Inspection on 05/02/09 for Standon Hall Care Home (The Beeches)

This inspection was carried out on 5th 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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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: Standon Hall Care Home (The Beeches) Standon Hall Care Home (The Beeches) Nr Eccleshall Stafford Staffordshire ST21 6RN     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: Yvonne Allen     Date: 0 5 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Standon Hall Care Home (The Beeches) Standon Hall Care Home (The Beeches) Nr Eccleshall Stafford Staffordshire ST21 6RN 01782791555 01782791396 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Standon Hall Home Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 34 Number of places (if applicable): Under 65 Over 65 34 dementia Additional conditions: DE over 60 years only Date of last inspection Brief description of the care home 34 Standon Hall - The Beeches is a care home providing personal and nursing care and accommodation for up to 34 older people suffering from enduring mental health problems. The home is owned by a private company called Standon Hall Homes Limited. The company own a number of other nursing and residential homes across the country. The home is located on the outskirts of the small village of Standon near to the town of Eccleshall in Staffordshire and is situated in a rural setting with views over the surrounding countryside. It is not within walking distance of any amenities and transportation would be required to visit the nearest village. The home was opened in 1998 and consists of two single storey buildings, which were built around 1930 as a hospital. A long covered walkway forms a corridor link between the two units Beeches One and Beeches Two. All the bedrooms are single and have the provision of Care Homes for Older People Page 4 of 33 Brief description of the care home a sink. Bathing and toilet facilities are located close to bedrooms. The home is situated opposite the Standon Hall Care Home. This was previously a stately home and the two homes share the spacious grounds. The range of fees charged by the home ranges from 369.00 pounds to 695.00. This range includes both funded and privately paying residents. Extra charges are made for hairdressing and toiletries. The Providers have currently closed Beeches 1 unit and people are now all accommodated in Beeches 2. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This is an overview of what the inspector found during the inspection. The quality rating for this service is ONE STAR. This means that the people who use this service experience ADEQUATE quality outcomes. The Providers have completed a self assessment tool which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to undertake a self assessment, which focuses on how well outcomes are met for people using the service. This was completed to a good standard and gave us detailed information about the services offered. The AQAA has been referred to in each outcome of this inspection report. Care Homes for Older People Page 6 of 33 During this inspection we assessed all the Key standards and made a judgment for each outcome based on the evidence we have collated. Each judgment summarizes what life is like for the people who live in this home. The ways in which we gathered our evidence are as follows We walked around the home and looked in some of the bedrooms and communal areas. We held discussions with the acting manager and other staff members. We spoke to some of the people who live in the home. We spoke with two visitors who were present during the inspection visit. We looked at relevant records and documentation. At the end of the inspection visit we discussed our findings with the acting manager of the home. What the care home does well: What has improved since the last inspection? What they could do better: The environment continues to be poor. The fabric of the building is in a poor state and is in desperate need of complete modernization. The Providers have told us, on several occasions, that they intend to replace the home with a brand new building. However this has not transpired and the home remains in a poor state of repair. Bedrooms are in need of redecoration and refurbishment, with much of the bedroom furniture, including the vanity units being in a poor state of repair. The lounge area is also in need of redecoration and new flooring as this is ripped and unsuitable for use in a busy care home. There have been some small improvements made over the years to the environment but the home does not have a homely feel with fittings - such as lighting being of the institutional type appearance. We have made some requirements to help improve the environment for the people who live at the home. The social and therapeutic needs of people living in the home are not fully met and this needs developing further. The staff members responsible for planning and delivering social care in the home should receive specific training in this area. This will help the staff to understand the specific social needs of people with enduring mental health problems and be able to meet these needs. The manager of the home has held the position of acting manager for over six months now and we have not received an application for Registered Manager in respect of this home. This was discussed with the acting manager and we have sent a letter to Care Homes for Older People Page 8 of 33 her outlining this. We agreed that we must receive this application within the timescale outlined in the letter. 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 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are only offered a place at this home after having a full assessment of their needs and can be assured that their specific needs will be met by the staff at the home. Evidence: In their AQAA the Providers tell us that the home has excellent links with the NHS and Social Services funding teams and prior to admission in depth comprehensive reports are obtained. They say time and effort is taken to examine these reports along with their own assessment of the person. They tell us that all staff receive briefing regarding any new person and that there is a low staff turnover at the home which helps with consistency and understanding of the needs of this group of people. They tell us that people and their families are given information about the home in order to help them make a decision. They are also invited to come and visit the home prior to admission. Care Homes for Older People Page 11 of 33 Evidence: During our visit we identified that people are only offered a place at this home following an assessment of their needs. We saw records of these assessments in individual care plans. These had been carried out by the acting manager of the home who is qualified to do so. These assessments look at all the personal care and nursing needs of people but with a particular emphasis on assessing mental health needs. We also noted that assessments had been carried out by other professionals involved in placement. These included assessments by Social Services and health care professionals. Assessments also included the involvement of family members and representatives, as often the person coming into the home lacks capacity to make decisions. Discussions with the acting manager identified that no person is offered a place at this home unless she is satisfied that staff are able to meet that persons individual needs. The acting manager and care manager are both undertaking the Diploma in Dementia Care, entitled Dementia Care Matters. Also we saw records of staff training in dementia care and managing challenging behaviors. We spoke to some staff members about meeting the needs of the people in the home and they confirmed that they felt able and equipped to do this. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual care is planned and delivered with attention to promoting dignity and meeting specific needs. Evidence: In their AQAA the Providers tell us that each person has a working care plan in place which instructs staff on how to look after individual people. They tell us that plans are clear comprehensive and holistic and reviewed at least monthly. The Providers say that people and their representatives are encouraged to participate in reviews of care plans and sign in agreement. They say that where people have no relatives then an advocate is assigned to them. The AQAA explains how the care plan is constructed, based on the original needs assessment and further risk assessments and care plans are developed. The Providers tell us that people have full access to outside professionals and health care professionals including, wherever possible, maintaining the links with the health care professionals who have been involved in their care before admission to the home. They tell us that their system for the management of medication is robust and that medication is managed and administered by the nurses Care Homes for Older People Page 13 of 33 Evidence: in the home with regular audits and reviews of working practice. The AQAA talks of maintaining and promoting dignity for people and that staff are monitored daily by the nurses and undergo regular supervision sessions to monitor care practice. We looked at a number of individual care plans during our visit. Generally plans are of a satisfactory standard and contain information as outlined by the Provider above. Some of the risk assessments, however, such as the falls risk, did not identify where a care plan is required and after discussion with the acting manager it was identified that a new system of care planning is being introduced at the home which will improve this. One of the plans relating to a lady who had recently been admitted to the home had not been signed in agreement by her or her representative. Care plans did include personal choices and preferences of people in respect of activities of daily living. This too, could be further developed with help from family members or representatives. Care plans also contain evidence of visits by health care professionals such as the doctor, Optician and Chiropodist. At the time of our visit the Podiatrist was attending to some of the people in the home. There is also documentation of people being assisted to attend clinic appointments. We looked at the medication process and are satisfied that medication is being administered safely, as prescribed and in accordance with the medicines act and Nursing and Midwifery Council (NMC) guidelines. We observed staff interacting well with people and two visitors told us that the staff arevery good and attentive. Staff were heard to address people in a respectful and dignified manner. We observed people being helped with drinks mid morning and then assisted to eat their lunch. Nutritional needs and weight are assessed and monitored at the home. We were told that there was no one in the home with a pressure ulcer at the time of the visit. Tissue viability of people is assessed monthly and steps are taken to help avoid the development of pressure ulcers. Should this happen then we were told that the advice of the Tissue Viability Nurse Specialist is sought and she will visit the home. People admitted for non-nursing personal care are visited by the district nurse should they need this input. We saw records of where the district nurse had visited people. Staff are trained to manage challenging and difficult behavior and we observed an incident between two people in the dining room which was managed very well by the manager and staff. Care Homes for Older People Page 14 of 33 Evidence: Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provision of activities at the home is continuing to improve, and further development in this area will help to ensure that individual social and therapeutic needs are met. The meals served in this home are very good and help to ensure that individual dietary needs and preferences are catered for. Evidence: In their AQAA the Providers tell us that, when planning activities of daily life, peoples choices are listened to and their preferences adhered to as much as possible. They tell us that they listen to what people want and an example of this is the increase in the number of trips out which have taken place. Such trips out have included a pub lunch and visit to Trentham Gardens amongst others. Peoples preferences are documented in their care plans and letters are sent out to families requesting information to help compile a biography of the person. Forthcoming events and activities are displayed on the notice board and the home has a monthly newsletter sent around. They tell us that people are asked for suggestions at residents/relatives meetings. Arrangements are in place to transport anyone wishing to attend the local Church to services there and Care Homes for Older People Page 16 of 33 Evidence: regular services are held in the home which most people prefer. The AQAA describes the job roles of the two activities coordinators and the group and one to one support they provide. The Provider tells us that visitors are welcome at any time and that there are plenty of facilities to visit in private, including the seating areas in the gardens. There is extensive information in the AQAA relating to the meals provided, the exceptional qualities of the chef and the inclusion of peoples choices into the menus. There was a 4 star rating provided from the last visit by Environmental Health in the kitchen and no recommendations made. The AQQA also tells us about how autonomy is promoted for people who live at the home in respect of choices about daily life. We noted that two activities coordinators at employed at the home. One has worked here for many years and the other has joined more recently. Neither of these staff members have received specific training in meeting the social care needs of people with mental health conditions. It is therefore recommended that this training be undertaken in order to help ensure that the social and therapeutic needs of people are met. We noted that more trips out to local venues have taken place since the last Key Inspection held on February eleventh 2008, and evidence was seen of trips out in the form of photographs. People and staff also told us about these. From the records contained in care plans, we could not identify whether individual hobbies and interests are being promoted at the home. There was insufficient information available to identify what people like to do and what they are interested in. The staff are making attempts to obtain this information from relatives and representatives on admission in the form of a biography. We did see staff naturally interacting and singing with people at the time of the visit. Some people were watching the television and others were holding items which are important to them. The manager said that items that are interesting and important to people will be left around for them to pick up at their leisure. She also told us that she had plans to make the lounge and corridor areas more visually stimulating for people. This will help to make the environment more stimulating for the people who live there. The two visitors told me its ok here but there needs to be more stimulation for Care Homes for Older People Page 17 of 33 Evidence: people they went on to say that often, when they visit, they find their relative just sitting staring around the room. They said that she does not particularly enjoy trips out but would benefit from more one to one stimulation. There is no stimulation for this person in her bedroom and, on further discussion with her relatives, they thought that she might like to have her television brought in. They confirmed that they would discuss this further with the manager. The visitors did tell us that they are free to visit at any time. The home runs an open visiting policy with visitors welcome at any reasonable time and at other times by arrangement with the manager. We saw records of activities which people have participated in and, at the time of the visit, the care staff were arranging activities for people in the lounge. The spiritual needs of people are recorded in care plans and we were told that church services are held in the home regularly. Representatives from the Clergy visit some of the people in the home. We saw the lunchtime meal being served. Almost all of the people go to the dining room for their lunch as this is a social event as well as a meal. The lunch appeared very appetizing, well presented and nutritious. There was various forms of fish for the main menu and an alternative dish. People who require a soft diet have this served to them attractively in separate portions. Staff supervise mealtimes, including the nurses in charge, and help people who need assistance to eat. We looked at the menus and spoke to the chef. Menus are based around what people want and what is seasonal and includes any special diets. The menus are varied and the meals served in the home are very good. The home has the benefit of employing an excellent chef who listens to what people want and produces dishes which are appetizing, nutritious and well presented. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to raise any concerns they might have and can be assured that they will be listened to and acted upon. People who live in the home are kept safe by the safeguarding systems in place. Evidence: In their AQAA the Providers tell us - that the home has a clear concise complaints procedure that is prominently displayed. They tell us that by running an open door policy this often helps prevent minor problems from escalating into complaints. Full records are kept of the complaints received in the home and all parties are informed of the outcome within 28 days. An action plan is then put into place to ensure that the issues are dealt with and not repeated. The AQAA states that the Providers work in an open and honest way with other relevant parties in respect of complaints and protection. The home has a policy on Protection Of Vulnerable Adults (POVA) and all staff are made aware of this and receive training in this area. We have not received any complaints or Safeguarding referrals for this home since the last inspection. Care Homes for Older People Page 19 of 33 Evidence: When we spoke with visitors to the home they told us that they know who to raise concerns with and would speak to the clinical or acting manager. The acting manager is also the registered manager of the other home on the same site and has a good record of addressing complaints effectively. She also has the support of a Regional Manager who visits the home regularly. The manager told us that staff are carefully selected to work at the home and undergo the required checks including Criminal Records Bureau (CRB) checks. We saw these contained in employee files. We also saw records of staff training in the Protection Of Vulnerable Adults (POVA). Staff members whom we spoke to confirmed that they receive training in the above and are aware of the action to take in the event of reporting abuse. The acting manager is familiar with the local safeguarding policies. The home also has a Whistle blowing Policy in place so that staff who want to report abuse and bad practice are protected. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a very basic level of comfort for the people who live there. The whole fabric of the building is in need of complete modernization and fails to offer people a homely and comfortable place to live. Evidence: In their AQAA the Providers tell us that the home is adapted to meet the needs of the people who live there. They say that all the equipment used is regularly services and meets the requirements of the Disability Discrimination Act. They say that all rooms are accessible and on one floor level. The AQAA tells us that the home is set in extensive grounds and that there is an enclosed rear garden for use by the people who live in the home. There is one lounge which, by arrangement of the furniture, is divided into small clusters to allow different activities to take place. There is a smoking room available and a separate dining room. They tell us that all the rooms are for single occupancy and exceed the minimum room sizes required. People are able to choose whether or not they would like a lock fitted to their bedroom door and would be able to have a key should they wish. The Providers tell us that the home meets the guidelines of infection control, fire safety and environmental health. They say that there is plenty of hot running water and an ambient temperature is maintained throughout. Care Homes for Older People Page 21 of 33 Evidence: During the inspection visit we walked around the home visiting some of the bedrooms, the lounge and dining room. There has been a bed replacement programme in place at the home since the last inspection. The bedrooms we saw were in need of redecoration and refurbishment. Bedroom furniture, including vanity units is worn and in need of replacement. The lounge is in a poor state of repair and there were two tears in the floor covering, the floor covering itself is unsuitable and is not hard wearing. This should be replaced with a more suitable, effective floor covering. One of the window frames in the lounge was so rotten that this allowed fingers to go straight through, making a hole through to the outside. This was temporarily mended by the maintenance person. However, this now requires a new window frame to be installed. Two of the easy chairs were ripped and in a poor state of repair. The manager explained that these belonged to two of the people who live in the home. This should be explored further, including discussions with families involved, with a view to replacing the chairs. The easy chair in bedroom number 22 provided by the home for the person to sit on daily had completely bottomed out. This provided little or no support for the individual and must be replaced. Discussions with the visitors present at the time of the visit, suggested that they wished to bring in the persons own easy chair from home. We discussed this with the acting manager at the time who stated that this person could bring in her own chair if she wished to or she would replace the seat cushion with a new one. The enclosed garden is in need of general tidying and gardening in order to allow easy access for the people who live at the home. People are able to enjoy views of wildlife in this garden through the rear window of the lounge. The staff records identified that staff have received training in infection control. At the time of the visit the window cleaner was working his way around all the windows in the home. The home has had some small improvements added over the last few years but still Care Homes for Older People Page 22 of 33 Evidence: retains an institutional appearance and feel. The Providers have told us that a new build is planned to replace the home but this has not yet transpired. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are cared for by a skilled and competent staff team who understand and are able to meet their assessed needs. Evidence: In their AQAA, the Providers tell us that their recruitment procedure is robust and they have a strong ethos on staff training. They tell us of their commitment to training care staff to NVQ standards. The Company has a training manager who assists the manager in facilitating training at the home. They say that the home is compliant with all mandatory training. The Manager has recently completed IOSH training in Health and Safety and the manager and clinical manager have recently commenced a leadership in person centered dementia care course. This will ultimately lead to a Diploma In dementia care. We looked at staff files in respect of recruitment and training and development and we spoke to staff who work in the home. There is a robust staff recruitment procedure where all the required information is obtained and staff are carefully selected to work at the home. The staff training and development plan is effective and ensures that staff are equipped with the skills necessary to meet the needs of people living in the home. Care Homes for Older People Page 24 of 33 Evidence: Staff feel well supported with training and confirmed that they receive training which supports them to meet the specific mental health needs of the people in the home. A staff member told us, We are very well supported with our training needs here. Its ok when everybody is here but if a member of staff doesnt turn up then it is very busy. Staff are generally provided in adequate numbers but at the time of the inspection visit there was a shortage of one care assistant. This was addressed by providing a member of the care team from the other home on the site. There is a good skill mix of staff at the home with provision of Registered General and Registered Mental nurses, NVQ trained and senior care staff. The staff induction programme is comprehensive and ensures that new staff have the basic skills to be able to understand and care for the people living in the home. The on going staff training and development programme helps to ensure that all staff are equipped with the knowledge and skills required to meet the needs of people in the home. Some visitors told us, The staff are all good and very helpful. The training programme (Diploma in Dementia) which is being undertaken by the acting manager and the clinical manager should help provide valuable knowledge and expertise in dementia care. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed by the acting manager and clinical manager and is run in the best interests of the people who live there. There is currently no registered manager for this home and this needs to be addressed in order to ensure overall management responsibility and accountability. Evidence: In their AQAA the Providers tell us about the strong leadership qualities of the acting manager. She is also the general manager and registered manager of the other home located on the same site. They also tell us of the visits and support given by the Company Regional Manager. The AQAA says that the manager liaises well with external professionals and that she has built up excellent relationships with them. They say that the manager runs an open door policy and encourages open and positive communication between people. They tell us that regular three monthly meetings are held with people who live in the home and their families. The AQAA says Care Homes for Older People Page 26 of 33 Evidence: that the manager undertakes regular monitoring and reviews of all aspects of quality assurance and health and safety. They say that the manager ensures that staff have received the relevant health and safety mandatory training sessions and that regular up dates take place. At the time of the visit the acting manager Beverly Davies was present. The clinical manager was on annual leave. We spoke with the acting manager about her role and intentions with reference to registration. She informed us that she wished to become Registered Manager for this home but was unsure how to proceed as she is already Registered Manager for the other home on the same site. We informed her that because she had been in the role of acting manager for longer than six months she was, in fact, committing an offense by continuing to do so. We emphasized the need for us to receive her application to become registered manager for the home as a matter of urgency. We agreed that this would be received within three months of the date of the inspection visit. We have since sent a letter to the acting manager outlining this. Beverly informed us that she and the clinical manager are undertaking the Diploma in Dementia. This will help to enhance their knowledge and skills of the subject and will bring the expertise into the home to train other staff. There is a Quality Assurance programme in place at the home where audits are carried out regularly on all areas. We saw evidence of these audits. We also saw evidence of residents and relatives meetings where people are encouraged to communicate their feelings and suggestions and talk about any concerns. We also noted that both managers are very approachable people and often see relatives on a one to one basis, running an open door policy. The Regional manager visits at least monthly and completes a Reg 26 report. The acting manager confirmed that she feels very well supported by the regional manger. We held discussions with the acting manager about the management of personal allowances in the home. The same system is in place as at the last Key Inspection. This is maintained by the administrator. There is no one working at the home who is an agent or appointee for anyone and people are allocated advocates where there is no family. There is an effective Health and Safety policy in place and we spoke to the manager and looked at records relating to this. Care Homes for Older People Page 27 of 33 Evidence: Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 23(2)(d) The registered person shall having regard to the number and needs of the people, ensure that all parts of the care home are kept clean and reasonably decorated. The lounge must be redecorated in order to provide a pleasant environment for the people who live there. The bedrooms must also be redecorated and refurbished and vanity units replaced and updated. 02/07/2009 2 19 23 23(2)(b) The registered 02/04/2009 person shall having regard to the number and needs of the people, ensure that - the premises to be used as the care home meets the needs of the people who live there. Care Homes for Older People Page 30 of 33 The flooring in the lounge must be replaced as the current floor covering is both unsafe and unsuitable. 3 19 23 23(2)(b) The registered 02/04/2009 person shall having regard to the number and needs of the people, ensure that - the premises to be used as the care home meets the needs of the people who live there. The rotten window frame in the lounge must be replaced in order to maintain the sound construction of the home. 4 31 11 CSA 11 - Notification of offences. We must receive an application for Registered Manager for this home from the acting manager within the agreed timescale of this report. The acting manager is, under the CSA, section 11, committing and offence by continuing to act as manager for longer than six months. 05/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 It is recommended that the staff members responsible for meeting the social and therapeutic needs of people undertake training for this with particular emphasis on Care Homes for Older People Page 31 of 33 people with mental health care needs. This will help to ensure that these needs of people are met 2 12 It is recommended that more information be obtained about peoples hobbies, interests, abilities and preferences in order to help ensure that social and therapeutic needs are met. To replace the easy chairs located in the lounge area which are in a poor state of repair, with the consent of the people involved. To liaise with the visitors of the person in room 22 about bringing in her own easy chair, with the usual fire safety checks carried out. Failing this, the cushion on this chair must be replaced as the current one is unsuitable for use. 3 19 4 19 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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