Inspection on 11/11/08 for Sunningdale House, Perranporth

This inspection was carried out on 11th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunningdale House, Perranporth 16/03/09

Sunningdale House, Perranporth 28/11/07

Sunningdale House, Perranporth 27/06/06

Sunningdale House, Perranporth 08/02/06

Sunningdale House, Perranporth 29/04/05

Sunningdale House, Perranporth 03/11/04

Sunningdale House, Perranporth 13/08/04

Sunningdale House, Perranporth 27/05/04

Sunningdale House, Perranporth 24/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sunningdale House, Perranporth Boscawen Road Perranporth Cornwall TR6 0EP     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: Melanie Hutton     Date: 1 9 1 1 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 © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Sunningdale House, Perranporth Boscawen Road Perranporth Cornwall TR6 0EP 01872571151 01872572633 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Welling Limited care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: One service user may be admitted aged 55 years to 64 years Date of last inspection Brief description of the care home The registered provider for Sunningdale House is Welling Ltd; the responsible individual is Mr Alan Beale. Sunningdale House provides care for up to 36 older people. This includes registration for six people with dementia and six people with a mental disorder. The Registered Manager Alison Watson is due to become an Area Manager for the company. There is a new Manager Joanne Cauchi, who is due to make her application to become the Registered Manager. The home is situated near the centre of Perranporth with easy access to shops and other local community facilities. The home has a front garden with seating provision overlooking the boating lake. The car park is steeply sloping and there is ramped access from this to the main entrance. There is a passenger lift to the bedrooms on the first floor. The majority of bedrooms in the home Care Homes for Older People Page 4 of 33 Over 65 6 6 36 0 0 0 Brief description of the care home are en suite. The home has a choice of communal areas including a sun lounge. The home provides some day and respite care. The front door to the home is locked at all times. The visiting arrangements are flexible. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place over two days on the 19 and 27 November 2008. On the first day two inspectors were present, with one completing the second day. We received an Annual Quality Assurance Assessment (AQAA) prior to the inspection which gave us brief information about the service provided. We sent out quality assurance surveys to people who use the service and the staff. Ten surveys were completed either by or on behalf of people who use the service. Six staff members returned completed surveys to us. The last inspection of this service was a random inspection which was conducted on 23rd July 2008. Since the last inspection a new manager has commenced duties at the home. We were told that the registered manager is due to begin a new role within the organization. Care Homes for Older People Page 6 of 33 We were told that people who use the service are generally referred to as residents. Two people who use the service confirmed this. For the purpose of this inspection we shall respect this terminology. What the care home does well: What has improved since the last inspection? What they could do better: 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 8 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 9 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 statement of purpose and service users guide provides sufficient information, to enable people to make an informed choice about the home. Detailed care needs assessments are undertaken by the home to ensure that they can meet prospective residents care needs. Evidence: The home has the current certificate of registration displayed on the wall behind the reception desk in the entrance to the home. The statement of purpose and service users guide for the home have been reviewed and updated since the last inspection when requirements were made regarding these documents. The statement of purpose and service users guide are combined to form one document. The registered provider told us that people who use the service and / or their representatives are given this document and it is available within the home. This does not appear to have been the case for all current residents and people who Care Homes for Older People Page 10 of 33 Evidence: have previously used the service based on comments we have received from some relatives and representatives. We discussed with the registered provider the way in which the outcome of the residents survey summer / Autumn 2008 has been presented. This is not particularly user friendly, which the registered provider agreed with and stated that work is underway to address the way this information is provided to people. The manager told us that the home obtains a summary of potential residents care needs from the referring body e.g. Department of Adult Social Care (DASC) or health, prior to agreeing to provide care to the person. A pre admission care needs assessment is undertaken by the manager prior to the person moving into the home, whenever possible. On the first day of inspection, the manager visited a person in thier own home and completed a pre admission assessment. Records inspected identified that care needs assessments are in place for residents and that these assessments and are sufficiently detailed to form the basis of the care plan. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans must continue to be reviewed and developed in order to fully direct and inform staff of the action they must take to meet residents assessed care needs. The privacy and dignity of residents is respected. Evidence: The manager told us that a planned programme is in place to review and update all care plans within the home. She advised that this is expected to be completed by the end of November 2008. A requirement was made at the last inspection regarding care planning. During case tracking of residents records, we inspected a number of care plans. The care plan documentation now includes an overview of the resident and their care needs, followed by specific care plan documentation for particular care needs e.g. personal care, agitation. The care plans do not always provide full information and guidance to staff regarding residents individual needs, choices and preferences. For instance, some care plans did not reflect the persons preference of a bath or shower or the frequency they would like Care Homes for Older People Page 12 of 33 Evidence: this to take place. It was not always clear within care plans, particularly around personal care, how the residents independence could be promoted and encouraged. Where residents may have an issue with continence, the care plans do not always identify the type of pad worn and when or how the persons continence may be promoted. Some care plans showed evidence of the residents or their representatives involvement in the planning and others did not. We have been advised by some residents and/or their representatives that they feel they have had limited involvement in the development of their care plan. During discussion with the manager we heard that she is committed to the involvement of residents, their representatives and external professionals within this process. When developing care plans staff must take care to sign and date each care plan, it was noted during the inspection that some did not evidence this information. Residents commented on the care they receive including the staff are very kind and helpful, I am well looked after here and the staff are mostly lovely. Two people commented on differing attitudes of staff and whilst did not complain about how they are treated mentioned that some staff can be a bit sharp to me and some staff are better carers than others. It was evident from the residents records that external professionals access the home to meet their health needs e.g. community nurses, general practitioners, community psychiatric nurse, optician. We saw that brief information is recorded during the care needs assessment of residents nutritional needs and any specific detail incorporated into the care plan. The manager was able to show us that she has introduced a system for ensuring that appropriate action will be taken for any resident experiencing weight gain or loss. Limited information was evidenced to show that continence assessments have been undertaken, are up to date and show the type of incontinence pad used by individual residents and when they need support with managing their continence. The team leaders administer or assist residents with their medication. We were told by the team leader on duty that they have been provided with medication training and also that further training regarding medication has been booked and is due to take place next week. Individual medication administration records (MAR) are in place for each resident and these were up to date and are completed by the person administering the medication. A system is in place to show medicines received into and out of the care home. Care Homes for Older People Page 13 of 33 Evidence: The medication within the home is stored securely in a locked clinical room. A medication trolley is stored within this room and then used to transport medication throughout the home. A second medicines trolley was observed on the first floor in a corridor. This was not attached to the wall but we were told it is no longer in use and empty, this is because only one trolley is used now that the passenger lift has been installed. A medication fridge is located within the staff room and is locked. The daily temperatures of the fridge are recorded. We were told that it is planned to move this fridge to the clinical room. It was observed that a urine sample was being stored in this fridge. The guidelines from the Royal Pharmaceutical Society of Great Britain regarding Handling Medicines in Social Care advise that the medication fridge should be used only for medicines. Residents told us during the inspection that they felt their privacy and dignity was generally respected. Within surveys people said that the staff listen to them and act on what they say. The preferred form of address for each resident is recorded and we heard staff using these names. Staff knock and were seen to wait prior to entering bedrooms. Residents receive their post unopened and we saw one member of staff helping a resident with their mail. While each room has a lock, with some residents holding their own key, some of the locking mechanisms are stiff and prove difficult to use. Care Homes for Older People Page 14 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. Residents are enabled to make choices about their daily lives. Residents are provided with a wholesome and appealing diet and can choose when and where to take their meal. Evidence: A programme of activities is in place for residents. A member of staff (also the maintenance person) spends time in the afternoon leading activities. An arts and crafts session and music and movement is provided by an external person. The manager was able to tell us how the residents have been involved in a review of the activities programme for the home. Residents life stories are being collated with the assistance of family and friends and residents have been asked what activities they would prefer. As a result of this process, bingo has been included in the programme and a bingo game took place on the afternoon of the inspection. Care staff are advised to record more fully around activities that people take part in. A number of residents were able to partake in a trip to a local garden centre and one resident told us how much they enjoyed this trip out. Another person told us how they like to walk to the local shops when staff are able to take them. We understood from this person that this depended upon the staffing levels within the home. It would be good practice to display or Care Homes for Older People Page 15 of 33 Evidence: provide information to people about the forthcoming activities, some residents we spoke with were not clear about the activities currently and planned to be provided. We discussed this with the manager who stated it was in hand and being addressed. Visitors are welcomed to the home and the visitors book shows that the home receives many visitors. Visitors are assisted by a staff member to get in and out of the home as the front door is secured and opened by a key pad. Residents told us that they were able to choose when to go to bed and when to get up. We observed that a resident was able to choose when to have their main meal of the day, this was to fit in with their planned activity of an outing with family. Rooms were observed to contain personal possessions. A menu board has been put up on the wall near the dining room. We were told that this is changed daily to reflect the main and evening meal of each day. Two residents made positive comments to us about this board. The menus are planned on a four week rota. The chef told us that he is due to update the menus and plans to include more winter foods e.g casseroles and stews. A record of the food provided to each resident is maintained. There is a choice at each meal and the main choice of lunch on the day of the inspection was home cooked ham, roast potatoes and a selection of vegetables. We observed two residents eating a chicken curry. The meal sizes were generous and people appeared to be enjoying their meal. Residents that we spoke with after lunch told us that the food was generally very nice. One person said the food is very good, it couldnt be better and sometimes we have two hot meals a day. Another person said sometimes the meal is better than others but I generally like it all Staff were available to help residents with their meal and were observed sitting next to people and helping them in an unhurried manner. The chef told us that since the last inspection he has completed the intermediate level 2 food hygiene certificate. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are aware of who to make a complaint to should they need to. In order to safeguard residents against abuse, training must be provided to all staff that reflects the local multi agency policies and procedures. Evidence: The registered provider has included details of the complaints procedure within the service user guide / statement of purpose. Since the last inspection the home has received nine complaints that are reflected within the complaints log. This log also identifies the action taken to resolve the complaints. Between the two days of inspection the manager told us that a verbal complaint had been made and dealt with promptly. Since the last key inspection dated November 07, we have received 4 concerns about this service from relatives / representatives of residents. The issues around these concerns are contained within the random inspection report dated 23 July 2008. We were told by residents, that since the manager has been in post she has met with them individually and advised them that if they have any concerns or complaints to speak with her. There is a procedure for safeguarding adults that includes whistlelblowing and restraint. The home also has a copy of the local multi agency procedures available. We saw training records for most staff regarding safeguarding adults and No Secrets. One newer member of staff did not have evidence relating to this on file. Discussion with Care Homes for Older People Page 17 of 33 Evidence: staff evidenced that some were not fully aware of the procedures around safeguarding adults, but all were clear that should they observe or suspect any abuse they would report this to the manager. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The communal and private areas of the home are comfortable and homely. Further risk assessments must be undertaken to ensure that all parts of the home that residents have access to are safe. Evidence: Sunningdale House is located in a pleasant residential area near the centre of Perranporth, with the local facilities and services nearby. The main reception area and corridors are spacious, attractive and well-maintained. The car park at the front is very steeply sloping to the front door. There is a ramp from here to the main entrance, which has a small step for people using wheelchairs or have poor mobility. Many of the rooms on the ground floor have doors that open out onto the communal paved patio area, which circles the home. The home overlooks the boating lake. An area of garden at the front of the home has been developed and now provides attractive and pleasant seating areas that are secure for residents to use, accessible from the dining room. Residents made positive comments to us about this area. The front door to the home is locked, residents and relatives / representatives require assistance to gain entry or to leave the home. There is a flat on the second floor which is not registered, this is used to accommodate staff. There is no designated separate entrance and tenants walk through the main area of the home. On the second day of this inspection it was noted that an empty room had belongings in e.g. suitcase and clothes in it. The Care Homes for Older People Page 19 of 33 Evidence: manager told us that one member of staff was using this room to change in. On the second day of this inspection, the fire officers were visiting the home and told us verbally that a previous enforcement notice had been complied with and would be lifted. The home provides residents with a choice of seating areas. The main communal areas are interconnecting and offer four lounge / seating areas accessed by doors and in one case an arch way. There is a spacious and attractive dining room, with additional dining provision between the lounge and dining room. A separate sun room is available which some people enjoy using. Since the last inspection a small lounge off the reception area has been converted into an ensuite bedroom - this is not yet being used. The registered provider told us that this will not affect the registration of the home as they do not use the registered double rooms for single people. All of the communal areas are accessible to residents as they are all on the level. The communal areas of the home are attractively furnished and decorated. There are toilets located throughout the home and these are clearly signed. The majority of the rooms are ensuite, those that are not have a toilet close by. Assisted bathing facilities are located on each floor and some ensuite rooms have a shower facility. Aids were observed throughout the home e.g. grab rails, hand rails and hoists. On the first floor, hoists were observed to be stored in an alcove in the corridor. During the course of the inspection it was noted that the hoists were partially blocking a fire exit. This was discussed with the manager and the issue addressed. Personal accommodation was homely and comfortable. A process of maintenance and redecoration is being carried out at present and during this inspection we observed two bedrooms being redecorated. The manager told us how the residents have been involved in the choice of colours and furnishings. New bedroom furniture has been purchased for some rooms which is attractive and domestic in nature. All bedrooms have been provided with new tables. Several residents were pleased to show us new bed covers that have been purchased for their rooms. One resident and their visitor were complimentary about the redecoration of their bedroom. Some rooms did not have an attachment for the call bell so would not always be able to summons help from the bed or chair. If there is an identified reason as to why the person has not been provided with an extension cable for the cal bell, this should be clearly identified within the residents risk assessment. We discussed this with the registered provider and manager. Individual rooms have a door lock and residents are provided with a key if they request this or unless their risk assessment suggests otherwise. We noted that some of the locks are very stiff and difficult to open from the inside - we discussed this with the registered provider. One resident we spoke with holds their own key and values being able to secure their room when leaving it. Currently the majority of Care Homes for Older People Page 20 of 33 Evidence: rooms do not have access to secure storage facilities. The new bedroom furniture that is being purchased to replace the existing, provides a lockable drawer. All of the rooms in the home are naturally lighted and ventilated with windows that have restrictors applied. The home is centrally heated and radiators have individual thermostatic controls. Most radiators in bedrooms are guarded to ensure that residents are not at risk of burns from hot surfaces. It was noted that some hot surfaces are accessible within the home e.g. radiators in the communal areas, passageways and some bedrooms, exposed hot pipes were noted in one ensuite toilet. Risk assessments were not available within the home relating to hot surface temperatures on either day of the inspection. We discussed this with the registered provider and manager who assured us that these had been completed but not locatable. They further added that a series of environmental risk assessments will be completed to identify these issues. Pre set valves appear to be in place for bathing facilities to ensure that the water does not exceed 43 degrees centigrade. Some hand basins provided very hot water, signs above the basins informed people of this. There have been several concerns raised during and since the last key inspection and random inspection regarding the cleanliness and hygiene of the home. On the first day of this inspection there was a team training taking place for all the domestic staff of the home from the housekeeper of another care home within the organisation. The manager has increased the domestic hours within the home. A period of extensive cleaning took place between the two days of the inspection and on the second day the home was found to be clean and hygienic and free from odours. Residents told us that they were pleased with the cleanliness of the home. The manager told us that positive comments have been received from residents visitors and visiting professionals to the home and further added that she will be taking responsibility to oversee the cleanliness of the home in future, to ensure that the domestic staff maintain this standard. We will undertake a further unannounced inspection to assure ourselves that this level of cleanliness and hygiene has been maintained. This is due to the number of concerns raised to us and by us regarding this issue in the last years inspection process. The manager has developed a new laundry and infection control policy. This is now in the process of being issued to all staff. We were told that a verbal complaint had been received during the inspection site visits regarding the inadequate cleaning of commodes and this was promptly addressed by the manager. New commodes have been purchased by the home and provided to residents who wish or need to use them. Hand washing facilities with liquid soap, paper towels and sanitising gel are available throughout the home. Care Homes for Older People Page 21 of 33 Care Homes for Older People Page 22 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. Residents are protected by the homes robust recruitment practices. Residents generally feel their needs are met by the current staff group. Evidence: On the first day of the inspection there were four carers and a team leader providing care to residents in the morning. Additional staff are on duty during peak times of the day including an additional person at 7 am to provide breakfasts and during the evening meal period. A team leader is on duty for each shift. The duty rota also reflects the domestic and kitchen staff. On the first day of inspection there was a training session for the domestic staff and five members of staff were attending this. The manager told us that 3 members of care staff are contracted to provide domestic hours in addition to their care hours. It is identifiable from the duty rota which role they are undertaking and when. The managers hours are reflected on the duty rota and we were told that her main hours are from 09.00 to 17.00 hours, although this is flexible and currently she does not finish work until later in the evening. She also performs an on call role during the evenings, nights and weekends. The duty rota identifies that each night there are 2 waking night staff on duty. The AQAA received from the home stated that there are 21 care staff employed at the home, 15 of whom have achieved NVQ level 2 training and the remaining 6 are undertaking this training. Care Homes for Older People Page 23 of 33 Evidence: The personnel records relating to five members of staff were inspected fully. It was evidenced that required recruitment checks are made prior to appointment. It is recommended that further evidence regarding the CRB checks is held in the home e.g. the date the CRB was sent, received, the certificate number and the outcome. Training records held on file, demonstrate that staff are provided with an induction training package and receive ongoing and update training e.g. moving and handling, dementia, infection control, fire safety, health and safety, safeguarding adults, managing challenging behaviour, dementia care, diabetes and communication. The training is mostly provided in house using a DVD, work book and discussion. Some of the newer staff have yet to complete these training courses, but we were told that there is an ongoing programme that all staff are part of. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager appears aware of her responsibilities and we are told will be applying for registration as the registered manager. The home seeks the views of the residents with regard to the quality of care at the home. The home maintains accurate records of monies that they hold on behalf of the resident. Risk assessments are not in place to identify that all areas of the home that residents can access are free from risk. Evidence: A new manager has recently been appointed and was available during the inspection. The registered manager is currently still in post but was not present during the inspection. We were told at the last inspection that her role will change to become the Area Quality Manager for the organisations group of homes and we understand that this is still planned. The registered provider told us that the newly appointed manager Care Homes for Older People Page 25 of 33 Evidence: will be applying to CSCI for registration. The manager told us that she is a registered nurse and has managed a care home in her previous job during which she achieved her registered managers award. On the first day of the inspection the manager had been in post for two weeks. During that time she had held a staff meeting and has planned a meeting with the community nurses. Between the two days of the inspection a residents and relatives / representatives meeting had been held to which four relatives attended. Residents and staff were positive in their comments about the new manager and her role within the home. An up to date insurance certificate is displayed clearly on the wall in the reception area. The registered provider told us that systems are in place for reviewing the quality of care at the home. A quality assurance survey was provided to the residents recently, the outcome of this is included within the service users guide. We discussed with the registered provider the complexity of the format that this is currently in. He agreed that it needed to be clearer and stated it is being addressed. We sent out quality surveys prior to the inspection but received comments from residents and relatives that people were helped to fill these in by care staff. It is preferable for residents to complete these by themselves or with the support of their relatives / representatives or independent advocates if necessary. The registered provider and manager acknowledged this and stated they had identified this themselves and in future quality surveys will be conducted in a more appropriate manner. We were told that the registered provider does not act as an appointee for any residents for their benefits or manage any savings accounts for residents. We were told that the home does provide a safe keeping service for residents personal allowances. Records are kept of money paid in e.g. by relatives, amounts paid out on behalf of the resident and a running balance. A sample audit of some of these individual records was undertaken and found to be accurate. Staff records identify that supervision has been provided to staff but not on a regular basis. The manager has commenced a process of supervision for all staff but due to the short period of time in post this could not be seen for all staff. The manager told us about the system she intends to implement. The AQAA detailed maintenance information including portable electrical testing in May 2008, hoists and chair lifts in June 2008, fire detection and fighting equipment in December 2007, the heating system and gas appliances in March 2008. The registered provider told us that the hard wiring is being tested on an ongoing basis in that 20 percent is carried out annually to ensure that over 5 years the complete system is checked. On the second day of inspection the fire officers were visiting the home to ensure that Care Homes for Older People Page 26 of 33 Evidence: work identified within an enforcement notice was completed, we were informed verbally that this had been completed to a satisfactory standard. One of the fire exits on the first floor is alarmed so that staff know if anybody exits the building. During the inspection we opened this door and no member of staff attended for 5 minutes. Another member of staff in the vicinity was not sure if the door was alarmed or set to be on or what the procedure was if this door was opened. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 The registered person shall after consultation with the service user prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. This shall be made available to the service user, be kept under review and the resident be advised of any revision. 01/10/2008 2 8 12 The registered person shall 01/10/2008 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of residents. 3 12 16(2) The registered person shall consult with residents about the programme of activities arranged by or on behalf of the care home and provide facilities for recreation. 01/10/2008 4 38 13(4a) The registered person shall 01/10/2008 ensure that unnecessary risks to the health and safety of residents are identified and so far as possible Page 28 of 33 Care Homes for Older People eliminated e.g. hot water Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 It is required that the 02/02/2009 registered provider shall, after consultation with the service user or a representative of his, prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. The care plan must inform and direct staff of the action that they must take in order to meet their assessed individual care needs and respect their preferences and choices. This requirement is repeated from the last inspection report as the previous time scale has not been met. 2 25 13 It is required that the registered person shall ensure that unnecessary risks to the health or safety of service users are 02/02/2009 Care Homes for Older People Page 30 of 33 identified nd so far as possible eliminated. If hot surfaces e.g. pipes and radiators are not guarded, a detailed and thorough risk assessment must be available in order to identify the risk to residents and how that risk has been reduced. 3 36 18 It is required that all staff within the care home are appropriately supervised. Written records must evidence that each member of staff has formal supervision at least 6 times a year. 4 38 13 The registered provider shall 02/02/2009 ensure that all parts of the home that service users have access to are as far as reasonably practicable free from avoidable risks. Up to date risk assessments must be in place and available within the home that identify the action taken to reduce environmental risks to residents. 02/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 It is recommended that the service users guide is provided to people in a suitable format e.g. the service users views are not easily understandable in their current format. It is recommended that the registered provider obtain a 2 7 Care Homes for Older People Page 31 of 33 signature from the resident and / or their representative if appropriate to demonstrate the residents agreement with the care plan. 3 9 It is recommended that the medicines trolley from the first floor is removed as no longer in use. it is recommended that the medication fridge is only used for the storing of medicines. It is recommended that residents and / or their representatives are provided with clear information on the regular activities within the home and additional activities from external sources. It is recommended that full and detailed records are maintained of the activities that residents attend and their participation and enjoyment of the activity. It is recommended that all staff are provided with safeguarding adults training and are aware of the local multi agency procedures for reporting any suspected abuse. It is recommended that fire exits are clear from obstruction at all times e.g. that equipment is stored tidily and in a manner that does not impair the exits. It is recommended that an audit is undertaken to ensure all doors have a locking facility that is in full working order. It is recommended that each resident has the option of a lockable storage facility within their own room. It is recommended that more detail is available in the home regarding the CRB checks undertaken for staff. It is recommended that written detail be provided to CSCI re the management arrangements in the home or a formal application for registration be made. 4 12 5 18 6 19 7 24 8 9 27 31 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. 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