Inspection on 28/10/08 for Symphony House

This inspection was carried out on 28th 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Symphony House 04/10/06

Symphony House 22/12/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Symphony House 43 / 45 Queens Park Parade Northampton NN2 6LP     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: Louise Bushell     Date: 2 8 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. 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: Symphony House 43 / 45 Queens Park Parade Northampton NN2 6LP 01604722772 Telephone number: Fax number: Email address: Provider web address: dsweeks@ukonline.co.uk Name of registered provider(s): Type of registration: Number of places registered: Symphony Care Ltd care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Symphony Care Home is registered to provide personal care with nursing to male and female service users who fall within the following categories:- Old age, not falling within any other category (OP) 25 The maximum number of persons to be accomodated at Symphony House is 25 To accommodate the person named in application number V34225 who is under the age of 60 years To accommodate the person named in application number V34226 who is under the age of 60 years Date of last inspection Brief description of the care home The home is situated in a residential area of Northampton, close to local shops and amenities. Accommodation is provided in a Victorian house that has been extended and has recently been refurbished by its new owners to a very high standard. All rooms have ensuite facilities and are single occupancy. It provides facilities for the elderly frail and for the terminally ill. 0 Over 65 25 Care Homes for Older People Page 4 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: Standards identified as key standards and highlighted through the report were inspected. In addition to the key standards a number of other standards were inspected to assess the services ability as part of case tracking people that use the service from the admission stage to placement stage. The key standards are those considered by the Commission to have a particular impact on outcomes for the people who use the service. Inspection of the standards was achieved through review of existing evidence, the annual quality assurance assessment, pre-inspection planning, an unannounced inspection visit to the service, any information sent to us from the service and other professionals, collating information received in person from relatives and the people Care Homes for Older People Page 5 of 33 who use the service, and drawing together all of the evidence gathered. The service has not received any complaints since the last inspection. The pre-inspection planning was carried out over the period of a day and involved reviewing the service history, which details all contact and correspondence with the home and previous inspection reports. This unannounced inspection visit was carried out by one inspector and covered the morning and afternoon of a weekday. The inspection was carried out by case tracking, which involves selecting samples of individual records and tracking their care and experiences. Observations of the services routines and care provided were made and views on the care provided were sought from people who use the service, visitors and staff. Additionally questionnaires were sent to a random selection of people to ascertain their views. In addition to this the views of a visitor, staff and people that use the service were obtained on the day of the inspection. The management of medication was checked through reviewing prescribed medication for a sample of people as part of case tracking. Communal areas and a sample of bedrooms were viewed and observations were made of peoples general well being, daily routines and interactions between staff and people who use the service. Verbal feedback was provided at the end of the inspection to the manager of the service. The range of fees for this service are from four hundred and eighty to nine hundred and eleven pounds per week. Items excluded are personal papers, chiropody, personal items toiletries and hair dressing. What the care home does well: What has improved since the last inspection? A number of improvements have been made to the service since the last key inspection in 2007. These include many of the communal and individual areas being redecorated. A new large plasma television has been purchased for one of the main lounge communal areas. The service also now provides a lap top computer with wireless Internet connection and a new digital camera and printer to capture events in the service. The AQAA states that staff have become more focused on the individual needs of residents, there are no hard and fast rules at Symphony House. We have developed a reputation for going that extra mile to make life more pleasant for those who live, visit and work at the service. A new night time individualised care plan is in the process of being developed further ensuring that personalised care plans are developed in order to tailor the service to meet the needs of the individual as required. The AQAA states that the service have improved their administration procedures and records for prospective individuals and an email address has been added to the services web site. Care Homes for Older People Page 7 of 33 The service is aiming to further improve by the care planning process being completed and updated by computer, making entries more legible and updates easier. The AQAA states that the service will be auditing its own records further in order to summarise its own actions and clear direction for continued improvements to be made. 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. Pre admission assessments are completed with sufficient information to ensure that the immediate needs of the people who use the service are being met. Evidence: The service has developed a Statement of Purpose, which sets out the aims and objectives of the service, and includes a guide, which provides basic information about the service and the specialist care that is available. The guide details what the prospective people using the service can expect and gives an account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. All people who use the service are given a copy of the guide. The Statement of Purpose had been reviewed and contained all of the required information in order for Care Homes for Older People Page 10 of 33 Evidence: the person and or their representatives to make informed choices about the service. The Annual Quality Assurance Assessment (AQAA) states that the manager assesses and personally sees all prospective residents prior to an agreement for admission. It states that in the last twelve months the service has improved by gaining more experience in providing residents and their families with appropriate information. We have a much clearer idea about the type and range of residents needs which Symphony House can meet. One person using the service commented that I am very happy at the home. A total of two people were case tracked fully. In both cases the manager had completed the pre assessments. In general they were completed well. The assessment explored some areas of diversity including preferences, religion and involvement from family and or partners. Recognised assessment tools were used to assess a persons risk level for nutrition, pressure prevention, falls and dependency levels. Although minor shortfalls were identified, it was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. One person who uses the service stated that its one of the best homes I have been to, I really like it here. The service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process. The people residing at Symphony House confirmed that they had enough information about the service. Individual term and conditions of residency were in place and detailed the information required in order to ensure that that rights of the person were maintained. One relative commented that Symphony is a lovely clean care home and i know they try very hard to keep every one happy. In addition to this a further relative commented that this care home is very well run. Food is very good and tasty, staff are easy to talk to and i always enjoy my visits. Feedback received from the people who use the service determined that they have enough information in order to make active choices in their lives, that they are in receipt of a contract and terms and conditions of their residence and that they receive the care and support that they need. 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. Failure to compile suitable care plans for the people who have recently arrived at the service and shortfalls in medication practices, does not ensure that the health, safety and well being if individuals is maintained. Evidence: A total of two care plans were case tracked fully it was established that the aim for the people who use the service is to receive personal and healthcare support using a person centred approach. Personal health care needs including specialist health, nursing and dietary requirements are recorded in the care plan. The care plan is generated from the pre admission assessment and includes guidelines, risk assessments for the management of falls, manual handling assessments, self medication risk assessments and care plans. A recently admitted persons care plan was reviewed, although a pre assessment had been completed it was noted that care plans had not been formulated even though the person had been residing at the service for just over three weeks. There were two care plans in place. The first care plan aimed to provide a safe environment whilst assisting the person from bed to a Care Homes for Older People Page 12 of 33 Evidence: chair. The care plan did not detail any additional or alternative moves required by the person. The manager further commented that the person used a stand aid and slide sheet. It did not detail how often this was to be reviewed. Care plan number two aimed to ensure that the individuals continence care is provided accurately. It details that the person is to be encouraged to drink at least fifteen hundred mls to two thousand mls of fluids in twenty four hours. The remainder of the care plan was incomplete. We asked an Registered Nurse about the care plan and whether a fluid in take chart was required. The Registered Nurse stated that he does not need one in place. There were no additional care plans formulated from the pre assessment completed. The pre assessment highlighted that the individual is at moderate risk of nutritional deficiency. The pressure prevention assessment highlighted that the person was at high risk of developing pressure sores. The assessment relating to the persons ability to complete daily living and activities states that the individual has a high dependency rating. The falls risk assessment also determines that the person is at high risk of falling. This information was discussed with the manager of the service who acknowledged that there were no additional care plans in place. It was observed that personal support is responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. Good practices were observed, with staff positively engaging with a number of people who use the service, singing, reading news papers and relaxing in the main lounge area. It was pleasing to see a number of people engaging and being stimulated by the positive engagement. The service listens and responds to individual choices and decisions about who delivers their personal care. Three questionnaires were received back as part of this inspection process and determine that the people who use the service always receive the medical support that they need and that staff listen and act on what they say. Information received from the service and in the AQAA, states that a night care plan in the process of being devised which further explores and records individual preferences, and needs through out the night. The completed care plans were viewed. The people who use the service have access to health care and remedial services. The health care needs of those residing at the service who are unable to leave the service are managed by visits from local health care services. One person using the service was discussing her visits to a health specialist and commented how she felt supported by the manager in attending these visits. Care Homes for Older People Page 13 of 33 Evidence: A number of comments were received directly from people that use the service, their relatives and friends. One person commented that, Darren is wonderful, very good, very caring, its home from home. Another commented that the staff are friendly and caring and very nice. The AQAA states that Care plans are based on a problematic approach and these could be improved by planning for all activities of daily living. The AQAA continues to state that over the next twelve months that they are aiming to move away from the problematic approach to care planning and introduce individualised holistic care plans. The service has an efficient medication policy in place. The AQAA states that medication is only administered by Registered Nurses and all nurses complete the homes induction programme alongside the home manager. Nurses within the home also complete a further training module for the safe administration of medicines in conjunction with the University of Northampton. The service receives its medication from a high street supplier. The service confirmed that the supplier conducts audit of the medication every six months. Medication records were viewed. The records showed that people where receiving the prescribed medication as required. However a number of areas were identified as requiring further attention. Several medicines had not be stock checked and signed in event though the administration cycle had commenced. A number of bottles were observed that did not have a date opening added on commencement of the medicine. Handwritten entries had been made to the Medication Administration Record MAR but not signed. Two separate medicines were found to not balance the amount as stated on the MAR. It was further established that one of these issues was due to the incorrect balances being carried forward on the this cycle of medication. A further medicine was observed to be in use as prescribed but had not been dated upon opening or booked in prior to administration. The management of controlled drugs is effective with records being accurate and stock balances being correct. A total of three peoples medication was case tracked in order to ensure compliance. Fridge temperatures were being recorded where medication was stored. Room temperatures were not being recorded. During the entire inspection the medication trolley was being stored in the entrance hallway. The service works with individuals regarding any refusal to take medication. The people using the service are given the support they need to manage their medication. If individuals prefer or where they lack capacity, care staff can manage medication on their behalf. The majority of care plans tracked contained suitable and sensitive plans and arrangements for the management of end of life. Care Homes for Older People Page 14 of 33 Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a range of activities provided and find the life style experienced in general matches their expectations and satisfies their individual needs and preferences. Evidence: People who use the service have the opportunity to develop and maintain important personal and family relationships. Feedback from one of the people who uses the service confirmed that we sometimes play bingo or sit in the new garden. On the day of the inspection a number of people who use the service were waiting for family members and or friends to visit and commented that they are able to have visitors as they wish. One person commented that its very nice here and i feel very welcome. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. This was indirectly observed through the practices of the staff on duty. A number of people who use the service were seen to be very relaxed and calm within their own environment and engaging with staff in an equal manner. The people using the service had a variety of communal and or personal spaces to relax and the main Care Homes for Older People Page 16 of 33 Evidence: communal lounge area was well equipped with activity items including a large plasma television. The manager provided information that the court yard garden had recently been completed and provided a very relaxing communal space. A number of people who use the service commented positively about the garden seating area. Part of the care planning process does identify peoples preferred activities and comments in brief about their life history. In the main communal lounge there is an activities area and notice board with forth coming events and important updates for the people who use the service. In this communal area, during the inspection a number of staff were indirectly observed simply sitting with a number of individuals and taking about every day life. The AQAA determines that the residents are involved and consulted about their preferences in respect of their daily activities and routines. It goes on to state that the activity coordinator organises and evaluates all social activities within the home. Records are maintained concerning all organised activities. One relative commented that recreational facilities, I feel could be improved. The people using the service can access and enjoy the opportunities available in their local community, such as a library services, the local pub and local leisure facilities. The service has also set up a small activities forum to assist with the planning of larger events. One relative commented that on occasions events take place for families to get involved, these are always special occasions and are enjoyed very much by all. One relative has made a suggestion that the service provides a hot drinks machine as I feel it is nice to be able to share a drink with her. Three people using the service were surveyed and asked if they felt there are suitable activities in the service. Two stated that there were always suitable activities available and one commented that usually there were suitable activities available. One person commented that i enjoy the music and liked the belly dancers. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Menus were on display. The food provided appeared appetising and well presented. Comments received included, I like the food, we get a choice and other foods are always available, the foods OK, but i really like the choice of puddings. One relative commented that the food is excellent, and my mothers diabetes is at last in control. Snacks are available throughout the day and the service provides a drinks trolley for those who may wish to indulge in wine or spirits during their meals or in the evening. Care Homes for Older People Page 17 of 33 Evidence: The care staff are sensitive to the needs of those people who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. The AQAA identifies that the service is planning to hold further restaurant evenings so that residents and their visitors may choose their meals and dine together. We have been producing minutes of resident meetings and we are going to produce a newsletter within the home to keep residents, visitors and staff up to date with activities and progress. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust systems are in place for the management of recruitment and complaints ensuring that the people who use the service are kept safe at all times. Evidence: The service has an open culture that allows people who use the service to express their views and concerns in a safe and understanding environment. Complaints leaflets were on display at the service, with the procedure to follow as well as a suggestions box. People who use the service have commented that they are happy with the service provided, feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. The AQAA determines that the service has not received any complaints in the last twelve months. It states that the latest quality report indicated that eighty eight percent of respondents felt very confident that if they did have a problem or difficulty within the home that they would be resolved appropriately. The service has a complaints procedure that is clearly written and easy to understand. It can be made available in a number of formats such as different languages on request. The complaints procedure is supplied to everyone living at the service and is displayed in a number of areas within the service. it was noted that the procedure Care Homes for Older People Page 19 of 33 Evidence: displayed in the foyer detailed the incorrect address. People who use the service are aware of who to speak to if they are unhappy or have any concerns. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received training in safeguarding and felt confident in reporting any issues as they occurred. The service understands the procedures for safeguarding adults and would attend meetings as required. The AQAA states that the staff recruitment and induction procedures are maintained to the highest standard to ensure that all staff are suitable and safe to work with vulnerable adults. The Manager personally takes responsibility for the induction of new staff in this area. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical layout of the building, internal decoration and equipment provides individuals with an excellent environment tailored to individual choices and needs. Evidence: The people who use the service are encouraged to personalise their bedrooms. All the homes fixtures and fittings meet the needs of individuals and can be changed if their needs change. The building design supports the needs of people using the service. The AQAA states that the results from our recent quality assurance questionnaire indicates that the home and the environment are maintained to a very good standard. One hundred percent of all respondents rated the home as good and above in all areas. The dining rooms are laid out to encourage communal dining with a calm relaxed atmosphere. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The home has an infection control policy. The service is clean, well lit and in smells fresh. A number of people using the service commented that they liked living at the service and the decoration was nice. The provider and manager have ensured that the physical environment of the home Care Homes for Older People Page 21 of 33 Evidence: provides for the individual requirements of the people who use the service who live there. The living environment is appropriate for the particular lifestyle and needs of the people and is homely, clean, safe and comfortable, well maintained and reflects the individuality of the people using the service. The service finds creative solutions to issues with the environment in ways that are not necessarily dependent upon cost. The service goes that extra mile to provide an environment that fully meets the needs of all residents and plans for the diverse needs of people that might use the service in the future. A new court yard garden seating area has recently been completed and is well equipped. A number of people using the service commented that they like this new area. Individuals are encouraged to see the home as their own. It is a very well maintained, attractive home and has very good access to community facilities and services. It has a wider range of up to date specialist equipment and adaptations to meet the individual needs of people who use the service. The environment is fully able to meet the changing needs of people, along with their cultural and specialist care needs. It is fully accessible throughout to people with physical disabilities, adaptations and specialist equipment are designed to fit within the homely environment. The management has a proactive infection control policy and they work closely with their own staff and external specialists, such as NHS infection control staff, to ensure that infections are minimised. One person using the service commented that the service is very clean and it never smells. Others fed back in general that they were happy with the environment. The service is designed to provide small group or cluster living where individuals can enjoy maximum independence in a discrete non institutional environment. This is achieved through small communal lounges where people can choose from a variety of areas to relax. People are involved in decisions about the decoration and any changes in their communal and personal accommodation. The service is creative in how it involves people in decision making and positively encourages people with a limited capacity to be as fully involved as possible. The service has single rooms available for all people who wish to have one. The rooms are very well designed and all have en suite facilities. The fixtures and fittings are of high quality, well maintained and adapted to meet the wishes of the present occupant. Individuals personalise their rooms and can use their own furniture if they wish. The bathrooms are homely and include aids and adaptations to meet the needs of the people using the service. There are sufficient toilets to enable immediate access. Care Homes for Older People Page 22 of 33 Evidence: The service spends money on the environment in the best possible way so that outcomes are improved as much as possible for the people using the service. The rights of people who have more difficulty in communicating their views are just as valued as those of other people. All bedrooms promote high levels of privacy and have locks. The AQAA determines that inspections records from the Local Environmental Health Department and Fire Service confirm that all requirements are met. The service has also recently achieved a four star rating from the Food Hygiene Regulations 2006 inspection. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are inducted and are in sufficient numbers to complete their roles, however the process for the management of training must ensure that all staff have completed mandatory training to ensure that people who use are in safe hands at all times. Evidence: Most of the staff are qualified, competent and experienced staff to meet the health and welfare of people using the service. Staffing rotas take into account the needs and routines of the people using the service. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the National Minimum Standards (NMS). The manager is aware that there are some gaps in the training being provided and stated that he plans to deal with this. The Manager also confirmed that the service is in the process of creating a training matrix to show a clearer picture of those staff who have completed certain courses and review for those requiring refresher courses. Staff have recently received training in abuse and protection, Infection control and are in the process of completing the Liverpool Care Pathway Training in supporting people who are terminally ill. In addition to this the service is working with Northamptonshire County Council and has attended a course in Mental Capacity Act and is working with Northamptonshire College for staff to attend training in supervisions and customer Care Homes for Older People Page 24 of 33 Evidence: care. Induction programmes are in place and the manager stated that he personally works through the induction programme with the staff to ensure that they are fully aware, competent and able to complete their role for better outcomes for the people who use the service. All staff are clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. One person who uses the service commented that the staff are very good. A relative commented that the staff are always very helpful and that the support Darren and the staff gave us was wonderful. The service has a recruitment procedure that meets statutory requirements and the NMS. The procedure is followed in practice and there is accurate recording at all stages of the process. Despite the service having several staff unable to work currently there has not been any use of agency staff. The AQAA states that Symphony House maintains a high level of permanently employed staff. The home does not use agency staff and therefore continuity of care is maintained. There is a high ratio of qualified staff on duty which is required as a consequence of the increased needs of our residents. The AQAA determines that twenty two of the twenty six staff have completed an induction training programme expected by the NMS and shows that a total of fifteen staff have obtained a National Vocational Qualification or above. Six of these staff are care workers and a further nine are Registered General Nurses. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed well and strives to seek better outcomes for the people living there to ensure that individuals have a positive experience of receiving care at Symphony House. Evidence: The manager has the required qualifications and experience and is competent to run the service. The manager confirmed commencement of the new Leadership Management Certificate that he is due to start. This is being completed through an external training organisation. The AQAA states that the manager has over ten years experience in senior management positions and maintains his Nursing registration and practice within the home. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. The manager works to continuously improve the service to achieve better outcomes for the people who use the service. Care Homes for Older People Page 26 of 33 Evidence: Symphony House provides an increased quality of life for individuals with a focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. The AQAA states that they are working more closely at individualised resident care plans. All care plans are personalised and reviewed on a monthly basis or according to their changing needs it continues that we are progressing with further work to ensure that our residents preferences and spiritual needs are identity and met. There is a strong ethos of being open and transparent in all areas of running of the service. The manager leads and supports a loyal caring team. One relative commented that the manager is extremely efficient at letting us know all we need to at all times. I have total faith in their communication with my family and I. The AQAA contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The managers practice, skills, and knowledge, is based on continuous development, gained through training and enthusiasm for the role. The service has sound policies and procedures, which the manager effectively reviews and updates, in line with current thinking and practice. The manager ensures staff follow the policies and procedures of the home and, in the case of a corporate provider, those of the parent organisation. The staff team are positive in translating policy into practice. Management processes ensure that staff receive feedback on their work. Examples of this were viewed and discussed during the inspection process. The home works to a clear health and safety policy. All staff are fully aware of the policy and are trained to put theory into practice. Regular random checks take place to ensure they are working to it. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. The home has a consistent record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. Records are of a good standard and are routinely completed. Care Homes for Older People Page 27 of 33 Evidence: Staff receive supervision (one to one formally recorded), however records and discussions with the manager determined that this is an area which needs additional development. The manager stated that supervisions are commencing however currently he is the only person completing them for the entire team. The manager discussed the plans in place to train the Registered Nurses in providing supervision in order to distribute more equally. Currently the manager is working through the supervisions to be provided however there are a number of staff where by this is now over due. A new supervision template and a number of records were shown during the inspection. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 A comprehensive care plan must be in place for each individual covering all aspects of care needs. To ensure that the service can demonstrate that the needs of each individual has been identified and that the service is able to meet their needs in order to protect the person from harm. 16/01/2009 2 9 13 Medication must be stored under appropriate environmental conditions with their product licence to maintain their stability. To ensure that the quality of the medication in use and the protect people from harm. 26/01/2009 3 9 13 All hand written entries on to the Medication Administration Record must be signed by one person authoised to do so. 17/12/2008 Care Homes for Older People Page 30 of 33 To ensure that people who use the service are protected, and kept safe from risks. 4 9 13 Medication audits must be 17/12/2008 conducted to ensure that medication being held, administered and disposed is an accurate reflection of the services stock and records. To ensure that people who use the service are protected, and kept safe from risks. 5 9 13 All medication must be stock 26/01/2009 checked in and signed prior to administration following the services policy and procedures for the safe administration of medicines. To ensure that all medicines are accurate in dosage, quantity and prescription and that medicines are being administrated in accordance with the policy to protect and keep people from harm 6 29 18 Staff must be in receipt of all mandatory training and this documented on a system suitable for purpose. To ensure that the people who use the service are supported by competent and qualified staff at all times. 13/02/2009 Care Homes for Older People Page 31 of 33 7 36 18 Staff must receive adequate one to one formally documented supervision in their role. At least six times a year. To ensure that staff are supported and monitored sufficiently in order to ensure personal development and training needs are met. 29/01/2009 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 3 The service should ensure that all areas as identified in the services own assessment process is completed to ensure that long term needs are identified and are being met by the service. All medication in bottles and boxs should be dated upon opening. The service should consider making available a hot drinks machine for visitors. 2 3 9 12 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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