Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: The Conifers 253-255 Seymour Grove Old Trafford Manchester M16 0DS 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: Kath Oldham
Date: 1 1 0 2 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 32 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 32 Information about the care home
Name of care home: Address: The Conifers 253-255 Seymour Grove Old Trafford Manchester M16 0DS 01618819380 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Santosh Trehan care home 12 Number of places (if applicable): Under 65 Over 65 0 12 dementia old age, not falling within any other category Additional conditions: 12 0 The registered person may provide the following category 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, Dementia - Code DE. The maximum number of service users who can be accommodated is: 12. Date of last inspection Brief description of the care home The Conifers provides residential accommodation with personal care for up to twelve service users within the category of old age (OP) and who may have a physical disability (PD) and four with dementia. The Conifers also provides additional day care for up to three (3) service users although no day care was being provided at the time of this inspection. On the day of the inspection there were ten service users living at the home. The home is owned and managed by Dr & Mrs Trehan and is located in an established residential area of Old Trafford close to the village of Chorlton, close to shops, bus and train routes and other amenities. The home is a two storey Victorian property set in its own grounds and consists of 10 bedrooms (eight single and two Care Homes for Older People
Page 4 of 32 Brief description of the care home double), one dining room and two lounges. Stair lifts are installed on both sets of stairs. The home has gardens to front and rear of the property, which are well maintained. Parking is available to the rear of the premises. Care Homes for Older People Page 5 of 32 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: We did an annual service review for The Conifers on 27th March 2008. An annual service review is a report that we write for good or excellent services that have not had a key inspection in that year. Good services only have an inspection every two years and excellent services every three years. The annual service review does not routinely include a visit to the service. The review is an analysis of all the information that we have gathered about the service since the last main inspection. When we did the annual service review in March 2008 we found no evidence to suggest that our quality rating had changed or that we needed to bring the inspection forward. This visit was unannounced, which means the manager and staff were not told we Care Homes for Older People
Page 6 of 32 would be visiting, and took place on 11th February 2009 commencing shortly after 9.00am. The inspection of The Conifers included a look at all available information received by the Commission for Social Care Inspection (CSCI) about the service since the last inspection in October 2006. We also sent the manager a form to complete before the visit to tell us what they thought they did well, and what they need to improve on. The manager completed this. We considered the responses and information provided. There was a lot of information contained within the document which was handwritten and difficult to read. We call this form the Annual Quality Assurance Assessment (AQAA). The Conifers was inspected against standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to staff and posted to specific residents to obtain their views of the service, the views expressed in returned comment cards and those given directly to the inspector are included in this report. We found our information at the visit by observing care practices, talking with people staying at The Conifers, talking with the Care Management Consultant, the deputy manager and staff. A sample of care, employment and health and safety records were looked at. The main focus of the inspection was to understand how The Conifers was meeting the needs of residents and how well the staff themselves were supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to three residents were looked at in detail to help form an opinion of the quality of the care provided. A brief explanation of the inspection process was provided to the deputy manager and the care management consultant on our arrival at The Conifers. We gave full feedback to them at the end of the visit. Since the last inspection at The Conifers we have not received any complaints, concerns or safeguarding matters. The weekly range of fees charged by the home is between 385 and 400 pounds each week. Additional charges are made for hairdressing, personal toiletries, podiatry and magazines. References to we or us in this report represent the Commission for Social Care Inspection. The preferred term for people living at The Conifers is residents and this is the term we have used when describing the people living at the home. Care Homes for Older People Page 8 of 32 What the care home does well: What has improved since the last inspection? The requirement to check that the medication records agree with the medication actually being administered to residents has been addressed by the procedures now in place. The handyman ensures that any fallen leaves are removed from the paths around the home on a daily basis to ensure the safety of residents when they walk out. All fire doors are now checked regularly and are recorded as having been checked to Care Homes for Older People Page 9 of 32 make sure they operate properly as a safety precaution. The deputy manager told us that all the fire doors have been checked to make sure that they close fully into their rebates. We were sent as required on the last inspection evidence that the homes gas boiler had been serviced annually since 2003. The records we looked at on this visit were in order. The deputy manager said that the Commission (CSCI) are told about all incidents affecting residents health and well being in line with the regulations. One resident who had some experience of other care homes said, the best move I made was to come to the Conifers. Another resident, when asked what the best thing about the Conifers was, replied everything is great here if you want anything they will get it for you. The good quality of care at the Conifers has been maintained. What they could do better: The manager needs to include with the medication administration records a photograph of the resident to assist in identification and to provide an additional safeguard that medication is being given to the right person. The manager should obtain a controlled drugs book so if a residents doctor prescribes controlled drugs these can be recorded in line with regulations. We made a requirement on the last inspection to make sure that staff were checking in medication to ensure that it has been dispensed as required. When we looked at the medication records we saw that the quantity received had been signed in and the date indicated. For one resident for a period of four days the medication hadnt been in stock to give to the resident. The process of booking in medication must include checking that everybodys medication has arrived into the home so the resident can be given it at the right time. To make sure residents receive their medication when they should, the manager needs to review the ordering of medication so that medication doesnt run out mid cycle or if it does it is reordered in good time, before tablets or medicines run out. If the administration of medication is changed and the dosage or frequency is altered by the doctor the manager should make sure that this detail is included on the medication administration records and this detail is signed and verified by a second person, if handwritten to confirm accuracy. To promote residents safety when moving or transferring them in wheelchairs the manager should make sure that footrests are fitted and used on wheelchairs unless there is a clear risk to the resident that this would not be safe for them.Which should Care Homes for Older People Page 10 of 32 be documented. To further promote residents enjoyment of the meal in addition to promoting the respect of the individual, staff practice needs to be changed when they are assisting residents to have their meals by ensuring staff sit with the individual resident throughout the meal. To provide residents with the opportunity to look at or to refer to what they are having to eat for their meals, the manager should display a menu for the day which they can see and have easy access to. The manager needs to further develop the complaints procedure by recording the comments and complaints received by residents, staff or families to demonstrate what action had been taken and the outcome for the residents when comments have been made. The manager should arrange for all staff to attend protection of vulnerable adults training so they know how to recognise the signs or symptoms of abuse, and know what to do if an allegation is made. To further promote the health and safety of residents and staff the manager needs to speak with Greater Manchester Fire Authority to check out the practice of wedging open fire doors to see if this practice is acceptable to the fire service in line with their regulations. The manager should ensure the pipework and radiators are guarded or have low temperature services to make sure residents are safe and the risk of harm from burns are minimised. To further promote residents privacy when using the bathroom, shower room or toilet the manager should fit blinds or curtains to the windows. Examine the reason why the locks fitted to bathrooms are not working properly and remedy this to enable residents to lock the door when using the bathroom if they so wish. The manager should arrange to have the upstairs bathroom flooring replaced or deep cleansed ensuring that the appearance of the floor is clean, which, in turn promotes the respect of the residents that live at the Conifers. 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 11 of 32 Care Homes for Older People Page 12 of 32 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 13 of 32 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. Residents needs are assessed prior to moving into the Conifers and they are given information about the home. Evidence: A service user guide and a statement of purpose are available and contained all the information required in the National Minimum Standards. Initial enquiry forms are filled in to start the process for a prospective resident. The manager will visit the person at their own home or in hospital to carry out a full assessment of their needs and wishes to ensure the service can meet in full the residents needs. One resident said in response to the question did you receive enough information about the home before you moved in , no, because I was taken here at a very short notice when my husband was taken to the hospital. Care Homes for Older People Page 14 of 32 Evidence: Prospective residents and or their representatives are encouraged to visit the home for a look around, a meal and a trial visit. A resident told us, social workers helped me to view the home and the information and brochure was given to me by the manager. A further resident said, visited one afternoon to look around. Bedroom was shown to me and got the brochure stayed back for lunch and enjoyed it. One staff said, (the home) offers a friendly environment offers choice of meals, offers daily activities for service users. Care Homes for Older People Page 15 of 32 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. Residents receive the care and support they need in a way that meets their expectations. Evidence: Each resident had their own care file that contained information, medical information and information that gave details of their contract with the home. A selection of these files were looked at. Individual files also contained care plans that identified residents needs and wishes, relating to their mobility and transfers, personal care, social activities, mental health needs, hair and nail care, foot care, oral care and dietary needs. The care plans we looked at contained detailed information about the residents individual needs and wishes. Day to day care and support activities were recorded on daily records by the staff team and there was evidence that these records were reviewed. Entries on the daily
Care Homes for Older People Page 16 of 32 Evidence: notes were reflected of the residents care plan. Individual risk assessments were available on residents files. These assessments showed that areas of risk had been considered for individual lifestyle activities. We saw a resident being taken to the dining room in a wheelchair without the use of footrests. Staff practice needs to be reviewed and amended when transferring residents in wheelchairs. Footrests do need to be used to ensure residents are transferred safely in line with moving and handling requirements. An optician visits residents to assess their vision on a regular basis to ensure that all residents have their vision tested annually. Each resident was registered with a general practitioner in the local area and there was a written record that district nurses and other health professional visited residents on a regular basis when this was needed. Residents spoken to said they receive the medical support they need . The manager stored medication appropriately and staff recorded what medication they had administered on a Medication Administration Record (MAR). A medication policy for staff was in place. The policy provided detailed information about the managing and administration of medication at the Conifers. This supports staff to do their job properly. A sample of medication for residents was looked at. Not all the medication records had photographs of residents with them. This we recommend as it is another way of making sure of the identification of residents before they are given medication to make sure they get the right medicines. None of the residents were prescribed controlled drugs. When controlled drugs are prescribed by residents doctors these drugs need to be recorded in a controlled drugs book as well as on the medication administration records. The manager needs to get one of these books just in case controlled drugs are prescribed and then they will be recorded in line with the regulations. When we looked at the medication for one resident we saw that for a period of four days the medication hadnt been in stock at the home. This needs to be sorted out as residents should have some medication in stock so they can have their medication as and when prescribed by their doctor. For another resident one medication hadnt been recorded as being given to them since 14th January 2009. The deputy manager told us that this medication was prescribed as and when needed and didnt have to be given twice a day as recorded on the medication administration records. If there are changes to the administration of medication this should be detailed on the medication records.
Care Homes for Older People Page 17 of 32 Evidence: The current method looks as if staff are being selective when they give someone their medication. The manager needs to make sure that when medication comes into the Conifers that the quantity is indicated on the medication administration records. There were at least two occasions when this detail was not recorded. The deputy told us that they do usually clearly record the number of tablets for example that are delivered as they should do. There was a change of dosage of medication for one resident . The detail on the medication administration records did not indicate how often this medication should be given. This does need to be included so residents are given the correct medication at the correct time to keep them well. During the visit the inspector observed staff addressing residents in a dignified manner, knocking on doors prior to entering and addressing requests from individuals. Residents who completed comment cards said staff listen and act on what they say and one resident added, very nice staff. One staff said they felt that they had the right support, experience and knowledge to meet the different needs of people who use the service. One added, treating each service user with respect and giving them privacy and dignity. Most importantly giving them choices. Giving them the best quality of care possible. One resident told us that they definitely receive the care and support they need. A service user said, happy as a pig in muck We asked residents if they receive the medical support they need. All residents who completed comment cards said always and one added, Apart from the pills that I brought with me when I came here, for the first time, I saw a doctor this morning about my legs and that I will get water pills. Care Homes for Older People Page 18 of 32 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. The activities programme provides residents with entertainment and stimulation. Evidence: Meals are served in the dining room and residents said they were supported to take their meals in their rooms if they wished. The menu for the week was displayed on a board in the dining room. Residents said they didnt realise it was there as they couldnt really see it. Menus would be much better placed where residents could see and read them. There was some discussion on the visit to write the meal of the day on the board in the dining room or have the menu on the table so residents could refer to them if they wanted to see or be reminded what was for lunch and tea. All residents spoken to on the visit spoke positively about the food that was served at mealtimes. One resident told us that theyusually liked the meals and added, usually but they take notice of this always. Another resident said the meals were brilliant. A further resident said the meals werevery good, definitely suits the elderly, enjoy the food. We had a meal with residents and the meal was attractively presented. Two residents need support to eat there meals. Staff didnt sit with the resident but stood
Care Homes for Older People Page 19 of 32 Evidence: next to them whilst assisting to feed them. Best practice is that staff stay with the resident for the duration of the meal and sit with them and talk with them and in some cases let them know what they are eating when they are not aware themselves. The manager needs to support and direct staff to promote best practice to further support residents enjoyment of mealtimes. Families and friends of residents are encouraged to visit the Conifers One person who visits people in the home on a weekly basis informed the inspector they were always made to feel welcome by the staff Residents said they were able to choose if they wanted to take part in activities One resident told the inspector that they chose to spend most of the day in their room but was always given the choice to be assisted to the lounge if they wanted We asked residents whether there were activities arranged by the home that they could take part in one resident responded, Not interested in any of the activities apart from reading and watching television. Mobile library brings the books of my choice. Another resident said, play different games. Do exercises. One resident said, we get plenty of books to read and get to watch own favourite programmes. Care Homes for Older People Page 20 of 32 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 in the Conifers complaints procedure and that any complaints would be listened to and acted on. Evidence: The manager has a complaint policy and procedures which is available in the home. All residents who spoke to us during the visit said if they had a concern they would approach the deputy, a member of staff or the manager. Residents who completed comment cards indicated they always knew who to speak to if they were not happy or needed to make a complaint. We asked to look at the record of complaints or comments received from residents or staff or families since we last visited the home. The deputy told us that they havent had any complaints, so none had been recorded. A comments and complaints record can be used by the manager to monitor the service provided as well as being used to see if there are any patterns to comments or the service provided at The Conifers. It would be good to see what comments or complaints had been raised to evidence how the deputy or manager respond to these comments and how it develops the service they provide. Staff said they knew what to do if a resident or friend or relative had concerns about the service. One staff added, Discuss the matter with the deputy manager, senior
Care Homes for Older People Page 21 of 32 Evidence: carer or manager. We asked if service users knew who to speak to if they were not happy. One resident responded, It depends on who but I am happy. A policy for the protection of vulnerable adults along with a copy of Social Services joint agency Adult Abuse Policy was available within the home. Some of the staff had attended protection of vulnerable adults training. This training informs staff what abuse is and also provides them with training in signs and symptoms of abuse and what to do if abuse is alleged. All staff should attend this training as a safeguard to residents. It is important that all staff attend the training so they know what to do and how to recognize abusive situations.The remainder of the staff team should have this training. All residents who were asked expressed the view that people were safe at the Conifers and protected. Some staff indicated they had an understanding of the need to be vigilant about the possibility of abuse and of action to take. This included letting the manager know if they saw or heard anything that they thought was abusive. The Commission for Social Care Inspection (CSCI) has not received any complaints or safeguarding allegations about the Conifers. Care Homes for Older People Page 22 of 32 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety issues potentially placed the safety of residents at risk.Residents were provided with comfortable and welcoming environment. Evidence: The lounge is on the ground floor and is linked to the small dining area. Residents said they were comfortable in the lounge and spend some if not for others, all of their day sitting and chatting, watching television or reading. The lounge is split into two sections so residents have the choice to sit in a different area. One resident said they always sat in a particular place as the people they liked to talk with were in that section of the lounge. The lounge was furnished with a variety of chairs which we were told provided residents with comfortable seating. The room had a homely feel. The deputy told us that the decorators were coming into the Conifers after the visit during the night to repaint the lounge. This is arranged this way so as not to inconvenience residents. We had a look around the building and in some of the residents bedrooms. We saw that two bedroom doors were wedged open. This compromises residents safety. In an emergency situation these doors would not close and act as a barrier as they were designed to do. We were told that one resident likes to have there bedroom door open
Care Homes for Older People Page 23 of 32 Evidence: while they are in the room in the day, so they can here who is coming and going and what is going on. The manager needs to talk to Greater Manchester fire officer to check out if what they are doing conforms to the fire regulations. Sometimes automatic door closures which are linked to the alarm system are fitted to bedroom doors or other doors in a care home so it makes it easy for residents to walk around independently if the doors are heavy for example or if they want to hear what is going on outside there bedroom when they spend time in their room. Three of the radiators in the bedrooms we looked at were really really hot and could pose a risk to residents being harmed by them. The care management consultant told us that they were having guards fitted to radiators in the home. This needs to be addressed sooner rather than later to promote residents safety. Residents had personalised there bedrooms and one resident said they, had everything they could possibly need in their bedroom and they were cosy. We looked in the bathrooms and toilets. Some of the bathrooms do not have curtains or blinds fitted to the windows. It would be better if they were fitted as this would further promote residents privacy when using the bathroom. Two of the bathroom door locks didnt appear to work, they didnt lock from the inside. Fitting locks to the bathroom or toilet doors that are working would also promote residents privacy when using these rooms. The type of lock needs to be of a design that in an emergency the locks could be opened from the outside. The floor covering in one of the bathrooms needed replacement as it looked shabby and dirty, even though it wasnt necessarily dirty this is how it looked. The flooring needs replacement or deep cleaning to bring it up to a satisfactory standard. The hoist in the bathroom was receiving attention from contractors on our visit. We were told that the flooring needed some attention and that this work was being done before the hoist contractor was due to return to the Conifers. One resident said they hadnt had a bath because the hoist wasnt working. The deputy told us that residents were asked if they wanted a shower instead but some said that they would wait for the hoist to be repaired. Care Homes for Older People Page 24 of 32 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. Staffing arrangements, recruitment and training ensure that residents are cared for and supported safely. Evidence: All the staff files we looked at contained a completed application form, written references and the dates of previous employment. All gaps in employment history were explained. This is how it should be to offer some safeguards to residents. Completed Criminal Record Bureau disclosures were in the staff files and some files identified that POVA 1st checks had been carried out prior to staff starting work at the Conifers. We asked to look at the record which details the training staff had received to make sure they had the training that they should receive to do their job well. The training record we looked at on the visit wasnt very clear. We asked the care management consultant to send us a record which clearly indicated the training staff had received since we last visited. We received this record as we had requested. The record identified that some of the staff needed infection control training. The care management consultant indicated that this had been arranged with the local authority. The record of manual handling training indicated that some staff had received this training or an update for this training in 2008. This ensures that staff are up to date
Care Homes for Older People Page 25 of 32 Evidence: with the training they need to move residents safely. We were told that five staff have food hygiene training arranged with the local authority. Staff spoken to were positive about the courses they had taken part in and said it helped them in their job. We looked at the duty roster which indicates the names of staff on duty throughout the day and night. There are two staff on duty throughout the day. At night time there is one member of staff on waking duty and one staff who sleeps in. The duty roster needs to clearly detail the hours staff work at night. The manager we were told works predominantly office hours during the week. Comments about the staff by residents were positive and included, The staff here are very kind and will do anything for you Staff are never too busy to listen to me and help me they are a great bunch. Care Homes for Older People Page 26 of 32 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 Conifers is being run in the best interests of residents who live there and their welfare is promoted and protected. Evidence: Previous visits to the Conifers have confirmed good standards of the maintenance of equipment for health and safety purposes. There has been a regular routine of testing fire alarm and detection equipment. The deputy manager said the Conifers was maintaining all appropriate health and safety testing and compliance. A sample of this documentation was looked at and indicated these standards were being maintained. Records identified that staff had received some fire safety training. It could not be confirmed that they had completed practical fire drill training at the appropriate frequency. Hot food temperatures are recorded as are water temperatures and fridge and freezer temperatures. This is in keeping with food hygiene regulations. Care Homes for Older People Page 27 of 32 Evidence: Accident records were in place which indicated that accidents and incidents were recorded. A system was in place for all the policies and procedures to be reviewed and updated. This ensures that staff know the new ways of working and are kept up to date with changes in the regulations and standards they should work to. Health and Safety risk assessments and policies and procedures were available for staff to access. This makes sure that staff have a reference to these procedures if they need to check something out. Procedures are in place to find out what people think of the service these include staff and resident meetings Staff told us these meetings were arranged regularly. Maintenance contracts were in place to regularly monitor the health and safety aspects of the Conifers. Care Homes for Older People Page 28 of 32 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 32 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 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 8 To promote residents safety when moving or transferring them in wheelchairs make sure that footrests are fitted and used on wheelchairs unless there is a clear risk to the resident that this would not be safe for them.Which should be documented. Include with the medication administration records a photograph of the resident to assist in identification and to provide an additional safeguard that medication is being given to the right person. Obtain a controlled drugs book so if a residents doctor prescribes controlled drugs these can be recorded in line with regulations. To make sure residents receive their medication when they should review the ordering of medication so that medication doesnt run out mid cycle or if it does it is reordered in good time, before they run out. If the administration of medication is changed and the dosage or frequency is altered by the doctor make sure that this detail is included on the medication administration records and this detail is signed and verified by a second person if handwritten to confirm accuracy. 2 9 Care Homes for Older People Page 30 of 32 3 15 To further promote residents enjoyment of the meal in addition to promoting the respect of the individual, amend staff practice when they are assisting residents to have their meals by ensuring staff sit with the individual resident throughout the meal. To provide residents with the opportunity to look up or to refer to what they are having to eat for their meals display a menu for the day which they can see and have easy access to. 4 16 The manager needs to further develop the complaints procedure by recording the comments and complaints received by residents, staff or families to demonstrate what action had been taken and the outcome for the residents when comments have been made. Arrange for all staff to attend protection of vulnerable adults training so they know how to recognise the signs or symptoms of abuse, and know what to do if an allegation is made. To further promote the health and safety of residents and staff speak with Greater Manchester Fire Authority to check out the managers practice of wedging open fire doors to see if this practice is acceptable to the fire service in line with their regulations. Ensure the pipework and radiators are guarded or have low temperature services to make sure residents are safe and the risk of harm from burns are minimised. Fit blinds or curtains to the bathroom, toilet, shower rooms to further promote residents privacy when using these rooms. Examine the reason why the locks fitted to bathrooms are not working properly and remedy this to enable residents to lock the door when using the bathroom if they so wish. Replace or deep cleanse the upstairs bathroom flooring ensuring that the appearance of the floor is clean which in turn promotes the respect of the residents that live at the Conifers. 5 18 6 19 Care Homes for Older People Page 31 of 32 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 32 of 32 - 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!
