this activity was popular amongst people that use the service. The mobile library bus visits on a monthly basis and leaves a plentiful supply of books. The Manager said that people that use the service have not been on any trips out other than if their family had taken them. She said that the amount of activity hours Care Homes for Older People Page 16 of 32 Evidence: provided has only increased in recent months and as such intends to plan a number of outings for people. Some people who use the service have been assessed as needing individual activities and outings on a one to one basis. An additional person has been employed by the Local Authority but is based at the home to provide social care. Activities and outings taking place include going to the pictures, shopping and doing jigsaws. The Manager said that one person that uses the service visits his daughter independently using a taxi. The Manager said that there are monthly visits from representatives of the local Church of England and Methodist Churches and that a Special Minister visits one person weekly to give communion. Visitors are welcome at any time. One relative spoken to during the inspection said, The staff are always pleasant and I always get offered a cup of tea. Comments made in respect of activities from people spoken to during the inspection and surveys received included, I like to read and listen to music. I use the mobile library. I have a few friends here and, I dont join in the activities but I do like to watch and, We have knitting sessions, play bingo and have night entertainments I love them all. The lunchtime of people on the dementia unit was observed. The lunch time menu of the day was mince and dumplings with spring greens, mash potato and turnip or pork curry and rice. Dessert was semolina. The tea time menu was bacon or fish cakes with hash browns and beans. Peach melba was on the menu for dessert. Lunchtime was relaxed with people some people having pork curry and others having mince and dumplings. Tables were nicely set and salt and pepper was available on tables. A cold drink of water or juice was given to each person. Prior to the inspection the Commission for Social Care Inspection and Middlebrough Council had received some concerns in relation to food provided and portion size. The Manager said that they have worked hard to improve the food provided. She said that menus had been reviewed and portion size has increased. During the inspection the homes four week menu plan was looked at. Menus provided a variety of choice. Food stocks within the kitchen area were checked and found to be in a plentiful supply. Bowls of fresh fruit are available in communal areas within the home. Whilst walking around the dementia unit some people that use the service were seen to be enjoying a Care Homes for Older People Page 17 of 32 Evidence: packet of crisps. People who use the service and surveys received in general spoke positively about the food provided. Comments made included, The food is brilliant and, The pork curry today was lovely, and I eat more than I did at home. I especially love the salads. The Manager said that she intends to continue to monitor the food provided and speak with people that use the service to make sure that they are happy with the food provided. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are confident that their complaints would be listened to, and acted upon, however the complaints procedure needs to be updated to include names and contact details of who to complain to ensure that complaints are dealt with promptly and appropriately. The adult protection procedure does not include clear action for staff to follow if abuse is suspected, adult protection training is out of date and as such could impact on safeguarding. Evidence: The home has a complaints procedure, however this is insufficiently detailed. The complaints procedure needs to be updated to include names and contact details of who to complain to. The homes record for recording complaints was also confusing some were recorded in a book whilst some others were recorded in a separate file. The Manager said that she was to start a new complaints log and ensure that all complaints are logged and recorded individually to ensure data protection. This inspection was carried out a little earlier than originally planned because the Commission for Social Care Inspection had received a number of concerns in respect of the service. In general concerns received were in relation to insufficient staffing, food, and on occasions there being no hot water. Some concerns received were specific to a person receiving care. Concerns received were also shared with Middlesbrough Council who carried out contract and compliance visits and look at concerns raised. The Commission for Social Care inspection has received confirmation Care Homes for Older People Page 19 of 32 Evidence: from the provider that the dependency of people that use the service has been reviewed and as such staffing levels have been increased on a day to day basis. We have also received confirmation that menus and portion size of food have been reviewed. People spoken to on the day of the inspection were happy with the food provided. The Provider has advised that despite the home only being two years old that unfortunately they have had problems with the hot water, however action is being taken to address this. On the day of the inspection hot water was available in the home. People spoken to during the visit said that they would feel confident in raising any concern that they may have with staff working at the home or the new Manager. The home has an adult protection procedure for staff to follow, however this is confusing. The procedure advises that any allegation of abuse should be reported to the Manager who will then investigate then at the bottom of the procedure it says to follow No Secrets. The Procedure needs to be updated to ensure that in the first instance any allegation of abuse should be reported to the Local Authority prior to any investigation taking place. Examination of the homes training matrix identified that adult protection training was last provided to staff in 2007. The Manager said that she would take immediate action to arrange training for staff. Care Homes for Older People Page 20 of 32 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 standard of the environment is good providing people that live there with an attractive, homely and comfortable place to live. Evidence: Stainton Way is a purpose built care home which is situated in the village of Stainton on the outskirts of Middlesbrough. The home is registered to provide care to a maximum number of sixty seven people, eighteen of whom may have dementia. The home is divided into four units. The ground floor of the home has two units named Daisy Chain and Memory Lane. Daisy Chain can accommodate a maximum number of seventeen older people. There are fifteen single bedrooms and one double bedroom all of which have ensuite toilet facilities. Communal space consists of a lounge and a dining room. Memory Lane can accommodate a maximum number of sixteen older people. All bedrooms are single and have ensuite toilet facilities. Communal space consists of a combined lounge diner. On the first floor of the home there is a further two units named Lavender and Peace Haven. Care Homes for Older People Page 21 of 32 Evidence: Lavender can accommodate a maximum number of eighteen people with dementia. There are sixteen single bedrooms and one double bedroom all of which have ensuite toilet facilities. Communal space consists of a lounge and dining room. Peace Haven can accommodate a maximum number of sixteen older people. All bedrooms are single and have ensuite toilet facilities. Communal space consists of a combined lounge diner. Toilet and bathing facilities are available on each unit. A passenger lift enables people to access the first floor. There is a garden area for people to use. There is a designated lounge on the ground floor of the home for people who wish to smoke. During the visit the Inspector walked around the home with the Manager. Communal areas were well maintained with good quality furniture. Bedrooms of people that use the service that were looked were nicely decorated, had appropriate furniture and were personalised. Comfortable chairs were also placed in corridor areas and in the main entrance of the home. One person that uses the service said that she liked to sit in the main entrance area she said, I can see everything that is going on. I see all of the visitors, some of who stop and have a chat. Its a good place to sit. Appropriate laundry facilities are in place. Staff said that there was a plentiful supply of protective clothing. On the day of the inspection the home was clean and odour free. The home has a key pad locking system which allows people to gain access and leave the building by entering a code. It was noted on the day of the inspection that this code is freely shared amongst visitors and staff. A discussion took place with the Manager regarding the key pad locking system and the fact that anyone who knew the code could gain access to the building without staff knowledge. Discussions took place with the Manager regarding the possibility of a code being given out to people who want to leave the home but not to be able to gain entry or the possibility of changing the code at regular intervals. The Manager said that she would discuss with the Provider how best to improve security. Care Homes for Older People Page 22 of 32 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. The homes recruitment procedure is good, which helps to ensure that people are protected. Although mandatory training is provided to staff inadequate induction training could impact on the care given to people that use the service. Evidence: At the time of the inspection there were fifty eight people who were using the service, sixteen on Peace Haven, twelve on Memory Lane, fourteen on Daisy Chain and sixteen on Lavender. On Peace Haven there are two to three care staff on duty from 8am until 4pm. From 4pm until 9pm there are two care staff on duty. On Memory Lane there are three to four care staff on duty during the day and two to three care staff on duty during the evening. On Daisy Chain there are two to three care staff on duty during the day and evening. On Lavender unit there are three care staff on duty during the day and evening. The Manager was asked why the unit with the least people on it had the most staff, she said that it was because the dependency of people on Memory Lane was higher. Care Homes for Older People Page 23 of 32 Evidence: On each of the units during the day and evening one of the care staff is either a Senior Carer or Unit Manager. On night duty for all units there are Six care staff on duty two of who are Senior Carers. In addition to care staff on duty the Manager works full time Monday to Friday. People that use the service and relatives spoken to during the visit said that they felt that there were sufficient staff on duty. Surveys sent to people that use the service before the inspection asked if staff were available when they needed them. Of the fourteen completed surveys received, seven people said staff were always available when they were needed, five said that staff were usually available and two said that staff were sometimes available. The Manager said that she is to continue to assess and review the dependency of people who use the service and make sure that there are sufficient staff on duty to meet their needs. The AQAA detailed that seventy three percent of care staff working at the home had achieved a minimum qualification of NVQ level 2 in Care. Records were available to confirm that good recruitment procedures are followed. Three files of staff working at the home were examined. Appropriate references were on file as was proof of identity and evidence of Criminal Record Bureau checks. Records were available to confirm that staff working at the home receive induction, however this does not meet with the required standard. The Manager said that she was aware that the homes induction was not sufficiently detailed and had already taken steps to address the situation. The homes training matrix and staff files examined during the visit contained certificates to confirm that staff had received training in Moving and handling, food hygiene, health and safety, fire and dementia. Staff files examined contained evidence to confirm that staff had been receiving supervision on a regular basis up until November 2008. The Manager said that she is to develop a system in which to ensure that supervision with staff recommences and Care Homes for Older People Page 24 of 32 Evidence: happens. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate quality assurance monitoring is in place to ensure that the home is run in the best interest of people that use the service. The homes record keeping of money belonging to people that use the service is not robust and as such does not offer safeguards for all. The problem of the water temperatures being too cool needs addressing to ensure well being of people that use the service. Evidence: Since last inspection of the home a new Manager has been appointed. At the time of this inspection visit the Manager had only been in post for two weeks. The Manager has many years of experience of working in care homes. She has almost completed an NVQ level 4 in Care and is then to do an NVQ level 4 in Management. The Manager is aware of the need to apply for registration with the Commission for social Care Inspection. Appropriate quality assurance monitoring systems are in place. Surveys are sent out to people that use the service on a regular basis to make sure that they are happy Care Homes for Older People Page 26 of 32 Evidence: with the home and the care that they receive. Surveys were last sent out in July 2008 a report was available that summarised the findings. The Manager said that surveys are also sent out to staff. Monthly auditing and monitoring of care provided is also carried out by the Provider. The home looks after small amounts of money for people who use the service. A system is in place for recording money given in for safe keeping and money that has been spent by the person that uses the service. Individual transaction sheets are kept for each person, however the receipts for each person using the service are kept together making auditing of the account very difficult. The recording of money spent is not sufficiently robust. One person that uses the service takes money out of their account twice weekly when they go out with staff. The money on return from the trip which hasnt been spent is re-entered into the persons account, but it does not state what money has been spent on and the person using the service is unable to clarify all purchases made. Although the relative of this person monitors the account, details of all transactions should be recorded to safeguard the person using the service and staff. A sample of health and safety records were examined and in general found to be in order. Records were available to confirm that the homes fire alarm and fire extinguishers portable appliance testing had been serviced in the last twelve months. The Manager said that the homes gas boilers had just been serviced and that she was awaiting certification. Water temperatures in bedrooms are taken on average every two weeks and in main bathroom areas on average weekly to ensure that they are within safe limits. Some bath water temperatures recordings were observed to be a little cooler than they should be. As highlighted earlier in the report the Provider has taken steps to address the problem. Gas boilers in the home environment are to be changed to rectify the problem of water being cooler than it should be. During the inspection the Inspector tested the water temperature in main bathroom areas this was found to be satisfactory. Records were available to confirm that weekly tests of the fire alarm system are carried out, but records examined did not identify the zone tested. Each test of the fire alarm system should be done in a different zone to ensure the full system is in working order and as such ensure safety. The Manager said that she was sure that each test was carried out in a different zone, however she would check. Care Homes for Older People Page 27 of 32 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 32 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 18 The Registered Person should provide an induction that meets standards as set by Skills for Care. This will help to ensure that staff are appropriately trained. 30/03/2009 2 7 15 The Registered Person must ensure that care plans are developed further to ensure that they are individual to the person. Care plans need to include limitations, abilities, preferences and assistance required. To help to ensure that all needs are met. 30/05/2009 3 18 13 The Registered Provider 30/04/2009 must provide adult protection training to all staff on a regular basis. To prevent people that use the service being harmed and ensure that staff are aware of what to do if abuse Page 29 of 32 Care Homes for Older People 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 is suspected. 4 30 18 The Registered Person should provide an induction that meets standards as set by Skills for Care. This will help to ensure that staff are appropriately trained. The Manager must complete an NVQ level 4 in care and management or equivalent. To ensure that she has the skills and knowledge to run the home. 6 31 8 The Manager must apply for registration with the Commission for Social Care Inspection and undergo fit person interview To ensure that the Manager is qualified competent and experienced to run the home. 7 38 16 The Registered person must address the problem of the cool water temperatures in the home to ensure that people that use the service have water at the correct temperature To maintain hygiene standards. 30/03/2009 30/05/2009 30/03/2009 5 31 9 11/03/2010 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Effective evaluation of care plans should be carried out on a monthly basis or more often as required. Care plans should include any deterioration, changes or improvement made. Hand written Medication Administration Charts should be signed and checked by two members of staff to make sure that correct information is recorded and people get their medication as prescribed. Medication carried over from one month to another should be recorded on Medication Administration Charts to ensure accurate recording, that people are getting their medication and enable auditing. The homes complaint procedure should be updated to include names and contact details of who to complain to. This will help to ensure that complaints are dealt with promptly and appropriately. A clear record of complaints should be kept which includes details of the investigation and any action taken. 2 9 3 9 4 16 5 18 The adult protection procedure should be updated to include clear action for staff to follow if abuse is suspected to safeguard people who use the service. The Registered Provider should review the current security arrangements at the home in respect of the key pad locking system to make sure that it ensures safety of all. The Manager should develop a robust record keeping system for money held for people that use the service to safeguard all. The Manager should develop a system in which to ensure that staff receive supervision at least six times yearly to ensure that staff are competent in all aspects of their work and receive appropriate training. The Registered Person should ensure that each weekly test of the fire alarm system involves a different zone to check that the full fire alarm system is in working order and ensure safety of all. 6 19 7 35 8 36 9 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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