Inspection on 16/09/08 for Stamford Bridge Care Home

This inspection was carried out on 16th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stamford Bridge Care Home 19/04/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Stamford Bridge Care Home Buttercrambe Road Stamford Bridge Near York Yorkshire YO41 1AJ     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: Anne Prankitt     Date: 1 6 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 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 35 Information about the care home Name of care home: Address: Stamford Bridge Care Home Buttercrambe Road Stamford Bridge Near York Yorkshire YO41 1AJ 01759371418 01759371682 h.lewis@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Barchester Healthcare Homes Ltd care home 107 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 107 The registered person may provide the following category of service only: Care Home with Nursing, Code 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, Code OP, maximum number of places 107 Dementia, Code DE, maximum number of places 107 Physical Disability, Code PD, maximum number of places 107 Date of last inspection Brief description of the care home Stamford Bridge Care Home is a Care Home with nursing that provides a service for older people who may have dementia or a physical disability. The home is situated in the village of Stamford Bridge and enables easy access to the local shops and public transport routes. Accommodation consists of one hundred and seven placements within single and double rooms on three floors with lift access. People have a choice of Care Homes for Older People Page 4 of 35 107 0 107 Over 65 0 107 0 Brief description of the care home six lounges and dining rooms in which they can relax and enjoy the company of others. People also have access to the grounds of the home, which are designed to be accessible to those in wheelchairs and with mobility problems. Information about the home and its service can be found in the Statement of Purpose and service users guide. Both these documents are available from the registered manager of the home, and copies are on display in the entrance hall of the home. The latest inspection report for the home is available from the registered manager on request. The registered manager told us on the day of the site visit that the current weekly fees range from 600 to 800 pounds. People pay extra for hairdressing, chiropody, items from the mobile shop and the bar, newspapers and magazines, and occasional one to one escorts. Care Homes for Older People Page 5 of 35 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 last key inspection took place on 19 April 2007. This key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Older People Page 6 of 35 Information from an Annual Service Review completed in May 2008. During this process we gathered comments from people living at the service, and their representatives. A sit visit to the home carried out by two inspectors, which lasted for approximately nine hours. During the visit to the home, several people who live there, some staff, relatives and the manager were spoken with. Several care plans were looked at, as well as two staff recruitment files, and some records that the home has to keep about complaints, health and safety, and policies and procedures that the home has to follow. Some time was also spent watching the general activity to get an idea about what it is like to live at Stamford Bridge Care Home. The registered manager was available throughout the day, and feedback was given to her in detail at the end. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into the report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: More up to date information could be included in peoples pre admission assessment so that staff have up to date knowledge about how, and if, peoples needs have changed, before they arrive. People and/or their family could be involved in the development and review of their care plan. This would make it possible for them to agree their plan of care. Where equipment is provided to stop peoples skin from deteriorating, and which the person finds difficult to use, and alternative could be asked for so that this area of their care is still properly met. Some improvements could be made to the way peoples medication is managed to make sure that every effort is made to ensure it is handled safely, and given according to need, and instructions from their doctor. To help maintain peoples independence, the programme of forthcoming activities could be made more accessible to them. It would also be to their benefit if they were given the option to have their their personal allowance to spend as they wish. Care Homes for Older People Page 8 of 35 Peoples concerns about their care, and the service they get, could be taken more seriously. And the right people could be told at the right time about any allegations that are made which affect peoples welfare and safety. This would help to protect vulnerable people. The way that staff are supervised, deployed, and communicated with could be improved to make sure the service people get runs more smoothly, by staff who enjoy coming to work. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before any decision is made about whether the home will be suitable for them. However, the information passed to staff where people are readmitted for short stay care could be clearer. Evidence: People admitted for long term care get an assessment by a senior staff member of the home before they move in. Information is also gathered from other professionals who have already played a part in the persons care. All this information helps to decide whether the home will be able to meet their needs. People admitted for regular short stays are not necessarily visited before each admission. Sometimes, the registered manager may telephone them or their family to check that the persons needs have not changed. The assessment given to staff does not tell them that a follow up call has been made. It would be good practice to record Care Homes for Older People Page 11 of 35 Evidence: this, along with any agreed changes to care, so staff can be confident that the person admitted will probably have the same needs as before. People dont get a copy of the service users guide, which contains the commissions last report, as a matter of course. But they can ask for it if they want a copy. They do however get a copy of the homes brochure, which the registered manager said gives a basic outline about what the home provides. One person said I came to look round before moving in. Another person admitted for short term care said Its very nice here. I may come in permanently some time in the future. Staff agreed that they get a good handover each day, so they get to know about the needs of newly admitted people before they arrive. This helps to make sure they get the right care as soon as they arrive. However, one said that they would like more specific information in peoples assessment about risks that these people may be prone to. For instance scores, to tell staff more about the persons risk from pressure sores, or poor mobility. The home does not provide intermediate care, therefore standard 6 is not applicable. Care Homes for Older People Page 12 of 35 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. The delivery of care is satisfactory, but some improvements could be made to make sure it is consistent throughout the home, to include improvements in the way peoples medication is managed, to make it safer. Evidence: Peoples plans looked at how staff should provide their care, and any risks that they must consider to maintain peoples health and safety. However, in general, there was only limited involvement from people and their relatives in the planning of their care. This could be improved upon, so that people know that the care they get will be what they want and need. Where people and their relatives had been involved, the plans and subsequent reviews made the records more meaningful. However, we were told that two staff have been given the responsibility to talk to people specifically about their social needs and interests. Once written down, this will help staff to know people, and their former interests, better. Care Homes for Older People Page 13 of 35 Evidence: Where people are not well, their risk assessments are reviewed daily, to make sure that any changes in need or dependency are recognised by staff and acted upon. However, staff need to make sure they reintroduce plans for long term needs when people who have been very poorly, and have been receiving palliative care, show signs of recovery, so that these needs can be considered once more. They also must make sure that appropriate measures are always taken to reduce risk to people where they have been identified as being prone to pressure sores. In one case, this had not been fully thought through where the person was having problems with the equipment supplied for their use. In particular, the care plans for people with dementia took into account important factors, like how staff could maintain their dignity, and make sure they were treated in a respectful way. One told staff how the persons spirits could be lifted by staff when family were not about to give emotional support. This was very good, because it meant that staff were looking at peoples individuality. Another had been completed in detail with the persons family. So there was good information about what was important to the person in the past, and how their wish for greater privacy had been considered when deciding how best their personal care could be given. This sort of information helps to maintain peoples identity, and recognises that everyone has different needs and personalities. Although the records showed that the doctor and other health professionals are contacted where necessary, one person had waited for some time for tests to be done. The registered manager gave assurance that this would be followed up with the professional concerned. One person said If I want to see the doctor I will ask a nurse and she will organise it. People spoken with were mainly satisfied with the care they get. One said Staff generally understand my care needs, although some are more genuine than others. Other people said I like it here, and I think staff by and large are very good but they are pressurised by difficulties of the job, and some of the carers are good. But some treat people like children. Others, who commented in their surveys said Nothing but praise for services rendered. I cope quite well with the patient caring staff to help. All except one relative who returned their survey in May 2008 answered always when asked questions about whether the service was right for their family member. A visitor commented Im very happy with the care. Its nice here. No problems. Some professionals who returned their surveys at the same time made some positive comments like High quality nursing care and staff. Good communication with other Care Homes for Older People Page 14 of 35 Evidence: health care professionals. During the visit, staff were polite and courteous to people. They knocked before entering peoples bedrooms. This gives people the opportunity to tell staff to come back if they do not want to be disturbed. Staff look after most peoples medication. However, people can look after their own if they want to, but not before staff have assessed whether it is safe for them to do so. One such person explained that they have a locked drawer so they can keep their tablets safe. They confirmed that a nurse checked with them that they understood about the medication they would be responsible for. The medication room on one unit has been put out of use due to building works. The trolleys have been moved to an unoccupied bedroom. This was kept locked, but the key was hung up by the side of the door. This is not safe, because it means people who should not go in the room could get the key and enter it without staff knowing. The nurse and registered manager were told that the key must be held by the nurse in charge of the unit. This was organised. The registered manager was told about the following matters about peoples medication that needed to be put right: One persons chart had been signed several times to show that they had been given some of their medication, which was still in the trolley not dispensed. Staff had not altered the medication records when they had agreed with the individual to change the times they would receive their medication to fit in with their preferred lifestyle. Whilst the agreement, discussed with the doctor, shows that the persons choice is being taken into account, these changes need to be recorded on the medication record sheet so all staff are clear about the arrangements. Liquid pain relief with a limited shelf life had not been dated when it was opened. This means that it may no longer be as effective as it should be if the expiry date has passed. One person had a risk assessment, which said that they look after their own medication, when, in fact, they have not done so for some time. This needs to be removed to save confusion, and to properly reflect the care and support that they need now. One person said that staff were a bit erratic with one medication that they get very Care Homes for Older People Page 15 of 35 Evidence: regularly. Although they said this does not affect their condition too much, people should always get their medication at the time it is prescribed. It is Barchesters policy that people are not able to look after their own controlled drugs. It needs to be checked that this arrangement does not impact on peoples ability to remain independent when it has been assessed that they are able to look after their own medication. Because of sickness and annual leave, the normal weekly counts of the medication in one area had not been completed for three weeks. This could cause a delay in errors being found. Regular checks must be maintained. A new prescription had been written on the medication record but had only been signed by one nurse. We were told that normally two nurses sign, which is a better procedure, because it double checks that it has been written correctly. But it could not be evidenced that this had been done. These shortfalls need to be addressed so that people get their medication in the safest possible way. Care Homes for Older People Page 16 of 35 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 can maintain important social links with friends and family, and have a range of activities that they can join in. Although further improvements to the mealtime experience could be made. Evidence: People who can access the reception area and the lift can see the list of activities that are due to take place. It would be good practice to think about how those who are not as mobile could be given this information in advance, so that they can plan their time, and decide what they would like to attend. Activities advertised for the forthcoming week included baking, facials and manicures, and happy hour, where people can enjoy a drink at the bar. A gentle exercise session is provided weekly. And weekly religious services are also held at the home. People can attend these if they wish to help their spiritual needs to be met. People were looking forward to a baking session on the morning of the site visit. Some of those living on one of the units providing dementia care had enjoyed having their hair done, and looked pleased when staff told them how nice they looked. They also Care Homes for Older People Page 17 of 35 Evidence: enjoyed the company of the cat, who they pampered and stroked. A staff member provided individual activities such as board games, so there were lots of things that people could choose to join in with. The dementia units also have an indoor garden, and old memorabilia that people can look at and touch. This helps to instigate conversation, and helps people to recall things which have happened in the past. One person sitting in their room said I cant be bothered with activities, but I am offered them. I just love my room and my television. Another commented that many of the activities start at 10am. They said they would sometimes like to attend these, but often miss the chance to join in, because the staff have not had time to help them get them up and dressed. The registered manager was aware of this problem, and was looking at ways that the timings could be improved so that people have more choice. There are no strict rules which would stop people from having their visitors. One visitor said I can come and go as I please. I stayed and had lunch. It was very nice. Another said when they visit I get a cup of tea and biscuits offered. Staff try to give people choice in their daily routines, for instance, about when they get up and go to bed. One care plan showed other ways in which choice had been thought about. The staff had recorded Likes to pick out clothes that they want to wear, and No nail varnish. Three meals are offered each day. Supper is provided for those who want it. Drinks and snacks are offered in between, and we were told fresh fruit is available for those who would like it. One person though said I only get fresh fruit if my friend brings some. They continued I understand a trolley comes round every Wednesday but I have never seen it. Hostesses are employed to make the dining service run smoothly. Staff appreciated this, and said that they made a valuable contribution to the smooth running of mealtimes. The registered manager said they were aiming have a hostess available at each mealtime. The staff said that this would help to make the mealtimes more relaxed and organised. People get told what is the choice of menu at each mealtime. This means they can make a choice based on what they fancy at the time. The dining areas were nicely set out. This helps to make the meal a pleasant event. People had adapted cutlery and plates to make it easier for them to manage their meal in a dignified way. People can give their views about the meal in the comment book, which the cook looks at regularly. This helps them to make adjustments to the menu based on what people Care Homes for Older People Page 18 of 35 Evidence: say they enjoy, and what has not gone down so well. Some people had said previously that the food was not warm enough once it was served to them. This was a particular problem for those who had their meals in their room. In order to make this better for people, new hot trolleys have been ordered. These should help to keep the meals nice and hot until they are served out. One person confirmed that the food is generally good, and it is hot enough when it is delivered to my room. Another said the meals are very good and usually hot. Although people got the help they needed with their meals, staff did sometimes appear rushed. One person told a staff member who was helping them to slow down. The staff member apologised for rushing. One person said their mealtime experience had improved since staff became aware that they were not getting the help they needed. However, they said that this still depended to some degree upon which staff were on duty at the time, and how busy they were. Care Homes for Older People Page 19 of 35 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. An inconsistent approach to complaints, and shortfalls in promptly alerting the right organisations about safeguarding matters, means that people cannot be assured that the right action will be taken in response to concerns about their care. Evidence: The complaints policy is displayed in the home and in the service users guide. The results of the most recent satisfaction survey conducted by the company showed that people would like to see improvement to the quality of the response to complaints. Since the last inspection, concerns were raised with the Commission for Social Care Inspection about whether the care of one person was right. This was referred to the home so they could look at the persons care, and see whether any adjustments needed to be made to it. The home let the commission know what they had done. There have also been thirteen complaints made direct to the home since the last key inspection in April 2007. These involved concerns about fees, six separate complaints about shortfalls in meeting peoples needs, the abrupt attitude of a staff member, poor quality of bedroom furniture, and that the serving temperature of food was not hot enough. One complainant had commented that they had been made to feel unreasonable when they complained, and that they found the registered managers response unsympathetic. However, the registered manager had responded by letter to Care Homes for Older People Page 20 of 35 Evidence: each of the complaints made by members of the public, explaining the action taken by the home in response to their complaint. There was no such response for the two people living at the home who had complained about their care. Nor was there a record of any investigation or outcome to the complaints made by them. One person living at the home, whose concerns we discussed with the registered manager during the homes Annual Service Review earlier this year, said that nobody senior from the home went to see them following our discussion, to see how their concerns could be resolved. Some staff also echoed this view. One stated that they were not always happy with the way concerns were handled. Another said that they would talk to a nurse if they were not happy, but felt that nothing would be done. They said the management of the home are not interested. Although one person living at the home said I feel that my complaints would be dealt with and I feel quite safe, everyone living at the home needs to know that their complaints will be taken seriously so that they can have confidence in the service. During the site visit we were told about two incidents which had happened, and which the individuals who told us thought were abusive. They felt the incidents had not been handled properly. The first incident had happened two weeks previously. The registered manager should have told the local authority about the incident straight away, but did not. Neither did she inform the Commission for Social Care Inspection about the allegation made to her at the time. Instead she had investigated herself, and had decided that the allegation was not founded. We told the registered manager that she must tell the local authority about the incident, for them to investigate under their safeguarding responsibilities. This has now been done. The registered manager alerted the local authority correctly about the second incident during the site visit. Both matters are now being looked at by the local authority under their responsibilities to investigate safeguarding matters which may affect the welfare of vulnerable people. The registered manager must make sure that all such future incidents are referred to the right people straight away. This practice will help to protect people from harm. Care Homes for Older People Page 21 of 35 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 premises are warm and comfortable, and meet peoples needs. Evidence: The home is situated in Stamford Bridge, where there are a range of shops, pubs and other facilities for people to enjoy. All areas of the home are kept clean, tidy and fresh smelling. Accommodation is provided on three floors, with lift access to each area. This makes it easier for people to get about independently, or for staff to assist them when they need help. There are five separate units where people live, depending on their needs. This means that although the service is large, each area feels quite homely. The premises are kept maintained so that they are safe for people to live in. Work is being carried out to make improvements to the layout of the building, but which affects the sensitivity of the fire alarm system. This meant that in some areas it had been switched off. The registered manager had not told the fire officer about this temporary disruption. She was asked to do so in order that the brigade were fully up to date should they be called out in an emergency. There are two units providing care for people with dementia. Each area has been Care Homes for Older People Page 22 of 35 Evidence: developed with the needs of people with dementia in mind. Manor Lodge was peaceful and comfortable. The lounge dining area opens out onto safe garden areas, where people can walk safely. To help people keep their independence, doors had pictures depicting what was within the room, so they are easily distinguishable For instance, the bathroom door had a picture of a bath. The Croft has similar adaptations, and also an indoor garden. People in each of the areas had been able to bring in their own belongings with them to put in their bedrooms. This helped to make their private space more personal to them. Some people had their own telephone, which means that they can keep in contact independently with their family and friends. The laundry provides appropriate equipment to reduce the risk from infection, and peoples clothes looked well cared for. Staff get training in infection control to keep them up to date with good practice. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited properly to keep people safe from unsuitable workers. But people may not be cared for by a consistent and well organised staff team. Evidence: There are care staff vacancies, which the registered manager is trying to recruit into. The current staff vacancies mean that existing care staff from some areas of the home have to work on other units which they do not know as well because that is where they are most needed. Some find this unsatisfactory. They say it means they have to know about the needs of lots of people, not just of those on the unit where they normally work. They felt this affected continuity of care. One gave an example whereby on one shift the staff team on the unit had comprised of a new starter, a floating member of staff, and an agency staff member. Another said that people would like to go out into the village more often, but staff levels dont allow this. Views about staffing levels were different depending upon which unit staff usually worked. For instance, on one unit, they said that there were enough staff, and that colleagues were very supportive. On another, they said that staffing was poor every day, especially on a morning. On another, the staff were pleased that they do not get moved about to other areas. They said their staff work well as a team, despite having to depend upon agency staff sometimes. Care Homes for Older People Page 24 of 35 Evidence: Kitchen staff said that sometimes they ask for staff when there are shortages, but that they are not always made available. They said that the work gets done, but with a struggle. And a member of the ancillary staff said they were expected to carry out care tasks as well as their own. They did not feel confident to do this, because they do not know enough about peoples needs. They said that the management had been told, but that theyre not interested. The registered manager agrees that there are not enough ancillary hours. She said that she is trying to get more. People living at the home made comments like We could do with more staff. Especially on a morning. I have to wait a long time to go to the toilet and it can be very frustrating. Another said I think staff by and large are very good but they said that they are pressurised by difficulties of the job. One person said sometimes You ring the bell and no one comes for a while. And in a recent review meeting, although the family were happy with the care, they felt there should be more staff. Another relative commented The availability of staff depends upon how busy they are. New staff are properly recruited. One had begun to provide care after the registered manager had checked to make sure they were not barred from providing care, but before their police check was returned. She has given assurance that the circumstances were exceptional because the staff member was needed. We have been told that the staff member was be supervised at all times. This helps to keep people protected from unsuitable workers. Once recruited, staff undertake a full induction into the work that they are expected to perform. Staff keep their induction files with them so there were none to look at. One new staff member confirmed that they were not allowed to start caring for people until their police check had been returned. They said they were also allocated a staff member who they could go to for advice and support, and who they worked closely with at first. They hoped to have their full induction completed soon. They said it was very thorough. There is a home trainer who is responsible for making sure that the staff have to help them work safely, is kept up to date. The registered manager is aware that some staff need an update in food hygiene training, and said that this was being organised. Staff at all levels are getting a range of training to help them understand the needs of people with dementia better, and how they can best meet them. There is a continuous programme in place which encourages care staff to achieve National Vocational Qualifications in Care, and also in dementia. This extra knowledge helps care staff to provide good, consistent care. Care Homes for Older People Page 25 of 35 Evidence: Trained staff have particular areas of expertise. For instance, one is the wound management expert, and another is responsible for continence assessments. They get some training opportunities to maintain their professional qualification, although a comment was made that they sometimes have to fight for training. Particularly if it is expensive. In the information the registered manager gave us before the site visit, she told us that she needs to make sure that she provides more robust supervision, including clinical supervision. This would help to identify specific training that staff may need to update their skills and to help maintain their professional qualification. At the site visit the registered manager told us that although she records the date when supervision takes place, she doesnt write down what has been discussed with her staff. It would be good practice to do so, because it would allow the staff members concerned and the registered manager to reflect on previous practice, to comment where improvements have been made, and to identify where more training or supervision may be required. It could also assist in improving staff morale if staff see a more robust system in place for recording issues about their personal development, where they need support, and where they are doing well. Care Homes for Older People Page 26 of 35 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. There is insufficient clear leadership at the home to ensure that it is run in peoples best interests. Evidence: The registered manager has worked in this position for six years. She hopes to complete a management qualification by December 2008. She gets opportunities to attend a range of training to help her in her position. She has a management meeting with each head of unit on a daily basis to help her keep up to date with what is happening. However, a number of staff have lost faith in the management of the home, and feel that they could have more meetings so they too know more about what is going on and be able to give their views about how the home runs. They think that this would make communication better. Care Homes for Older People Page 27 of 35 Evidence: Staff views were different, depending on which unit they worked, and how much staff stability there was on the unit. For instance, staff working in one particular area of the home said that the registered manager was very supportive. One of them said Helen (the registered manager) is very good. From another unit, we were told that whilst staff get very good support from the deputy manager, they get very poor support from the general manager who does not get involved with the running of the home or residents. Other staff comments included that the management are not interested, and that they should communicate with staff more to see how they think they can improve the care they give. One staff member said that they had never seen the registered manager on the floor. Other staff said comments like There are a lot of unhappy staff here, Nothing ever gets done and nothing gets followed up. One said although the staff worked together as a team, they said there was not a lot of communication. It was reported in the key inspection in April 2007 that the staff morale was low. This continued general feeling of low morale from staff was discussed with the registered manager at this site visit. She said that although heads of unit meetings are held regularly, a general meeting to tackle this problem has still not been held as advised. It is vital that this situation is made better, and that communication is improved. By doing so, people should get a better service from staff who know they are being listened to, and who enjoy going to work. Results of the most recent annual satisfaction survey, completed in December 2007, are available in the foyer for people, their relatives, and visiting professionals, to read. The report shows what everyone said collectively, including what the home does exceptionally well, and where it could do better. The registered manager said an action plan has been drawn up to look at the areas where people thought improvements could be made to the service they get. This too should be published so people can see that their comments have been taken seriously and acted upon where appropriate. The home does not deal with peoples money, so there is no money kept in the building belonging to people for which the company is responsible. If people want to, the home will support them in managing their own affairs, but we were told that relatives who handle peoples monies, including their personal allowance, are asked not to give people cash. The home needs to be careful that this does not restrict peoples independence, and opportunity to look after their own personal allowance. The information provided before the site visit, and the selection of records seen on the day, showed that the building is kept maintained. However: Care Homes for Older People Page 28 of 35 Evidence: The sluice in The Terrace was unlocked. And the cleaning room on The Croft had been left unattended with the key in the door. Both contained hazardous chemicals. Staff organised for these to be locked straight away. Staff check the temperature of the water to make sure that it is not too hot before they assist people into the bath. In some areas the water was a little cool. The registered manager should make sure that the temperature is acceptable to people and make adjustments if it is not. Some of the food stored in the fridges in the kitchen was not labelled. The cook knew when it had been prepared, but had not had time to label it. They need to make sure that this is done as a matter of importance. By doing so, the job will not be forgotten, and staff on subsequent shifts will know when it has to be disposed of. This will make sure that people always get food which has not passed its shelf life and is fit for consumption. Care Homes for Older People Page 29 of 35 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 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Where people are unable to 30/11/2008 use the equipment made available to them to reduce the risk from pressure sores, further advice must be sought about available alternatives. This will help to make sure that risk to people is kept to a minimum by the provision of suitable equipment that the person finds comfortable and able to use. 2 9 13 The way that the medication 30/11/2008 is audited must be improved, so that anomalies in practice can be identified quickly, and practice improved upon. This will help to confirm that: People are getting their medication as prescribed. Medication is not stored or Care Homes for Older People Page 31 of 35 used beyond its shelf life. Peoples risk assessments are kept up to date, and relate to their current abilities and required staff support. 3 16 22 The complaints of those living at the service must be treated with the same level of seriousness as those of others who raise their concerns. This is so that people who live at the home can have confidence that their concerns are listened to and acted upon properly. 4 18 13 Allegations of abuse must be 30/11/2008 reported swiftly to the correct authorities for investigation. This will make sure that the allegations are investigated following agreed safeguarding procedures, by the right people at the right time. This in turn will protect people from risk. 5 27 18 Staff must be organised so 30/11/2008 there are sufficient of them organised in such a way that there is stability and continuity of care throughout the home. This is so people get a consistent service from suitably skilled staff who 30/11/2008 Care Homes for Older People Page 32 of 35 know and understand their needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Extra care could be taken to make sure that peoples needs are recorded in as much detail as possible before they arrive, so staff can begin to meet these need successfully as soon as the person arrives. People and/or their families should be routinely offered the opportunity to be involved in the development and upkeep of the persons care plan. This will help to make sure the care people get is in line with their wishes and choices. Peoples care plans should be revised and amended where peoples health has improved, as well as when it has deteriorated, so that care plans can be reintroduced to reflect the change needed to their every day care, and how it should be offered. 2 7 3 9 The blanket policy that does not allow people to look after their controlled medication should be reviewed, taking into account the current Royal Pharmaceutical Guidelines, to make sure that this policy decision does not impact upon peoples right to remain independent when it has been assessed that they are able to look after their own medication. Hand written entries made on peoples medication records by a staff member should always be checked, countersigned and dated by another suitably trained staff member to confirm that the information recorded is correct. 4 12 Further thought could be given as to how people, who do not have access to the entrance hall or lift, can get information about what activities are available to them, and when. This would help them to plan their time better according to what they want to join in. Mealtimes should always be organised so they are relaxed and unrushed. This will improve the dining experience for people, and make the occasion more social for everyone. 5 30 Staff files should properly reflect the supervision support that staff are getting to update and maintain their skills. This will benefit people because staff training needs and wishes will be better recognised and acted upon where Page 33 of 35 Care Homes for Older People appropriate. 6 31 The lines of communication need to be made clear between the registered manager and staff, so that the process of managing and running the home is clear and transparent. This will help to make sure that the home continues to run in the best interests of people who live there. Staff meetings should be held regularly so that staff have the opportunity to give their collective views about how improvements could be made to the way the service is delivered to the people who live there. The completed action plan for improvement drawn up following the results of surveys sent to people and their representatives should be published. This is so eveyone can see that their comments have been taken seriously, and acted on where appropriate. People should not be dissuaded from handling their own personal allowance. By allowing people to have access to their money, they will have more independence, and freedom to spend their money as they wish. The records maintained to show that hot water is kept at a safe temperature should also be audited regularly to make sure that the temperature is warm enough to be comfortable to bathe in. Opened or pre prepared items of food should be labelled when deposited in the fridge so that staff on subsequent shifts know when it should be disposed of. 7 32 8 33 9 35 10 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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