Inspection on 21/01/09 for Thatcham Court Nursing Home

This inspection was carried out on 21st January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Thatcham Court Nursing Home Chapel Street Thatcham Berkshire RG18 4QL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Stephen Webb     Date: 2 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 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 31 Information about the care home Name of care home: Address: Thatcham Court Nursing Home Chapel Street Thatcham Berkshire RG18 4QL Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Susan Smith Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 60 The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Date of last inspection Brief description of the care home The service is operated by BUPA Care Services Limited, and managed by Susan Smith. The home is purpose-built and will accommodate sixty residents of either gender in three separate units on three floors. It specialises in supporting residents with a diagnosis of dementia and has been designed to address their needs, through specialist signage and themed decor, as well as providing physical adaptations to meet the needs of those with varying degrees of physical disability associated with their old age. The home opened in July 2008 and resident and staff number are gradually increasing. At the time of inspection only the ground floor unit was open and all Care Homes for Older People Page 4 of 31 BUPA Care Services Ltd care home 60 Over 65 0 60 Brief description of the care home current staff were being deployed there to make the most efficient use of available resources. Once resident numbers rise above twenty, the service will expand onto another floor and staffing will need to be increased significantly to provide adequate staff cover over two floors. Current charges range from eight hundred pounds to eight hundred and fifty pounds per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection included an unannounced site visit from 10.30am until 5.00pm on the 21st of January 2009. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager, and briefly with some of the staff members on duty during the day, as well as some verbal feedback from residents. The inspector also observed the interactions between residents and staff at various points during the inspection. Inspection surveys were also completed and returned by three of the residents, eight relatives, and 2 staff members. The inspector examined the majority of the premises, including some of the bedrooms. Care Homes for Older People Page 6 of 31 Feedback from the residents and relatives was very positive and the staff members feedback was also positive about the caring attitude of the staff and management and the range of activities provided. What the care home does well: What has improved since the last inspection? What they could do better: There is a need to ensure that all staff receive the mandatory training and any other training they need to meet the needs of residents, and levels of NVQ attainment also need to improve. Management monitoring systems are currently failing to report sufficiently on observations of care quality, and on feedback from residents, staff and others, in order to provide effective ongoing monitoring of the care provided. Care Homes for Older People Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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. Prospective residents are provided with the information they need to enable them to make an informed decision about the suitability of the home. A detailed preadmission assessment is undertaken to identify personal and healthcare needs to ensure these can be met by the home. Evidence: The home provides a detailed Statement of Purpose and a Service User Guide, (entitled Resident Information), in type-written format, which provide information about the ethos, operation and staffing in the home. Copies are placed within each bedroom and are also available in reception, together with complaints leaflets and other information, which will include a copy of the most recent inspection report on the home. Some consideration could be given to the benefits of a more pictorial version to better support the needs of some residents. Care Homes for Older People Page 11 of 31 Evidence: The home has a detailed pre-admission assessment format which identifies the physical and healthcare needs of the prospective resident in detail, though social and emotional needs and more individualised aspects of the persons lifestyle and preferences are identified later within the personal (care) plan. The assessments do identify elements of self-caring ability on the part of the prospective resident. Copies of completed assessments were on the three care files sampled during this inspection, and were completed in appropriate detail. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal care needs and individual preferences of residents are identified within their care plan and associated documents, in order to enable staff to meet their needs. The home meets the healthcare needs of residents through positive relationships with external healthcare professionals and promotes the health of residents through its systems. Though none of the current residents is able to manage their own medication, the home has appropriate systems in place to do so on their behalf, which protect their wellbeing. The homes arrangements for providing support and personal care support the privacy and dignity of residents and promote their rights. Evidence: Residents each have a detailed care plan in place supported by risk assessments and other formats. A sample of three care files were examined in the course of this inspection. The care plans and associated documents contained lots of detail about the Care Homes for Older People Page 13 of 31 Evidence: individual wishes of the resident, any specific preferences with regard to how they are supported, and of their likes and dislikes with regard to food and activities. Information was also recorded about past employment, places visited on holiday, hobbies and any known allergies. A range of supporting formats are also completed including a nutritional screening tool and initial dietary record, a lifestyle profile, map of life, and a range of relevant risk assessments. To date there is limited information within the End of Life Care Plans but the home has signed up to Introduce the Liverpool Care Pathway approach to end-of-life care to the home so these are to be developed further. The care plan identifies any cultural or spiritual needs and the home undertakes to support residents to maintain these aspects as well as identifying emotional health needs. Examination of the care plans indicates that each section is reviewed on an approximately monthly basis and any updates recorded. In one case some of the care plan sections were not completed but had been signed. It is recommended that all sections are completed or addressed via entering not applicable where it applies, in order to make it clear that all aspects have been considered. Where relevant, behavioural records are also maintained where a specific plan is in place to manage behaviour, in order to monitor the effectiveness of the planned intervention, and to encourage a consistent approach. Daily notes are maintained on each individual resident to record significant events, issues, visitors etc. The files contain a range of healthcare appointment records demonstrating how the identified healthcare needs of residents are addressed. Weight charts were also seen on files to monitor this aspect. The home has developed a positive relationship with external healthcare providers. The home has an appropriate procedure in place for managing the medication on behalf of residents. At present none is able to manage their own medication. The medication records provide the required audit trail for medication, including records of the quantities received, their administration, and any returns to the pharmacy. Medication is only administered by nursing staff. Monthly medication audits are completed and sent to head office. Through the content above, the care plans address the dignity rights and privacy aspects of the individuals care. This is also supported by the design of the homes environment, which provides adaptations for dementia and physical disabilities as well as such aspects as lockable storage provision and appropriate bathroom and toilet locks. The home also allows residents to continue to care for existing pets, wherever possible and has linked with a charity called the Cinnamon Trust who can offer support with pet care, arranging veterinary services, and such aspects as dog walking, to residents. There was also evidence of the involvement of external advocates on some occasions. Care Homes for Older People Page 14 of 31 Evidence: Observations of the interactions between staff and residents also suggested a positive and individualised approach which enhanced individuals dignity, and this was borne out by the feedback provided by residents and their families. As noted above, the home has signed up to the Liverpool Care Pathway for developing their end-of-life care and this will be introduced within the home. Care Homes for Older People Page 15 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home tries to provide activities and entertainment to reflect the wishes of residents so as to provide a stimulating and rewarding lifestyle. Contact with family, friends and the local community is encouraged to maintain existing social networks. Residents are supported to make choices in their daily lives to maximise their autonomy, and are consulted about and provided with a varied and nutritious menu in pleasant surroundings, to encourage them to maintain a healthy diet. Evidence: The wishes and preferences of a resident are identified during the care planning process and are recorded within various formats comprising the care plan, including the Map of Life and Lifestyle Profile. Any risks associated with individuals hobbies, interests or preferred lifestyle are addressed through risk assessment, including any potential hazard from smoking. Where a resident wishes it, arrangements can be made for them to go out in the community, for example to the library, the local market or to visit a pub or garden centre. There are plans to further expand the opportunities for outings as resident Care Homes for Older People Page 16 of 31 Evidence: numbers increase. The home has access to the Volunteer Bureau adapted minibus. The home currently employs an activities coordinator for 20 hours per week over three days, though additional activities leaders will be recruited up to a proposed maximum of 70 hours per week, as resident numbers increase. The activities coordinator has established a good schedule of regular activities, with a scheduled activity at least daily during the week and more informal opportunities at weekends, and maintains some collective records of the level of individuals participation. The activities coordinator meets new residents to find out what activities they would like to engage in, and where an individual prefers not to take part in group activities, provision is made for some one-to-one time if this is preferred. At present, where the care staff lead on activities, these are not routinely recorded in an easily monitored format. This is regrettable as it does not provide a true picture of the level of activities and stimulation offered to the residents. It is recommended that care staff are also encouraged to record their engagement in any individual or collective activities as this will provide additional information to enable effective evaluation of activities provision, as well as validating their input in this essential aspect of care. The home also has visiting entertainers twice a month and has links with the local Alzheimers Society and their activities, including plans to hold regular singing for the brain and gentle exercise sessions at the home. Two of the homes staff are attending training to enable them to lead singing for the brain sessions. The care plans identify how staff may need to support family contact and maintain communication with significant family members As noted above, any religious observance by residents is recorded so that their spiritual needs are addressed, through visiting clergy or arranging support for visits to an appropriate place of worship. A monthly Holy Communion service is held in the home. Some residents have regular family contact and in some cases, family members join residents in activities and entertainment at the home. One of the homes neighbours visits the residents, and a local school choir has sung for residents. A visitor from the Pat a Dog scheme visits the home. Feedback from residents and families is positive about the activities and community contact provided by the staff. Staff were seen to actively offer and encourage residents to make day-to-day decisions and choices about their lives activities and food. The menu alternatives were not only displayed in the dining room but were also verbally explored with individuals. The layout, dementia signage and facilities in the home support residents to retain as much autonomy as they are able to manage. The garden provides level walks within a secure space so that individuals do not always have to be directly supervised if they Care Homes for Older People Page 17 of 31 Evidence: prefer to be alone. The chef initially established some of the menu preferences of residents and compiled a four-week rolling menu. Any wastage is monitored to confirm individual and collective preferences, and alternatives are offered. The menus offer a varied diet and a good range of choices at every meal, and snacks are available on request outside of meal times. The chef explained that the majority of meals were prepared within the home from the raw ingredients, the majority of which were fresh. Cakes, pastry, soup, pies etc. are all made fresh and individual birthday cakes for residents are baked on site. The meal sampled at lunchtime during the inspection was tasty, of very good quality and was well presented. The chef confirmed that individual dietary requirements would be met, but that aside from some pureed meals this was not an issue currently. The chef showed awareness of the effect of both presentation and portion size on residents appetite. In the first two weeks following admission, records of a residents dietary intake are kept in order to establish a baseline and monitor for the malnutrition risk assessment. These were seen on one of the files examined, for a recent admission.The chef has also spoken with new residents on admission to explore their meal preferences. It was positive to see that the chef also visited the dining room and made himself available and talked with residents at lunch, and hopefully this practice will continue as the home expands over its three floors with separate dining rooms. Care Homes for Older People Page 18 of 31 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. Although there had been no recorded complaints since the home opened, the complaints procedure was appropriately available to residents and relatives who confirmed that they were aware of how to complain should this be necessary. The home has appropriate systems in place to protect residents from abuse. Evidence: The home has a detailed corporate complaints procedure, which is outlined within the complaints leaflet. Copies of the leaflet, (which contain a form to record any complaints), are displayed within the entrance hall of the home and can be accessed without recourse to staff. Details of the procedure are also included within the statement of purpose and residents information pack, which is provided in every bedroom. The Manager indicated in the completed AQAA, (pre-inspection questionnaire), that as yet no complaints had been raised since the home opened in July 2008, and confirmed that this was still the case, during the inspection. One resident confirmed in conversation that she would talk to the manager if she had any complaints, and the three residents and seven relatives who returned surveys, also confirmed they were aware of the homes complaints procedure. In the absence of recorded complaints it was not possible to examine the actual operation of the complaints procedure, but the written procedure was appropriate. Care Homes for Older People Page 19 of 31 Evidence: The home has an appropriate policy and procedure for safeguarding vulnerable adults and the manager had an up-to-date copy of the local multi-agency safeguarding protocol. One incident between two residents had been discussed with the appropriate safeguarding team but it was agreed this did not necessitate a safeguarding referral. The manager confirmed that all but one of the current staff had received safeguarding training via an accredited in-house trainer, as part of their induction. One staff member did not appear to have received this training according to the records available, but was due to attend the next available course. The manager indicated that safeguarding training is updated annually which is appropriate. The manager also indicated that safeguarding is addressed within the interview process for new staff. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, homely, clean and well maintained environment with appropriate adaptations to meet the needs of residents. Evidence: Thatcham Court Nursing Home was registered in July 2008 and has not previously been inspected. The service is being provided in a purpose-built new home, which had been developed with due regard to the needs of residents with dementia. An appropriate colour scheme and specialist signage has been provided to help residents remain oriented, and the home has been designed to operate as three separate smaller units once fully occupied. At the time of this inspection only seventeen of the sixty beds were occupied and only the ground floor unit was in use, in order to make efficient use of the current small staff team, which is being increased proportionately with admissions. The home has been designed to incorporate appropriate physical adaptations and specialist equipment to meet the needs of residents with additional physical disabilities. Appropriate specialist advice has been sought on the types of equipment required. The specialist baths provided also address the health and safety needs of staff in providing for adjustable height and well as a range of hoisting facilities. Care Homes for Older People Page 21 of 31 Evidence: The bedrooms are all single occupancy and all have en suite shower/toilet facilities and fully adjustable profiling beds. The home also has its own supply of eight pressurerelief mattresses. Corridors are wide, airy and well lit and have colour coding and appropriate signage as well as themed pictures, to assist with orientation. The building provides an attractive and homely environment on a suitable scale, having been divided into the three separate units, each with its own lounge, dining and kitchenette/servery facilities. Windows throughout have been secured so as to only open on limiters for resident safety, whilst providing ventilation. There is an appropriately equipped central kitchen, from which meals will be distributed to the three floors via heated trolley. Appropriate storage cupboards have been included for wheelchairs and hoists, and a hairdressing room has been incorporated on the second floor. The home has two lifts accessing all floors. In addition to en suite facilities, each floor has three communal toilets as well as a bath/toilet and a shower/toilet available. Toilet and bathing facilities have appropriate locks for those able to use them and for staff use, and each bedroom also offers lockable space for storage should this be desired. The garden although not large, provided secure areas where a resident could walk freely without the need for constant staff supervision if appropriate. The planting within the garden was still developing but should provide an attractive outdoor environment as it matures. Standards of hygiene were observed to be very good and no unpleasant odours were found within the home. Appropriately equipped central laundry facilities were provided for the size of home. Care Homes for Older People Page 22 of 31 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. The needs of the current residents are met effectively by current staffing levels which are planned to increase in line with resident numbers. There are plans in place to increase the proportion of care staff who have attained NVQ to provide a baseline training, which together with the mandatory training courses, should ensure that all staff have received the necessary training to meet the needs of residents. Some shortfalls in mandatory training remain to be addressed. The homes recruitment systems provide protection to residents. Evidence: The manager is gradually building up the staffing complement of the home as resident numbers increase. At present only the ground floor unit is operational so as to make the most efficient use of the current staffing and provide opportunities for teambuilding and practice observation. The Current activities and catering teams will also increase as resident numbers rise. Only one staff member has left since the home opened in July 2008. It will be important for management monitoring and support systems to be in place as the the home increases up to capacity over three floors. At present only three of the fifteen staff have attained NVQ, but all of the care staff Care Homes for Older People Page 23 of 31 Evidence: will commence this in April, and the three staff who have level 2 will commence on level 3. A sample of three recruitment records was examined in the course of this inspection to verify recruitment practice. The staff recruitment files were indexed, systematic and in good order, with all items secured. The required evidence to confirm identity was present, together with copies of application forms, references and details of POVA first and CRB checks. Notes of interview responses were also on file. The initially recruited group of staff received a two week induction training programme in July 2008, covering the majority of the mandatory training, though a number still have to undertake health and safety training and one has yet to attend safeguarding. The manager indicated that fire safety training updates are provided twice per year. The home has an accredited manual handling trainer within the team, and two staff also need to attend this training. Most of the staff have now received training on the Mental Capacity Act, and most have also now attended dementia training though the manager is seeking a further course for all staff from the Alzheimers Society. The manager should ensure that any gaps in mandatory and relevant core training are addressed promptly to ensure that all staff have attended the baseline courses. The mandatory training currently provided to staff does not include a basic first aid training, even for non-nursing staff. New guidance from the government is also seeking training for staff on responding appropriately to a resident who may be choking, as part of a basic first aid training, as expected within Standard 38 and Regulation 13. The manager should consider how all staff can obtain and maintain an up-to-date knowledge of relevant first aid skills in order to meet the needs of residents. It is recommended that all care and nursing staff receive at least the one day first aid training to include responding to choking incidents, so that each is aware of current best practice at all times. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the interests of meeting the needs of residents, by an experienced and qualified manager and a team of senior staff. It is too early to assess the effectiveness of quality assurance and monitoring systems but there is currently a lack of reporting on observations of care quality, and of feedback from residents, staff and others, within monitoring formats; which needs to be addressed in order to provide effective ongoing monitoring of the care provided. The home has appropriate systems in place to protect residents finances. The health safety and welfare of residents and staff is promoted for the most part by the home though some improvements in training and records are needed to maximise this. Care Homes for Older People Page 25 of 31 Evidence: The home is managed by an appropriately qualified and experienced manager with eight years experience as a manager in three homes, who is also a qualified RGN and RMN. A new Responsible Individual is about to be registered for the service, who is the direct line manager for the home. As yet the home has not been open for a year so no annual quality assurance survey report or annual development plan has yet been completed. The provider has a monthly management audit system in place, linked to regulation 26 monitoring visits, which is about to be replaced by a new process. However, whilst the management audit system provides an effective audit of the homes systems and records, neither the existing nor the proposed new audit formats seen, include significant reporting of any observations on the care quality, or of direct feedback received from residents, relatives etc. which is a significant omission. The last page of the audit report doubles as the Regulation 26 report but only has one line of space for feedback from residents, staff and others, which does not suggest this is a significant expectation on the person undertaking the audit. Indeed few comments had been included relating to these aspects, in the reports seen. Regulation 26 does require that the visits shall include interviews (with their consent), of staff, residents and their representatives in order to form an opinion on the standard of care provided. The provider is asked to address this shortfall within future monitoring visits. The provider does have a quality assurance customer satisfaction survey system which is undertaken annually, and includes surveys to residents, relatives and staff, which will be undertaken in due course once the home has been open for a year. The home is also subject to annual accreditation by West Berkshire Council, which includes surveys to residents, relatives, care managers, external professionals and staff. The manager indicated that an annual development plan for the home would be devised for its second year of operation and would include budgetary planning and reference to the planned five yearly refurbishment cycle, which will include appropriate contingency funds for unforeseen needs. At present none of the residents is able to manage their own funds. All have relatives with enduring power of attorney to manage these on their behalf. The home hold a small amount of their personal allowance to pay for personal items, hairdressing etc. and contacts the family to top this up as required, providing bills for expenditure. Although the residents allowances are held collectively in a single account, individual computer records are available, and overspending is not permitted at the expense of others funds. Individual printouts can be provided to the responsible relative, and expenditure is reportedly receipted, to provide an audit trail. The home has only been open for six months so examination of health and safetyrelated certification was of original commissioning certificates on this occasion. Care Homes for Older People Page 26 of 31 Evidence: Appropriate certification was seen for the commissioning of the fire alarm and the testing of the electrical installation. The homes handyman undertakes the testing of all electrical appliances, including those brought into the home between testing cycles, and has established appropriate records of this process. The gas certification could not be located during the inspection and the manager is asked to provide a copy to the Commission. At present the manager maintains a collective record of all accidents, which meets part of the requirements and allows a management overview of accidents within the home. However, this record does not readily enable the tracking of accidents relating to a particular individual, and for this reason there is an expectation that accidents are also recorded within individual residents files as part of their care history in the home. This can be achieved in a number of ways and is an expectation within Regulation 17 and Schedule 3. The manager agreed to explore how best to ensure that this information is maintained and readily available. As noted above, staff do not currently receive first aid training. This has been addressed at Standard 30, above. The home has a risk assessment system in place to identify potential hazards and appropriate responses. These include personal risk assessments, assessments of bedroom safety, mental health, malnutrition, falls, skin integrity and other relevant areas. Care Homes for Older People Page 27 of 31 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 28 of 31 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 30 18 The manager must ensure that any shortfalls in mandatory or necessary training are addressed promptly. In order to maximise the skills and knowledge of staff and ensure they remain aware of current best practice at all times. 01/05/2009 2 33 26 The provider must establish a system for effective consultation with residents, relatives and staff as part of monthly monitoring visits, and include any feedback within the resulting reports. In order to ensure that direct feedback is regularly obtained about the quality of care provided. 02/04/2009 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 Care Homes for Older People Page 29 of 31 improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 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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