Inspection on 20/11/08 for The Alders

This inspection was carried out on 20th November 2008.

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

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

Other inspections for this house

The Alders 07/02/08

The Alders 11/10/07

The Alders 23/08/06

The Alders 21/02/06

The Alders 27/04/05

The Alders 11/01/05

The Alders 20/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Alders 1 Arnside Crescent Morecambe Lancashire LA4 5PP     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: Jennifer Hughes     Date: 2 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: The Alders 1 Arnside Crescent Morecambe Lancashire LA4 5PP 01524832198 F/P01524832198 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jacqueline Harrison Type of registration: Number of places registered: Calderdean Ltd care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 32 Date of last inspection Brief description of the care home The Alders is situated in a residential area of Morecambe, close to shops and local amenities. There are two separate dining rooms and three lounges that are used for a variety of purposes and provide residents with a choice of where to sit and who to sit with. Residents rooms are all single and have ensuite facilities. There are two stair lifts in the home. In the centre of the home is an attractive courtyard that is used by residents in the warmer months. Residents are encouraged to retain links with the families and friends and contacts in the local community. The Alders is a no smoking home. The current range of fees are from £386 to £412.00 per week for residential Care Homes for Older People Page 4 of 30 Over 65 32 0 Brief description of the care home accommodation, and respite fees vary. Further details over fees can be obtained from the manager of the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unnannounced visit to the home, in that the owners were not aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 6 and a half hours. Every year the registered persons are asked to provide us (CSCI) with written information about the quality of the servcie they provide. We use this information, in part, to focus our assessment activity. This document is called the Annual Quality Assurance Assessment (AQAA). Care Homes for Older People Page 6 of 30 Surveys were sent and received from residents and staff from the home. During the site visit staff records and resident care records were viewed, alongside policies and procedures of the home. The manager, residents, and care staff were spoken to, along with any visitors who called during the day. Their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining rooms, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. What the care home does well: What has improved since the last inspection? What they could do better: It needs to be made clear with evidence, such as a signature, that residents participate in decisions about the care they receive. The assessments and care planning systems are very comprehensive, holding plenty of information in several places. Due to this, it is easy for staff to omit making a record in the correct place, so it appears care has not been provided, although further research in other records would identify that it has. This issue needs to be addressed to ensure records are fully completed, relevant and effective, and easy to audit. Care Homes for Older People Page 8 of 30 The activities programme needs to be further developed. Some progress has been made with the appointment of an Activities Coordinator, who has started liaising with residents about what they would like to do. This needs to also incorporate some guidance from staff due to the differing abilities of residents. Guidance from relevant organisations could be accessed, such as the Alzheimers disease society. Regular one to one time with a keyworker may be adequate for some. Individual records need to show these events. Due to the number of residents with some level of confusion, staff training in dementia awareness would be very beneficial. There should be regular health and safety audits of the environment to ensure that the parts of the home residents use are free from any hazards. These may change depending on the assessment of each individual. Staff supervision sessions need to be held regularly. These not only help with personal development of staff, but also allow the manager to monitor the standard of the care provision, and so help identify where improvements can be made. A system needs to be established to enable residents, their representatives, and staff, to be formally consulted and provide feedback about the care provision. This could be through surveys, and meetings. The manager needs to apply for registration with CSCI. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear assessment procedure which is carried out for all residents. This means that the service provided is tailored to an individuals needs and preferences. Evidence: A copy of the Statement of Purpose for the home is available in the entrance hall. This informs on who the owner and manager is, and what services the home provides. This has been updated and much improved since we last viewed it, and gives clear and detailed information, using photographs to enable people to be as clear as possible about the home. It includes a staff list along with the training they have attended, the last CSCI report, and a copy of the complaints procedure, which helpfully includes the contact details for an advocacy service. The Service User Guide holds similar information, and a smaller version can be found in all bedrooms, outlining the routines of the home. Care Homes for Older People Page 11 of 30 Evidence: The name of the regulating authority needs to be updated to CSCI in these documents, as it presently states it as Lancashire County Council Social Services Inspectorate, which no longer exists. The certificate of registration is on view, presently naming a previous employee as manager. This is the correct procedure, and will remain until the present manager has been registered and a new certificate can be produced with the correct name. This situation needs to be made clear so as not to mislead residents, relatives, and others who visit the home. Individual records are kept for each of the residents, and there is a set procedure for admitting someone to the home, with a pre-admission assessment form being seen on three selected files. These held good information, including social histories. One had not been fully completed. There were also social work assessments available for these residents. The manager uses these assessments to make sure that staff can give suitable care to each person, and the home is the right place for them to live. Staff we spoke to were aware of the needs of the residents, and how to meet those needs. Care Homes for Older People Page 12 of 30 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. There is good care planning information in place meaning that the health and personal care needs of residents are met with good outcomes. Inconsistent recording may put good outcomes at risk. Evidence: There is a standard format for the care plans, covering areas that identify the needs of each individual, so that staff know how best to look after people. We selected three resident files to examine. We found the care plans were very comprehensive in terms of information, but due to the amount of forms to be completed on a regular basis, could be confusing for staff. This was evidenced when we found records which should cross-check having omissions. For example the Personal Hygiene chart for one resident had not been completed for seven days, indicating no personal care given, although other documents for this resident had been completed showing the care was provided. The care plan for a resident stated they should be weighed regularly, although the weight chart had not been completed. Daily Care Homes for Older People Page 13 of 30 Evidence: overview records had not been completed every day, although evidence within other records showed care had been given. Due to the same issue there was evidence of some conflicting information, for example a risk assessment for one resident indicated the need for only one carer to mobilise, although it was clear from other records that two carers assisted. There was also evidence that a hoist was being used, with no mention of this in the care plan. The manager needs to address the style of the care plans, as they can give the impression that some care is not being provided, although other evidence shows that the correct care is given, such as well healed pressure areas on two residents. Records showed good liaison with district nurses, turning charts fully completed, and a good approach to pressure care, leading to good outcomes for the residents. Continence problems had quickly been addressed for another resident, and the continence nurse was accessed straight away. The problem is linked to the recording of the care needed and given, rather than the provision of it. The manager confirmed that the system is still being developed, and that she is aware they have lots of information, but also a lot of places to record that information, which causes problems for staff. There was no clear evidence that all of the residents had been involved in the decisions about their care, but we found that one resident had been enabled to change rooms at their own request, and personal hygiene routines were also changed to suit their individual wishes. We saw that risk assessments and regular reviews and updates of the care provided were carried out. There was no clear evidence that an assessment had been made of an individuals capacity to make decisions, and the manager needs to ensure this is carried out. Staff we spoke to were able to discuss the care needed by residents, and why this care was needed. They said they felt trained and guided to provide right care. They discussed how they encourage residents to tell them if they need help, and one said I tell them, dont be worried about buzzing if you need anything. They also commented on how they would bring it to the managers attention if they thought someone wasnt getting the right care. I love my job. Its a nice place to work, said one carer. We saw that residents had contact with other professionals, and at this visit a nurse called to give a resident a flu injection, and an optician was giving eyesight tests to Care Homes for Older People Page 14 of 30 Evidence: several residents. A relative calling at the home said The home is very good - especially the staff, they are very welcoming. Another visitor said I am very pleased with all aspects of care, the manager and carers are very approachable, and I always feel like I could mention anything that was worrying me. I think they do an excellent job. Residents commented, I like the way they do everything, We all get on so well together here and I like living at the home. I am happy with everything, they are all so nice. Regarding staff attention, one stated You dont like to ask for things because they are so busy. The manager needs to guide staff in encouraging residents to always feel able to speak to staff and make requests. The pharmacy inspector visited the home at the end of June 2008, and after a thorough examination of the procedures found that all records relating to medication had improved, and showed that medicines are administered correctly. The manager carries out a weekly audit. All care staff had received training in the handling of medication to make sure thay follow good practice to keep people safe. She found that procedures for ordering medicines needed to be reviewed as on occasion some medicines had run out. At this visit, we found that a system was in place to address this problem. We made a spot check of medication records, finding them complete and up to date, and observed the correct administration of medication to residents over the lunch time period. There is a lounge and two dining areas in the main part of the home, and some residents chose to sit in the lounge watching the television, while another sat at a table with some crafts. A couple of smaller lounges in another part of the home afford people more privacy if they wish Id rather sit here on my own in the peace and quiet, said one resident. A few people simply preferred to stay in their own rooms. Staff were seen to respect the dignity of residents as they quietly knocked on doors and asked to enter rooms, closing doors where personal care tasks were to be carried out. Care Homes for Older People Page 15 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals are nutritious, and residents are encouraged to enjoy food and mealtimes. There are some social activities, meaning that people are sometimes being provided with stimulation. Evidence: There is information in the assessment and care plans about each residents social history, any religious needs, and activities and hobbies they preferred. One of the carers is the designated Activities Coordinator, and is trying to develop the activities available to the residents. The outcome of her discussions with residents was on the noticeboard in the corridor, and listed gardening, knitting, a pub lunch, a zoo visit and board games they would like to be organised. A handbell ringer was booked to visit the home in December, some of the residents had joined the trip to see Blackpool lights in October, and all had enjoyed a special Halloween tea. We saw plans for card making, a game of skittles, and a quiz. One resident is taken by staff to clubs they wish to attend, and one independent resident spoke about walks along the promenade. Care Homes for Older People Page 16 of 30 Evidence: We discussed the fact that many of the residents in the home have a level of dementia, so staff need to ensure they are providing the right stimulation, and including all of the residents. We advised accessing information from appropriate organisations, such as the Alzheimers Disease Society, on how to do this. We received varied responses from residents who were able to respond, and visitors, about activities. Theres not much going on really, I think activities could be improved. I dont think my relative gets enough exercise, I see things going on from time to time but only occasionally, I have formed the impression that very few communal activities take place,and Mostly folk sit around with the TV on in the background indicated few activities occurred. Sometimes we play records and have a sing song. We play dominoes and we make things, Activities are good (showing activities box and models previously made) and Activities have improved over recent weeks, indicate some small progress in activities provision. This needs to continue to develop in a person centred way, ensuring records of who has been involved and what they have done are kept correctly, so as to monitor inclusion. Individual stimulation could be developed by the key-worker for each resident. We found records of participation were not complete in individual files. Visitors call regularly, a visitors book giving evidence of this. The lunchtime meal seemed a little disorganised at first, with tables not being fully set as residents sat waiting, but staff busied themselves and meals were eventually served fairly quickly. Staff served food in the two dining areas, helping tactfully when needed. We took a sample meal of both the choices available. There are two choices of main meal every day, with a roast dinner at the week-end. The choices at this visit were pasta bolognese, or chicken wrapped in bacon served with fresh vegetables. Both were very tasty and well cooked. We saw that the residents were given good portions, and they all seemed to enjoy their meals. One resident said she had a bit of both dinners because she could not decide. Some residents need special diets, and the cook was able to discuss these. We saw one resident tucking into her blended meal. Surveys returned from residents showed that generally meals were liked at the home. The food is lovely said a resident. One relative said that they were not usually around at meal times, but was sure their parent would tell them if they did not like the food, which they had not. We spoke to the cook on duty. She told us that she holds a National Vocational Qualification in hospitality. She said that she speaks to the residents to make sure thay have enjoyed their food, and welcomes suggestions for anything different they Care Homes for Older People Page 17 of 30 Evidence: may enjoy. Care Homes for Older People Page 18 of 30 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. Residents are confident their concerns will be listened to and acted upon. Staff have an understanding of safeguarding issues, which protect residents from abuse. Evidence: There is a complaints procedure in place, with a complaints book to record any complaints that come to the attention of the manager. The procedure is available in the information about the home at the entrance to the home. There have been two complaints received about the home since our last visit, which were about the standard of care provided. We saw that the home dealt appropriately with the issues within the complaints, and used these to help develop and improve systems used in the home. We discussed ways to develop the quality assurance procedures of the home by recording minor dissatisfactions, and how they have been dealt with. This record would give a complete overview of events in the home, and any patterns emerging. It also helps towards improving the overall service delivered. One relative said I always feel I could mention anything that was worrying me. All of the surveys returned from residents stated that they knew who to tell if they were unhappy, and how to make a complaint.Id tell any of the staff a resident told us. Care Homes for Older People Page 19 of 30 Evidence: Staff spoken to knew about the Safeguarding procedure, and what to do if they had any concerns about a residents safety. They confirmed their knowledge of whistleblowing, and how they would inform the manager of any concerns. All staff have abuse awareness training. Care Homes for Older People Page 20 of 30 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 has a well maintained environment, which provides aids and equipment to meet the care needs of the residents. It is a pleasant and homely place to live. Some areas may have safety issues for some residents. Evidence: We toured the home and randomly chose rooms to view. All of the bedrooms we saw were generally clean and tidy, holding many personal possessions such as ornaments, pictures and occasionally small pieces of furniture. All rooms are ensuite. The home is well decorated, homely and bright. We saw domestic staff going about their work routine through the day. A relative commented Cleaning is always in evidence. The ensuite is spotless. The kitchen is spotless, although the dining room is not always pristine. I like to stay in my room with all of my own things, said a resident I really like my room. I think its the best. I can see all the comings and goings through the window. There is plenty of communal space, with a large lounge and dining areas in the main part of the home, and smaller lounges in other parts. People can choose where they want to be, and were seen moving from one place to another as they wished. Care Homes for Older People Page 21 of 30 Evidence: There is a central courtyard where people like to sit in the better weather. One resident was seen enjoying a short stroll around it having a bit of fresh air. The manager confirmed that maintenance is ongoing, and staff record any repairs that need to be addressed by the maintenance person. Bathrooms were clean, with soaps, shampoos, and razors freely accessible. We advised the manager that due to the support many residents need in the home regarding levels of confusion, she should address health and safety requirements and store products safely in cupboards. Grab rails, ramps, lifting and bath hoists, and raised toilet seats all go towards helping the mobility of people around the home. Call systems in every room are regularly checked. A smoking area for residents is located through the laundry area and down two large steps. A risk assessment has been done and advises that residents must be accompanied by staff. One resident told us that they go to the smoking area alone on occasion, without informing staff. The laundry door is always unlocked. The manager needs to further risk assess, addressing the safety of confused residents, and others, having access to the laundry and the large steps of the smoking area. The back door to the home, from the smoking area, was very badly fitted. This needs attention as it could be a fire risk, and security risk. The manager said that she was aware of this, and it was due to be dealt with. The laundry was clean and tidy. A clear system is used to collect laundry, and distribute clean laundry, with each item being logged in and out. Staff were aware of infection control procedures. Care Homes for Older People Page 22 of 30 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 home operates a good recruitment policy, which ensures that only people suited to this type of work are recruited. Residents are supported by trained staff in sufficient numbers. Evidence: We viewed four staff files, and noted that standard recruitment procedures had been followed, ensuring the protection of residents. References and Criminal Records Bureau disclosures were available. The manager ensures all checks are complete before staff commence working with the residents. All new staff have induction training, and sign to agree that they have understood it. The manager told us that new staff shadow experienced staff, until they are confident and the manager feels they are competent. A staff survey confirmed that the induction covered everything they needed to know to do the job when they started. We viewed staff rotas, and found the home was appropriately staffed, with minimal use of agency staff. One staff commented Were fully staffed now. We occasionally need agency staff, but it tends to be the same ones, so they know the routines and the residents. Its a good team Care Homes for Older People Page 23 of 30 Evidence: Staff felt communication had improved within the team, and told us about the handover they had at the beginning of each shift in order to pass on information and keep everyone updated with any changes. We spoke to staff about the keyworker role, and they were able to discuss the benefits for the residents, through providing more individual tasks by one person such as tidying drawers, watering plants, and generally knowing little things about the person better. One staff member told us how, through knowing the resident well, she noted they were not themselves and needed the GP. Examples of training include communication, confidentiality, fire safety, National Vocational Qualification 2 and 3, health and safety, pressure care, medication, equality and diversity, falls assessment, moving and handling, palliative care, Parkinsons disease awareness and first aid. We advised the manager should also address training in dementia care due to the number of residents in the home with some level of confusion. 50 of care staff hold National Vocational Qualifications. Residents said the staff usually listened to them, and were usually available. The management are always available, although I had to ask who the keyworker was said a relative, and one resident commented Staff disappear at times. We saw that the training provision for staff was developing, and advised that regular supervision would direct the manager to access the most relevant and needed training and guidance for her staff. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and staff are working to improve services to protect the health and safety of residents. Evidence: The manager of the home has not yet been registered with CSCI, and is due to send in her application. She is a fairly long term employee of the Alders, being promoted within the home, so has much experience of the home and its residents. She is well supported on a daily basis by the general manager of the company. The manager told us that over the last year the care team has been developing and evolving, and a full permanent team is now employed, reducing the need to use agency staff. She told us about her plans to ensure the structure remains consistent, with senior care staff employed to support and monitor care staff, allowing her to carry out management duties. Care Homes for Older People Page 25 of 30 Evidence: The manager confirmed that supervision and appraisal of staff is not being carried out very often at present, and we saw that there is a format in place, ready to use, covering personal development, performance and support. The staff have confirmed there is an open door policy, and they feel able to approach the manager if they have any concerns. We advised these individual one to ones need to be structured into staffs working life to help with personal development, which then helps improve the standard of the care provided. The manager told us that no formal staff meetings take place. These should be addressed as part of the quality assurance system, to get feedback and have discussion to aid development. There is also no formal system of getting feedback from residents or relatives, such as surveys. We saw that records are regularly audited and checked by the managers. During this visit the International Standards Organisation (ISO) inspector was in the home auditing the recording systems in use. ISO is about having an external body monitoring the business systems it provides and which are used by the home. The ISO inspector was satisfied with his findings. We viewed residents finance records, and found them correct, with most double signed. The manager should ensure this is always done. Some information was missing in the records regarding the whereabouts of a residents belongings. The manager was able to confirm where they were, and must always ensure there is evidence to show a clear pathway. In this instance a receipt would have sufficed. The manager must be confident of actions staff have taken, in order to be sure of what tasks need doing. Personal care tasks were found to have been omitted for a resident when the manager considered they had been carried out. It is important that the correct information is passed on so that the home can provide the best care. Health and safety audits need to be reviewed to make sure procedures in place are appropriate. Risks of products in bathrooms, and access to the laundry and smoking area may change these procedures due to the residents needs. We saw some wheelchairs with only one foot-plate being used. The manager told us more were on order, but residents should not be put at risk in the meantime. The manager confirmed that all equipment in the home has been serviced as required. Care Homes for Older People Page 26 of 30 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 27 of 30 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 14 There must be evidence of resident participation in decisions on the care provided. To show that the resident has been involved and agrees with their plan of care 31/12/2008 2 12 16 The activities programme must be developed in line with residents abilities and wishes So that relevant stimulation is provided to each individual 30/01/2009 3 38 4 Unnecessary risks to the health and safety of residents must be identified and as far as possible eliminated So as to provide residents with a safe place to live. 31/12/2008 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 7 The chosen recording sysem should be completed efficiently to make it effective in providing information An assessment should be made of each residents capacity to make decisions, as stated in the Mental Capacity Act 2005. This is so that it is clear when people can continue to make decisions over their own lives whenever possible. All parts of the home the residents have access to should be free from hazards to their safety Training in Dementia Awareness should be addressed for all staff, to further enable them to provide the relevant care to all the residents in the home. The manager should apply for registration with CSCI A system should be established to provide for formal consultation with residents and their representatives, and staff, to develop the quality assurance of the home. For example through surveys and meetings. There should always be a clear pathway of evidence of events regarding residents finances and personal belongings, through up to date records and receipts. There should be regular one to one supervision of staff to help with personal development and so improve the standard of care they deliver. 3 4 19 30 5 6 31 33 7 35 8 36 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!