Inspection on 31/10/08 for Summerhayes

This inspection was carried out on 31st October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Summerhayes The Square Sandford Crediton Devon EX17 4LN     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: Michelle Oliver     Date: 3 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 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 34 Information about the care home Name of care home: Address: Summerhayes The Square Sandford Crediton Devon EX17 4LN 01363777070 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Info.summerhayes@btconnect.com Mr Andrew Charles Fraser Mason,Charlotte Ann Mason Name of registered manager (if applicable) Charlotte Ann Mason Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 14. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Physical disability aged 65 years or over on admission (Code PD(E)) - maximum of 3 places Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Summerhayes is a care home providing personal care and accommodation for up to 14 older people. the home is a large detached, older style property standing in well maintained gardens. It is situated in the small village of Sandford just outside the town Care Homes for Older People Page 4 of 34 care home 14 Over 65 14 3 0 0 Brief description of the care home of Crediton. there are 14 single bedrooms situated on the ground and first floor, with passenger lift access to the first floor. There is a large lounge and separte dining room on the ground floor. there is level access to the garden, which has a covered terraced area at the front of the house. Inspection reports are avaialble on request from the homeowner. The current range of fees charged is £381-£450 per week. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star.This means that people who use this service experience adequate quality outcomes. This inspection was undertaken by one inspector over the course of 8 hours on one day. during this time we spoke with people living at the home and staff. We also spent time observing the care and attention given to people by staff. Prior to this inspection we sent questionnaires to 10 people living at the home and 5 staff. Five questionaiires were returned by those living at the home and 5 from staff. Their comments and views have been included in this report and helped us to make a judgement about the service provided at Summerhayes. Care Homes for Older People Page 6 of 34 To help us understand the experiences of people living at this home we looked closely at the care planned and delivered to 3 people. Most of those living at the home were seen or spoken with during the course of our visit and three people were spoken to in depth to hear about their experience of living at the home. We also spoke to staff including the manager. A tour of the premisies was made and we inspected a number of records including assessments, care plans and records relating to medication, recruitment and health and safety. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk. Copies of the inspection report are available from the office. What the care home does well: What has improved since the last inspection? What they could do better: Three requirements and 10 recommendations for good practice were made as a result of this inspection. Adequate precautions against the risk of fire are currently not being undertaken at the home. People employed by the registered person to work at the care home have not received training appropriate to the work they are to perform. Contracts are not given to all people when they are admitted to the service, to ensure Care Homes for Older People Page 8 of 34 they are aware of their rights and responsibilities. Assessments of peoples individual needs are not consistently recorded. Care planning is not being undertaken in a person focused way. Individuals are not consistently being involved in the initial drawing up of their care plans or in reviews, or consulted about any changes made. Care planning not not consistently record assessments of identified risks and how these may be minimised. Arrangements made for the recording, handling and safe administration of medicines received into the care home are not being followed by all staff involved in the management of medications at the home. Recreational interests are not being provided to meet all peoples individual needs. A record of all complaints, including details of investigation and any action taken, has not been maintained. Laundry floor finishes are not impermeable and wall finishes are not easy to clean. The manager has not yet undertaken an appropriate management qualification. Since this inspection was carried out the manager has undertaken, and sent the Commission a copy of, a detailed, comprehensive plan relating to actions already taken and those planned, to meet the requirements and recommendations made as a result of the inspection. 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 34 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 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has developed a system, which will ensure that peoples needs are assessed before they make a decision to make it their home. The home does not admit people for intermediate care. Evidence: The homes Statement of Purpose is available in the entrance hall of the home. It has been updated to include relevant information about Summerhayes since the home was taken over by the current owners 6 months ago. Information received before this inspection indicated that the new providers plan to incorporate the views of people living at the home in the Statement of Purpose. In response to questionnaires returned by 3 living at the home, and a relative at the time of this inspection, all confirmed they had received sufficient information about the Care Homes for Older People Page 11 of 34 Evidence: service before deciding to make Summerhayes their home. However, only one person confirmed that they had received contracts or terms and conditions when they moved to the home. We looked at the admission details for a person who had recently moved to the home and although we saw a contract, signed by the manager, the person agreeing to the contract had not signed this. This means that people may be at risk of not being made fully aware of their rights when they move into the home. We did see completed contracts agreed by the previous owners and some other people living at the home. Included in information received prior to this inspection, the manager confirmed that they intend to review and update current contracts/ terms and conditions. We were told that the homes policy is that no person will be admitted to the home before a detailed assessment of his or her health, social and welfare needs has been undertaken. The manager told us she would visit the person concerned at their home or in hospital to carry out an assessment of their health, social and welfare needs. This is to make sure that peoples individual needs can be fully met at the home. This includes making sure that staff knowledge and experience, environment and equipment are sufficient to meet the peoples needs. Meetings would be held with those also involved in the care of individuals such as care managers, other health care professionals and family to make sure that all relevant information is gathered. As part of this inspection we looked at the admission procedure for a person who had recently decided to make Summerhayes their home. An assessment of their individual needs had been undertaken by a community based health care professional before they moved to the home. The manager told us they had also visited the person at home and undertook an assessment of their needs but this was not recorded. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Continued improvements to the information recorded in individual plans of care would ensure that care is delivered in a person centred way. Peoples health needs are well met helping to protect peoples welfare. Medication practice has improved but some practices could place people at risk. People feel they are treated with respect and that caring staff uphold their privacy. Evidence: All eight members of staff who responded to questionnaires confirmed that they are always given up to date information about the needs of the people they care for and support at Summerhayes. All three people currently living at the home who responded to questionnaires confirmed they always received the care, support and medical support they need at Care Homes for Older People Page 13 of 34 Evidence: Summerhayes. Comments made included Dad is happy and content and We, as a family are very happy with mums care at Summerhayes. We like the home from home atmosphere. Since taking over ownership of Summerhayes in June 2008 the manager, who is also one of the owners, has invested in a computerised care management system to improve all documentation including assessment and care planning as well as many aspects of the daily operations of the home. As part of this inspection we looked closely at the homes system for planning care for 3 people. We saw care plans that had been generated by the computerised system. We were told that plans of care are developed by the computer system in response to an extensive detailed questionnaire being completed with relevant, up to date information about individuals. A plan of needs, and how these may be met, is then developed, which also includes individual assessments of any associated risks. Plans of care were very easy to read as they were computerised, were clearly laid out and clearly described individual needs. However, they did not include any strengths or abilities individuals have, or any goals or aims for individuals to strive for. For example how much help do they want or need in relation to personal care, what can they do for themselves or what degree of privacy would they like. One person had been assessed by a community health care professional prior to moving into the home. However, information recorded in the assessment had not been included in the persons plan of care. Information included that the person had poor circulation in their legs and that they also experienced pain, but this had not been recorded on their care plan. We also noted that the person was potentially put at risk of harm by being given a hot water bottle on 3 occasions. The risk of scalding had not been assessed or alternative measures to making sure the person was comfortable considered. Some information in the same plan of care was also conflicting. For example the plan indicated that the person did not suffer a particular medical problem but elsewhere it was assessed that they did. When looking through a persons file we noted some very informative details, which was not signed or dated, but this information had not been included in the persons plan of care. This information included important details relating to the persons past medical history. This means that the person is at risk of their needs not being met. Individual plans of care did not include information to enable staff to carry out care in Care Homes for Older People Page 14 of 34 Evidence: a person centred way. For instance, no details relating to what, why, when or by whom assistance should be provided was recorded. Daily reports are recorded in individual computerised plans of care. We looked at the daily reports for the 3 whose plans we had looked closely at. All were up to date and related to care that had been carried out, some activities taken part in and to individuals general state of health. However, we also noted that some daily reports, which had been hand written, referred only to what staff had done to the individual. For example Creamed, padded, dressed with no mention of choice or involvement of the individual. None of the people we spoke to during this inspection were aware they had a plan of care or that they should be involved in reviews or any changes made. When asked if they were aware of or had been involved in reviewing their relatives plan of care a relative confirmed they had seen the plans as they are kept in individuals rooms and can be referred to easily. Care planning is currently not particularly individualised but the manager is aware of this and aims to develop the relatively new computer system to fully reflect individualised needs and choices. All of the people living at the home that we spoke to were more than happy with the level of care they receive at the home. We were told that they could see their GP when needed and have access to other health care professionals such as chiropodists, dentists and community nurses. Medication is generally well managed at the home. Medication is supplied by a local pharmacy in individualised blister packs. These are stored in a locked cupboard at the home and a record is kept of all medications no longer required at the home and are returned to the pharmacy. Since taking over the home the providers have bought and installed a secure drugs cupboard and a Controlled Drugs cupboard in a locked outer cupboard which is bolted to the wall. This means that medication is safely stored at the home. We looked at the homes medication records. Most were accurate and up to date but some improvements are needed. Daily records indicated that records might be signed when staff actually hand out medication but not as a confirmation that it has actually been taken by the individual. For example in one persons daily record we noted Finding pain killers around the place, not taken. This procedure potentially puts people at risk of not taking Care Homes for Older People Page 15 of 34 Evidence: medication as prescribed. A senior member of staff told us that records are not signed until medication has been given just in case someone refuses. This would demonstrate good practice. We noted that medication such as antibiotics, or other medication that were prescribed for an acute situation, were hand written on to medication records but had not been signed for when received at the home or checked by two staff to ensure accuracy. This potentially puts people at risk of not receiving medication as prescribed. Alterations had been made to some records when dosages or frequency of administration of prescribed medications had been made. This had been done by crossing out the original directions and writing in amended instructions. The changes had not been witnessed and signed by two members of staff to confirm accuracy. We asked a member of staff why the changes had been made. We were told the circumstances and also showed a record of the changes recorded in a daily diary. However, details relating to this change had not been recorded in the persons plan of care. This practice potentially puts people at risk of not receiving medication as prescribed. We looked at the homes system for recording Controlled Drugs at the home. Individual hard backed notebooks are maintained to record the administration for each person currently prescribed Controlled Drugs at the home. However, there was no record of receipt of the medication when received at the home. This means the home would be unable to audit medication received at the home. When walking around the home we noted several containers of prescribed creams, ointments or lotions that had been opened with no indication of the date beyond which they should not be used. This means that people may be using creams that are not effective, as they have passed their shelf life. None of those currently living at the home look after their own medication. People told us they were more than happy for the staff to take care of my medicines and one less thing I have to worry about. People told us they received their medication at the prescribed times, were always given a drink with it and staff are always so patient as I cant be rushed. We were told the home has a close working relationship with the pharmacy that supplies medications to the home. A pharmacist visits the home and undertakes regular checks of the medication and policies and procedures being followed at the home. Care Homes for Older People Page 16 of 34 Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here benefit from having easy contact with their friends and family and from a varied and wholesome diet. Activities are provided at the home, which many people can join in, but this may not provide adequate stimulation and interest for all people currently living at the Home. Evidence: People benefit from flexible routines at the home and being supported to exercise control over their daily lives. People told us they choose the way they wish to live their lives, they can choose when they wish to get up, go to bed, have their breakfast, observe their religious beliefs, receive visitors and make informed choices about their health and medication. Social activities generally meet peoples expectations and preferences and people enjoy a balanced diet which takes into account the likes and dislikes of individuals. People benefit from being encouraged and supported to maintain contact with family and friends. The home has an open door policy and relatives, visitors and friends are Care Homes for Older People Page 18 of 34 Evidence: welcome at any time, made to feel welcome and have a meal if they wish. Throughout the day of this inspection relatives and friends visited the home and were welcomed and made to feel at home by all those living there and staff. We were told that Summerhayes is like a home from home. People told us they are encouraged and supported to live their lives as they wish. They said they can choose when they get up and go to bed, come and go, receive visitors and to make informed choices in relation to their general health, treatment or medication. During this inspection several people decided to go out into the garden for a walk as a group and one person walked into the nearby village. The majority of people living at Summerhayes had spent a large part of their lives in the village and have maintained links with the community. One person told us they had known several of the staff from when they were children being brought up in the village. This knowledge and familiarity gave an inclusive, family like atmosphere at the home that was very comfortable. People living at Summerhayes are given the choice of being served their meals either in their rooms or in the comfortable dining room. Since taking over management of the home the providers have employed a chef and menus have been redesigned as well as improving presentation of meals. All living at the home now has complete choice of healthy and nutritious food. Menus have been designed specifically to meet individual choices, which has been done by asking people living at the home what they would like. Menus are available for all people living at the home to see a week in advance and are also provided on dining room tables to remind people of their choice at the time of a meal. The manager aims to provide as much choice as possible at meal times. This is being achieved by people being offered a choice of two main dishes at lunchtime and a hot dish in the evening as an extra choice to sandwiches, promoting a 5 a day rule by ensuring fresh fruit and vegetables are automatically given at every meal. When we arrived at the home we heard people being reminded what was being served at lunchtime and asked if they wanted an alternative. Lunch served during this inspection was well presented and staff supported people, needing assistance with eating, sensitively and discreetly. All of those spoken to during this inspection praised the quality and variety of the meals served at the home. People living at the home are encouraged to have a good fluid intake. Hot and cold drinks are available throughout the day and water jugs are always available in every room, changed daily by housekeeper. Care Homes for Older People Page 19 of 34 Evidence: Comments made by staff in response to questionnaires included Since taking over by the new management the changes have been really good. Food wise the residents have a lot more choice, and lots of FRESH fruit and vegetable. The manager told us that the service has begun to introduce some structured entertainment including an entertainer, bingo, group aromatherapy, tea parties as well as buying some games and puzzles. However, during this inspection no organised activities were undertaken. Some people sat in the comfortable sitting room watching TV, another small group sat in the dining room chatting and speaking to visitors, whilst listening to the radio. Several people are able to go out for walks by themselves and others chose to stay in the comfort of their own rooms. Comments received prior to this inspection included (my relative) is 92, registered blind and deaf and therefore unable to partake in any activity. In response to the question what do you think the service does well comments included It gives maximum choice to people maintaining their lifestyles and well being in an environment that gives excellent standards of care. In response to what could the home do better staff commented Activities for the residents. The new owners have got it on their list to do and they could offer more activities within the home, games and exercise. They could be given more opportunities to enjoy days out and spend time out of home. Rearranging furniture and providing comfortable armchairs in the dining room have created a separate quiet sitting area for those not wishing to watch television. We were told by people enjoying this arrangement this has been a great success and provided a comfortable cosy area to chat. Care Homes for Older People Page 20 of 34 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 living at the home and relatives are assured their concerns or complaints will be dealt with appropriately through a satisfactory complaints procedure. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring people living at the home are protected. Evidence: The home has a complaints procedure clearly displayed on a notice board in the entrance hall of the home and a complaints book where people can make any complaints or issues known, anonymously if preferred. No complaints had been recorded since 2005. Information received prior to this inspection indicated that 2 complaints had been made during the last 12 months; both had been resolved within the time scale included in the homes complaint procedure, one had been upheld A complaint had been made to the manager and to the CSCI but this had not been recorded and no records of the actions taken by the home in respect of this complaint were available. The manager had responded to the complainant at the time of the initial complaint and again, and the Commission, following our involvement in the issue. Care Homes for Older People Page 21 of 34 Evidence: During discussions, people said that they felt comfortable speaking with staff about any grumbles and would report any complaints to the manager but had not had cause to. Staff confirmed that they know the importance of taking peoples views seriously and of listening and responding to any issues raised. Staff said they would report back to the manager or supervisor any requests, comments or complaints made by people living at the home. People spoken to said they feel safe and secure living at Summerhayes, staff are generally kind very helpful, respectful and that nothing was ever too much trouble for them. Although Safeguarding Adults training has not been provided at the home for some time staff were able to discuss different forms of abuse and all confirmed they would not hesitate to report any suspicion of poor practice. Care Homes for Older People Page 22 of 34 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 benefit from living in a home that has a family atmosphere. Evidence: Individual rooms were homely, many were personalised and all were reasonably decorated and fresh. People are encouraged to bring in personal items to make their room cosy and precious to them. The dining room is light, airy and spacious with space for people to move around. Tables were laid nicely with tablecloths, individual napkins, good quality cutlery, glasses cruets and flowers. The sitting room was comfortably furnished with new easy chairs and a wide screen TV. The gardens are a particular feature of Summerhayes and are well tended. Seating and shade, is provided at various spots in the garden. People told us of the pleasure they get from sitting or walking, on the covered veranda or by just looking at the various trees, shrubs and flowers and watching the seasons change. Care Homes for Older People Page 23 of 34 Evidence: A programme of refurbishment has taken place since the last inspection including redecoration of the entrance hall, sitting room, toilet areas and several bedrooms, which have been redecorated and had carpets and curtains replaced. At the time of this inspection the home was bright, clean and fresh. A ramp has been installed to enable a wheelchair user to visit a ground floor bathroom independently. (Previously staff had to lift a wheelchair up some steps for the person to be able to achieve this). The ramp is outside a persons room and means that the ramp itself presents a step when entering or leaving this room. Also, when people who are able to walk on this ramp, including staff, are at risk of slipping off, as it is not the full width of the steps. We asked whether risk assessments had been undertaken to ensure that people were not at risk and were told that none had been undertaken. The ramp is not permanent and can be used only when necessary. A fire door, which should be kept closed at all times to prevent the spread of a fire and therefore keep people safe, was propped open. This means that people living at the home are potentially at risk of harm. We discussed this with the manager and were told that a person at the home insisted the door was kept open and propped it open. The manager agreed to ensure the door is kept shut and will consult with the appropriate services to ensure that arrangements are made to keep people safe. (Refer to standard 38). Peoples laundry is managed on the premises. The laundry is well equipped but improvement to the flooring and wall covering is needed to ensure they are easily cleanable. Staff spoken to described procedures followed at the home to prevent cross infection and to maintain adequate hygiene. They spoke about wearing protective gloves and aprons and how these are disposed of. They also spoke about the procedure followed when undertaking laundry tasks. All of the procedures met with current good practice guidelines. Care Homes for Older People Page 24 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home currently provides adequate staffing to meet the needs of the people living at Summerhayes. An effective system to ensure that all staff are trained and updated to meet the needs of people living at the home has not yet been established. The homes recruitment practices are not consistently followed and do not support or protect people living at the home. Evidence: The manager aims to be available at the home throughout the day as well as 2 members of care staff, a housekeeper and a chef. During the night one care staff is on duty at the home and the manager is available on call. The manager said there are times when more staff are on duty to assist with other activities for people living at the home. In response to questionnaires 5 staff confirmed there were always, 2 usually and 1 sometimes enough staff on duty to meet peoples care needs. One member of staff commented This area is improved by the recent new employment role of a housekeeper which enables care staff to deliver and maintain the individuals well being Care Homes for Older People Page 25 of 34 Evidence: and lifestyles. Eight staff confirmed that current methods of ensuring that information is delivered to all staff always or usually works well. Comments received included this has always been a very good area but the introduction of a staff communication diary recently, I feel, is a very good back up to what is a very good service between staff and care manager. Currently 12 female care staff are employed at the home to care for 10 females and 4 males. The manager told us that they are currently looking to recruit another 2 carers and are hoping to that some males may apply and be suitable to be employed at the home. This means that people living at the home will be given a choice of who cares for them. Recruitment records were well maintained but documentation confirmed that the homes recruitment procedures had not been followed consistently. We were told that before appointing staff at the home two written references and police checks are obtained for all new employees prior to commencing in post. Since taking over the home the providers have ensured that all staff, employed prior them taking over the service, have completed police checks. We looked at the recruitment files for 4 recently employed staff. Documentation was poor. Completed police checks had been obtained for 2 staff, but this had not been obtained until after the staff had started employment at the home. No police checks had been applied for 2 staff, application forms had been completed for only 3 of the staff, files did not include proof of identity and only 2 files included 2 references as required. This potentially puts those living at the home at risk of being cared for by staff that has not been recruited through a robust recruitment procedure. The manager had identified the aim of producing a procedure check list for all recruitment in information received prior to this inspection. All newly recruited staff undertake induction training within the first month of employment at the home. The training includes familiarisation with the home, cleaning and laundry management, administration and storage of medication, preparation of food, fire drills, health and safety and policies and procedures. Individual induction training records are maintained. We looked at one training record and although a senior member of care staff had signed to confirm that training had been provided individual staff had not signed to confirm they had received and understood the Care Homes for Older People Page 26 of 34 Evidence: training. We received responses to questionnaires, sent prior to this inspection, from 8 staff. All confirmed that their induction covered everything they need to know to enable them to do the job when they started at the home. In response to questionnaires 5 staff confirmed they always and 3 usually have the right support, experience and knowledge to meet the different needs of people using service. They also confirmed that they are receiving training that is relevant to their role, helps them understand and meet individual needs of people living at the home and keeps them up to date with new ways of working. We looked at the files for 3 staff during this inspection. One included evidence that the member of staff had attended manual handling training in April 2008, which complies with requirements and that they had received training in diabetes and dementia but no evidence when. We saw no evidence of training in the files of the other 2 staff; one person had not received any training during the previous 3 years. The manager told us that staff training is a priority, but that due to staff shortages when they first took the home over this has not always been possible. The priority has been that care is delivered to those living at the home. We were told that training was all in hand. One carer is about to undertake a nationally recognised qualification (NVQ) at level 3 and another carer an NVQ at level 2. Staff comments included An NVQ qualification was an excellent way of learning In response to questionnaires, 3 people living at Summerhayes confirmed that staff are always available when needed and staff listen and act on what is said to them. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from the managers approach, which is open and friendly. On the whole, people can be confident that their views will be sought and acted on. Arrangements are in place to safeguard peoples finances. Health and safety of the building is generally satisfactory, but without adequate staff training and other arrangements, people could be placed at risk. Evidence: Mr & Mrs Mason were registered with the CSCI as providers of Summerhayes in June 2008 and although the home has recently gone through a number of changes people living there and staff have dealt with the changes well. Mrs Mason is also the registered manager of the service. Mrs Mason is a Registered General nurse, has also achieved a BSC (hons) in nursing studies since qualifying and has worked as a senior Care Homes for Older People Page 28 of 34 Evidence: nurse managing care. Her last job involved project managing the introduction of part of the NSF framework for Older People. Mrs Mason told us that she is planning to undertake a Registered Manager Award when she has sourced a training provider. Mrs Mason told us that she keeps herself updated in respect of good practice in care homes in a number of ways including accessing the Department of Health website, seeking information from Social Services, and networking with other homes. She also referred to keeping herself up to date professionally through reading nursing journals and using the Internet. Mrs Mason discussed how the service planned to promote equality and diversity for people living at the home and staff, emphasising individuality, choice, having a voice, meeting cultural and religious needs, and decision making for individuals. Mrs Mason also talked of equal opportunities, supporting staff career development, and providing an open and respectful environment for staff to share their views. People spoken to during this inspection confirmed they are listened to and their opinions and views are sought and taken seriously by staff and the manager. This is done through regular residents meetings, which are held every 2-3 months, records of which are documented. The manager told us that due to the size of the home people are consulted on all aspects of their life at Summerhayes on a daily basis when staff chat with them. Mrs Mason told us she intends to ask for opinions and make sure that people know that staff and management are open for any comments. As Summerhayes is their home also, Mr & Mrs Mason aim to develop close and informal relationships with the people who have made it their home. Mrs Mason told us that formal questionnaires will be sent to people living at the home, their relatives, visitors and other visiting health professionals to ensure that the home is run in the best interest of those living there. Mrs Mason said she is very visible and operates an open door policy, which encourages good communication and standards. Records looked at during this inspection included, individual plans of care, including risk assessments, daily reports and monitoring records, administration of medicine records, staff files and rotas, menus, complaint records, fire log and records of accidents at the home. Most records were well maintained and were securely stored. Some records of medication, including the Controlled Drugs Register were not accurate. The home does not deal with peoples personal finances. Any outgoings such as chiropody or hairdressing are paid by the home and individuals or those who deal with Care Homes for Older People Page 29 of 34 Evidence: their finances are sent a monthly account. People living at the home are currently not fully protected from harm by the homes procedures for the prevention of fire. We saw a fire door propped open, fire training had not been undertaken as required and the homes fire risk assessment was not up to date. We discussed this with the manager who immediately took action to ensure that a fire door was shut. Following this inspection we contacted Devon Fire and Rescue who will contact the home and discuss fire prevention measures to ensure that people living there are safe. Staff have not received up to date first aid, food hygiene or moving and handling training. This potentially puts people living at the home at risk of their needs not being met. The manager told us that establishing a training programme for all staff at the home is a priority. Records kept at the home are stored securely in locked cupboards. We were told that peoples individual records would be made available to them, or their representative, if they wished. Windows checked on the first floor had been restricted to prevent accidents, and radiators were covered to prevent burns. The risks associated to the use of a ramp, (being used to maintain a persons independence at the home) or ways to minimise the risks, had not been assessed. This potentially puts people who use it at risk. Any accident involving people living or working at the home are recorded. This information is currently held in one file rather than in individual files. This procedure does not meet current Data Protection guidelines. Information received before this inspection showed maintenance or servicing of gas and electrical systems was up-to-date. Also that other equipment, such as hoists, was serviced regularly. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 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 38 19 The registered person shall 24/02/2009 not employ a person to work at the care home unless the information and records specified in paragraph 1-9 of schedule 2 have been obtained. To ensure that people living at the home are protected by the recruitment procedure. 2 38 23 The registered person shall after consultation with the fire authority take adequate precautions against the risk of fire. To ensure that people living at the home are protected from the risk of fire. 23/01/2009 3 38 18 People employed by the registered person to work at the care home must receive training appropriate to the work they are to perform. 24/02/2009 Care Homes for Older People Page 32 of 34 To ensure that the needs of those people living at the home can be met by competent staff. 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 2 Contracts should be given to all people when they are admitted to the service, to ensure thay are aware of their rights and responsibilities. Assessments of peoples individual needs should be recorded. Improvement should continue to ensure that care planning is undertaken in a person focused way. Individuals should be involved in the initial drawing up of their care plans and in reviews, and consulted about any changes made. Care planning should involve assessments of identified risks and how these may be minimised. (This relates to the use of a hot water bottle for a person with poor circulation). 2 3 3 7 4 9 Arrangements made for the recording, handling and safe administration of medicines received into the care home should be followed by all staff involved in the management of medications at the home. Recreational interests should be provided to meet all peoples individual needs. A record of all complaints made should be recorded including details of investigation and any action taken. Laundry floor finishes should be impermeable and wall finishes easy to clean. All staff should receive training to enable them to meet the assessed needs of people living at the home. The manager should continue with their plans to undertake an appropriate management qualification. 5 6 7 8 9 12 16 26 30 31 Care Homes for Older People Page 33 of 34 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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