Inspection on 29/09/08 for Station View 16 - North Yorkshire County Council

This inspection was carried out on 29th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Station View 16 - North... 02/10/07

Station View 16 - North... 31/10/06

Station View 16 - North... 14/02/06

Station View 16 - North... 16/11/05

Station View 16 - North... 02/12/04

Station View 16 - North... 10/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Station View 16 - North Yorkshire County Council 16 Station View Starbeck Harrogate North Yorkshire HG2 7JA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 2 9 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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: Station View 16 - North Yorkshire County Council 16 Station View Starbeck Harrogate North Yorkshire HG2 7JA 01423887128 01423885935 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr David Barrington Type of registration: Number of places registered: North Yorkshire County Council care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: All Service Users for Intermediate Care (up to a maximum of 8) will be accommodated within the Rehabilitation Unit Care services provided for Service Users under category PD should be on a short term basis only and for service users over the age of fifty (50) Date of last inspection Brief description of the care home The last key inspection for Station View took place on 2 October 2007. Station View is a care home owned and operated by North Yorkshire County Council and registered to provide a service for up to thirty-nine older people. The home offers a range of different services, which include long stay care, respite care, interim care and intermediate care. The home also operates a day-centre, which offers up to thirty-six Care Homes for Older People Page 4 of 33 Over 65 39 0 0 3 Brief description of the care home places per day. People from the home can join in with the day centre activities. The home is a single storey building with level access. All bedrooms are single and arranged in small units. There are several inner courtyards and garden patio areas. The home is purpose built and is located in the Starbeck area. There are a good range of amenities close by, such as shops and public houses. Harrogate and Knaresborough centres are within a short distance. We were told at this key inspection that the weekly charge is 359.42 pounds. This is dependent upon income and savings. There are extra costs for hairdressing, chiropody, toiletries, personal clothing and dental treatment. The Commission for Social Care inspection reports are displayed in the home for anyone to read. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The 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. Comment cards distributed to some people who use the service and visiting professionals. Care Homes for Older People Page 6 of 33 A site visit to the home carried out by one inspector over approximately seven hours on 29 September 2008. During the visit, several people who stay there, and some staff, including some of the management team, were spoken with. Four peoples care plans were looked at in detail, as well as two staff recruitment files, some policies and procedures, and a sample of records about health and safety. Care practices were observed where appropriate. Some time was also spent watching the general activity to get an idea about what it is like to stay at Station View. Team Leaders and the Community Services Manager were available throughout the day, and feedback was given to them 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 where 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: The way that medication is stored and recorded could be reviewed, to make sure that it is secure, safe, and does not compromise peoples right to confidentiality. Peoples overall needs could be recorded in a better and more individual way, so that their care plan reflects more accurately the care and support that they actually get. Everyone admitted to the home could be assessed to check whether they have any problems which could relate to poor nutrition. This information could be used when assessing other areas of risk to their overall welfare. People could be told in advance about activities they could join in. This would allow them to plan their time better, and attend any activities that are of interest to them. All staff could be given updated training about safeguarding adults. This would make sure that they are all refreshed regarding the current guidance about what they must Care Homes for Older People Page 8 of 33 do, and who they should report to, if they were to ever have concerns about peoples safety and welfare. Peoples views about the service, and those of their relatives, and professionals who visit the home to support their care, could be gathered in a more consistent way, and used when deciding what the service does well, and where it needs to improve. A check could be made to make sure that any staff with gaps in their mandatory training are included in the forthcoming updates, so that they are all refreshed about how to work in a safe way. 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. The staff at Station View endeavour to make sure that people are assessed before they are admitted so that their needs can be understood and met when they arrive. Evidence: The home is divided into five self contained units, called flats. The majority of people are admitted for short term care. Before they are admitted, people are given information about the home, and what it provides. This helps them to decide whether it will be suitable for them. After they arrive, people also get a copy of the service users guide which is left for them in their room. If they want their own copy to keep, then they can ask for this. One type of care provided is called intermediate care, where the person is admitted for an agreed period of time, during which both the home and a team of community health professionals help the person get back their independence and confidence, so Care Homes for Older People Page 11 of 33 Evidence: that they can return home with the right support. Staff working on this unit have training to help them support people work towards set goals and targets to make their return to home successful. Another type of care is called interim care, where people may be admitted following a period in hospital, but before a joint decision has been reached about their future care, and where it can best be provided. People can also stay at the home for a short break, often planned. This is called respite care. They stay at Station View for an agreed period of time, after which they return to their home in the community. Many people are admitted from the local community. This makes it easier for them to have home assessments with the appropriate staff to check that everything is in place before they return. One person said it was especially nice because they knew some of the staff who care for them. They said I would certainly come back again, and would recommend the home to others. Another person said Well, it’s lovely here. Being their second admission, they said they had insisted on coming back to Station View where they knew they would like it. Finally, for four people, Station View is their home. They all live on one unit, which minimises the disruption to them from new faces, as people admitted for short term care come and go. For all types of admission, the home normally receives a referral from a professional in the community, or from a care manager, before the person is admitted. The staff expect the care manager to provide a copy of their care plan so that they can look at the persons current needs, and decide whether they can be met. The registered manager or one of his senior staff then visit the person. They complete their own assessment with the person concerned to check that they have all the information they need before offering them care. Staff need to make sure that they sign and date this assessment in case it needs to be used for reference at a later date. Sometimes the care plan from the care manager does not arrive before the person is admitted. This puts both the person and the home at a disadvantage, because this care plan may include information about the persons life, health and wellbeing, which the staff need to know about. However, the Community Service Manager responsible for Station View is liaising with the care management team to make sure that these situations do not happen. Out of the eight people who returned their surveys to the commission, five agreed that Care Homes for Older People Page 12 of 33 Evidence: they had been given enough information before they arrived. It is recognised however, that sometimes in an emergency situation it is not possible to pass on very detailed information, when the priority is to admit the person into surroundings where they are safe. However, following such admissions, this information is shared as soon as possible. People made comments like I came straight from hospital after an operation, and I have been here before and always had a pleasant and relaxing stay – very satisfactory. One person said David (the registered manager) came to visit me before I came in. This made me feel a lot better about coming to stay. They said that the home had lived up to their expectations. Staff generally agreed that they get plenty of information to know what needs people will have when they arrive. They said that in emergencies this was sometimes more difficult, but they agreed that they are given more information about the persons needs as soon as possible. Care Homes for Older People Page 13 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. People get good care, although the way that it is recorded could be made more individual. The way medication is stored could be more secure. This would protect people from unnecessary risk. Evidence: People have a basic assessment after they are admitted, which indicates which areas they may need help with, and where they can manage their own care. From this assessment, staff then look at and write down in more depth how they can help people further to promote their independence. For instance, one plan said that the person likes to make their own bed, and explained in detail how the person liked to have their bath organised. This helps to keep people in control of their care. Areas where people may be at risk are also assessed, and a care plan is written up to show how this risk can be minimised. For instance, a person who uses a walking stick, and who also needs help in and out of the bath, had a risk assessment in place to show how staff should assist them safely. Care Homes for Older People Page 14 of 33 Evidence: Staff working with people admitted for intermediate care complete risk assessments with input from visiting health professionals. They said they get loads of support from them when planning peoples care. One person admitted the week before was waiting for these assessments to be completed. Assurance was given that a meeting was planned for the following day so that these could be done. Another person said they get regular physiotherapy, and that the nurse comes in to see to their health needs. This is a good way of looking at peoples individual care, because it focuses on their strengths, as well as on areas where they need support. However, the care plan paperwork used by staff restricts them to some degree, because the pre printed form does not cover specific areas about people’s social and emotional needs. Nor is there a lot of space for staff to write down when they have reviewed things about that persons life or care that have changed. For instance, although staff were fully aware about the right way to approach one person who can be anxious, and who struggled to remember things, there was nowhere for this to be recorded, to tell others how best to support the person. The Team Leaders had already identified this as a problem, and have devised new paperwork which, if used, will help staff to record peoples care, and how it may change over time, in a more individual way. Staff gave assurance that anyone identified as at risk from dietary problems would have a nutritional assessment completed when they were admitted. However, people are not always weighed regularly, so it would be difficult for staff to evidence any changes in peoples nutritional wellbeing without such an assessment being completed. More thought could be given to the significance of this assessment, especially where people have been identified as being at high risk from pressure sores, because good nutritional health can play a major part in keeping peoples skin in good condition. It was agreed that peoples social needs could also be written about in more detail. Although people are generally admitted for only a short period of time, having this information would allow staff to know more about the overall needs of the person, and what could be provided to improve their social wellbeing during their stay. People answered in their surveys that staff always listen and act on what they say. The majority said that they always or usually get the care and support that they need. Although one person commented that it would be nice if staff came for a chat sometimes when they have the time. Visiting professionals said that the home always or usually seeks advice from them, and agreed that staff always consider peoples individual healthcare needs, privacy and dignity. Care Homes for Older People Page 15 of 33 Evidence: People on the day said that they were happy with their care. The said things like Its lovely here – the staff all get on well – and theres plenty of them. They are very kind – and I love my room, It’s fine here – everythings OK. I can see the doctor whenever I want. And staff are respectful, The doctor is always called if I ask. One person said that their care is always right. They said that staff know what to do to meet their needs, and that staff were flexible when giving care. On the day staff were very polite and courteous towards people. They spoke to everyone with respect and kindness. We were told that everyone who handles medication on behalf of people have completed training so that they know how to do so in a safe way. Staff confirmed that this was the case. Staff count and record how much medication people bring in with them, and keep a regular check to make sure that it is being given as and when the doctor has prescribed it. Staff on each separate unit handle the medication for those living there. Since the last inspection, medication has gone missing on two occasions. It could not be proven whether this was accidental, or whether it had been stolen. However, the registered manager took the matter seriously, and informed both the police and the commission about each incident. He has also taken extra measures to make the system more secure to stop it from happening again. The following points were discussed with the Team Leaders and Community Service Manager on the day of the site visit: The medication is stored centrally. The arrangement is not ideal, as the room where it is stored is also used as the hairdressing salon. It is also used by the home care services to store keys, and by the district nursing team. Therefore the door is left unlocked. We were told that this arrangement has been in place for a long time. The Community Service Manager said the Primary Care Trust pharmacist has visited, and finds the arrangement satisfactory. Some medication had been left out. Although it was locked away straight away once brought to staffs attention, this could have put people entering the room at risk if they took medication which was not theirs. People can manage their own medication if they wish, but not before an assessment is completed to make sure that it is safe for them to do so. The risk assessment belonging to one such person said that they had locked facilities to keep their tablets safe. However, they did not. This puts people who may enter their room when they are not there at risk, if they took medication which was not theirs. This was brought to the Care Homes for Older People Page 16 of 33 Evidence: attention of the Team Leader who gave assurance that locked facilities would be made available on the day. There was medication in use with a limited shelf life, but the day that it had been opened was not recorded. This record needs to be kept so that it is not used after the date that it may no longer be as effective. The number of tablets left for one person did not match the amount that the records said should be remaining. But staff had signed to show that it had been given regularly. The Team Leaders agreed to check what appeared to be an administrative error, so that the records could be put right. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to maintain important links with families and friends, and can exercise choice in their daily life. But the programme of activities could be more structured so people have enough information to be able to choose what activities they may wish to join, and when. Evidence: The majority of people are admitted for short term care, and for rehabilitation. Therefore many focus on their rehabilitation programme rather than on social activities, which the home itself tends not to organise in advance. There is no activities person. Instead, activities are arranged informally, depending on who is using the service at the time. For example, staff on one unit said that they sometimes organise board games or dominoes, bingo and beauty sessions for people if they want to be involved. Others are busy getting ready for their return to the community. One person who enjoyed their room, and the view from their window said Why do I need activities? – I have got enough here. However, there is an active day centre attached to Station View, and people are free to access these facilities if they want more to do. The day centre was very busy, and Care Homes for Older People Page 18 of 33 Evidence: one person admitted for respite care said how much they had enjoyed their morning visiting it, and catching up with people she hadnt seen for a while. Others spoken with were not concerned about the lack of a more formal activity programme, stating that they just enjoyed sitting in their room, or with new friends that they shared their unit with. The hairdresser visits regularly, and on the day of the site visit, the salon was busy with people who seemed to enjoy the social occasion. And there are religious services held at the home which will help meet peoples spiritual needs. At the last inspection, it was recommended that more formal activities should be arranged on a weekend for people for whom Station View was their home. No further weekend activities have been provided, because the Team Leader said that currently this is the time these people spend time with their families. Everyone who wishes to, joins together to eat on a weekend in the day centre room to make the meal more of a social event. And three weekly trips away from the home have been organised. This gives people something to look forward to away from the home. However, more thought could be given as to how people could be told in advance about what daily activities are available, so that they can decide whether there is something which interests them. This would help them to plan their time in advance, so they dont miss the activities they would like to attend. People confirmed that their visitors can come and go as they please, and that they can see them in their own room if they wish. This gives people privacy, and allows them to maintain important links with family and friends. They also said that their care is flexible, and that there are no rules about how they spend their day. This means that they can do things like get up and go to bed when they wish. People are offered three meals a day. At each meal they are provided with a choice of menu. Supper is also available if people would like some, and the kitchen is open during the night so staff can prepare a snack for anyone who may become hungry. A staff member explained how they made sure that one person has a sandwich prepared for them to have overnight in case they need it. This matches the routine they have at home, and shows that their individual needs have been recognised. The cook said they have enough budget to provide people with a good nutritious meal, and they get fresh meat, vegetables and fruit delivered regularly to help them achieve this. Special diets are catered for. It was unclear whether the cook had been given dietary information about one person recently admitted, although the staff said that they Care Homes for Older People Page 19 of 33 Evidence: themselves knew what the person could and couldn’t be offered. The staff agreed to make sure that the cook had been told about who needed what diet. Before the site visit we were told that some people had found the meals small during their stay. This was discussed at the site visit with the senior staff. It was observed that meals were not served on a full size dinner plate. However, people spoken with said The food is excellent, and very hot, I get plenty to eat, We almost get too much food, The food is lovely. I get enough – I don’t have a big appetite, and the servings are fine for me, We get nice meals – sometimes too much – I think I’m putting on weight!. People living at the home permanently have been asked about the food in their meetings, and there were no concerns recorded. However, it would be good practice to continue to consult with people about the food so that it can be certain that they continue to be satisfied after their meals. Care Homes for Older People Page 20 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 protected by staff who take their concerns and welfare seriously. Evidence: The complaints procedure is displayed at the home. People also get their own copy of the service users guide when they arrive. This gives them written information about how to complain. People who returned their surveys said they always or usually knew who to speak to if they wanted to complain. Everyone said however that they knew how to complain, except one person who said I haven’t needed to. One person at the site visit said I think the home would sort out any concerns I may have. Another was sure that they could grumble if they had any problems, and they were confident that their comments would be dealt with. A visiting professional said Any issue I have raised with the duty managers have always been promptly dealt with. Another thought that sometimes feedback could be better when they raised concerns. Four complaints have been made direct to the home since the last inspection. Three were about staff attitude, and one about some money which had gone missing. It was Care Homes for Older People Page 21 of 33 Evidence: not possible to see the full details about how these were handled, because the Community Services Manager had dealt with the complaints herself. She explained however how each complaint had been looked into. She described how she had fed back to the complainants with the outcome of her findings after her investigation was completed, and how she had put things right where shortfalls were found. Staff knew what to do if they thought someone living at the home was being abused, or if an allegation was made to them. They were clear that they could not keep secrets when they had such information, and that, in order to protect everyone at the home, they must report their concerns quickly to someone more senior. In turn, the senior staff knew that they must report any abuse or safeguarding matters to the local authority so that they in turn could consider investigating under their safeguarding procedures. By making sure that matters are reported quickly to the right people, the staff are helping to keep people safe from risk. Some staff are waiting to have training in safeguarding adults. This is being organised, and will further reinforce the responsibilities that staff have in protecting people from harm. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, warm comfortable home. Evidence: The home is separated into five small units. Each is self contained, having its own satellite kitchen area to which food is delivered in a hot trolley from the main kitchen each mealtime. There is a small sitting and dining area, as well as bathrooms and toilets on each unit. This means that people have all the daily living facilities that they need close by to them. All areas of the home were clean and free from unpleasant odours. People said they liked their rooms, which they are able to personalise during their stay. Although the bedrooms do not have an en suite, they have a small hand wash basin, and there are toilet facilities on each unit. Corridors with extra seating link each area of the home. Some overlook the gardens, which the maintenance man has worked hard on over the last year to make them attractive to look out on to. People who returned their surveys made comment such as The home is very clean and tidy, and Very clean and pleasant. And on the day, one person said Its lovely Care Homes for Older People Page 23 of 33 Evidence: here. Weve got our own sitting room and its very comfortable. There is a separate laundry area. Staff are supplied with gloves and aprons, and soiled linen is delivered to the laundry in separate bags which can be put straight into the washing machines. This helps to keep the risk from cross infection to a minimum. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by sufficient staff who are properly recruited, and trained to meet their needs. Evidence: The staff move around to different departments periodically, so that they remain flexible, and knowledgeable about how each unit runs. The exception to this is the rehabilitation unit, where people receive intermediate care, because it has been recognised that it is to the benefit of this unit to have staff in place who understand how the system works, and who are used to dealing with the community professionals who visit there. The dependency levels at the home can fluctuate, depending on who is living there at the time. The senior staff said that this is always considered, and extra staff provided if required. They said David (the manager) always listens if told more staff are needed. One care staff commented It would be nice to have a few more staff. Another said they are not too bad staffing wise. The majority of people said in their surveys that there were always or usually enough staff to meet their needs. Someone on the day said Staff come straight away if I ring my bell. Care Homes for Older People Page 25 of 33 Evidence: New staff are properly recruited. This reduces the risk to people from unsuitable workers who are unfit to provide care. Once recruited, they complete an in house induction, so they know about how the home runs. For instance, what they should do in the case of the fire alarm sounding. They then complete a full induction course. This helps care staff to work towards agreed standards, to know what good care is, and how it should be provided. Staff are also provided with training to meet the more diverse needs of people. For instance, dementia awareness. And staff on the intermediate care unit said that they have received training in rehabilitation, so that they can assist people in becoming motivated and involved in their care programme. Visiting health professionals also provide support and update to staff. For instance, one staff member said they were due to have some training so that they understood more about a certain medicine. Staff are encouraged to undertake National Vocational Qualifications in care, and there is an ongoing training programme in place to help achieve this. This helps to make sure that people are cared for by staff with up to date skills and knowledge about what good care is. Care Homes for Older People Page 26 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 a dedicated team. However, systems to seek peoples views, so that they can be assured that the service runs in their best interests, could be improved upon. Evidence: The registered manager was not available on the day of the site visit. The Team Leaders were working together to provide management support on his planned day off. They spoke highly of his support, and said that everyone works together as a team in what is a very busy office environment. Monthly team management meetings are held. This will help the management staff to communicate with each other, and to highlight problems, which may need attention, at an early point. Care staff spoken with said that the management were supportive of them also. One explained how they get regular supervision and appraisal, which gives then the opportunity to say what training they would like to develop their skills. Others said that Care Homes for Older People Page 27 of 33 Evidence: the management are there if we need them, but said that they worked quite independently. The way that people are asked their views about the service is not yet done in a consistent way. Those admitted for short term care are given a questionnaire to complete when they leave, so that the registered manager can get a view about what they think the home does well, and what it could do better. People living permanently at the home however have occasional meetings where their views are gathered collectively, and recorded. This does not give them the same opportunity to answer any questions anonymously. There was no evidence to confirm that any of the information collected is used to form an action plan to make improvements based on peoples collective views. The Community Service Manager was aware that this is an area which needs further development, and explained that the local authority are looking at ways that their homes generally can use the information gathered more effectively when deciding how the home can move forward based on peoples views. As part of this, she accepted that gathering the views of visiting professionals would also be useful. This should be given serious consideration, especially as many of these professionals will have continued contact with people who have used the service once they return home. The home can look after peoples money if they wish. There is an administrator who is responsible for this. The records kept were detailed, and showed when money had been handled on peoples behalf. People had also signed when money had been passed to them at their request. This helps people to have some independence when deciding how they would like to spend their money. The information given before the site visit showed that the home is kept maintained, so that it is a safe place to live. The fire alarm does not currently provide a receipt, as it should, to give instructions as to where the alarm has been set off. We have been assured that this does not affect the alarm from sounding, nor from identifying where the fire may be. However, the company responsible for maintaining the equipment should be contacted again to determine when this will be repaired. Staff get a range of training to assist them in giving care in a safe way, such as moving and handling training. Fire training is also updated regularly. There was some training needed to make sure that staff were fully updated in areas of training that they are required by law to undertake. However, the Community Service Manager was aware that this was the case, and gave assurance that these gaps were being addressed. Care Homes for Older People Page 28 of 33 Care Homes for Older People Page 29 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 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The medication storage and recording procedures must be reviewed to make sure they are safe, and action taken where shortfalls are identified. The service must inform the commission of the outcome of the review, and any resultant action taken. This will satisfy that the system protects the security of the medication so that medication cannot be tampered with, people are not at risk, proper records are kept, and that peoples confidentiality is maintained. 14/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans should be designed so that staff have the opportunity to record peoples overall needs, including their social needs and aspirations, and how the person can be Page 31 of 33 Care Homes for Older People best supported in the most individual way. 2 8 Consideration should be given to assessing everyone admitted to the home to check that they are not at risk from poor nutrition. So people can be assured that all staff will take the right action, and tell the right people if they have concerns about peoples safety and welfare, there should be no further delay in providing training in safeguarding adults. Consistent ways of gathering peoples views about the service, and those of their relatives, and professionals who visit the home to support their care, should be developed. These collective views would provide good information about what the home does well, and where it can be improved, and should be used when deciding what improvements should be made. A check should be made to make sure that any staff with gaps in their mandatory training are included in the forthcoming updates, so that they are refreshed about how to work in a safe way. 3 18 4 33 5 38 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 © (2008) 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. 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