Inspection on 03/02/09 for The Conifers Nursing Home

This inspection was carried out on 3rd February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Conifers Nursing Home 14/03/08

The Conifers Nursing Home 02/11/06

The Conifers Nursing Home 03/11/05

The Conifers Nursing Home 31/05/05

The Conifers Nursing Home 15/03/05

The Conifers Nursing Home 05/10/04

The Conifers Nursing Home 23/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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: The Conifers Nursing Home Brampton Road Wombwell Barnsley South Yorkshire S73 0SS     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: Jayne White     Date: 0 3 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 Nursing Home Brampton Road Wombwell Barnsley South Yorkshire S73 0SS 01226751007 F/P01226751007 none Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John Dominic Manfredi,Mr Anthony Constantine Manfredi,Mr Anthony John Manfredi,Mr Ian Hyde Name of registered manager (if applicable) Mrs Carole Law Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Persons accommodated shall be aged 60 years and above. Two specified service users under the age of 60 may live at the home. Date of last inspection Brief description of the care home The Conifers is a purpose built care home for people requiring nursing or personal care. On a site visit to the service on 3 February 2009 the manager stated the fee was 351.50 per week with additional charges made for hairdressing and chiropody. More up to date information may be obtained from the manager of the home. Care Homes for Older People Page 4 of 32 care home 33 Over 65 33 0 Brief description of the care home A copy of the homes statement of purpose, service user guide, complaints procedure and CSCI report was available in the entrance hall. 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: 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 a key inspection and comprised information already received from or about the home and a site visit. We visited the home on 3 February 2009 without giving them any notice between 08:30 and 16:30. Mrs Carole Law, the registered manager was present during the visit. The manager completed an Annual Quality Assurance Assessment before the site visit. This gives the service the opportunity to tell the CSCI how well they think they are meeting the needs of people using the service, what the home was doing well, what had improved since the last inspection on 14 March 2008 and any plans for improving the service in the next 12 months. Various aspects of the service were then checked during the site visit including inspection of parts of the environment, records relating to Care Homes for Older People Page 6 of 32 the running of the home, observing care practices and inspecting a sample of policies and procedures. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received. The care provided for three people was checked against their records to determine if their individual needs identified in their plan of care were being met. We checked all but one of the key standards and requirements from the last key inspection. All this information and peoples, representatives and staffs opinions and comments were considered for inclusion in this report. The manager was provided with initial feedback from the inspection during and at the end of the visit. The inspector wishes to thank people living at the home, the staff and the manager for their assistance and co-operation during the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The original assessment and care plan for people who use the home for respite services should be reviewed before admission, to ensure their needs can continue to be met and staff know how to meet those needs. Care needs to be taken that peoples health and personal care needs are met as identified in the plan of care, so people arent placed at risk. The social/activities assessment/care plan needs to contain more detail and be more person centred, so that staff and the service can determine/plan for each person how they are able to make sure all people have the opportunity to take part in social/leisure activities to enjoy a fulfilling quality of life. Care Homes for Older People Page 8 of 32 So that medication practices protect peoples health and welfare, there must be a record of the amount of medicines received into the home for people, an assessment of staffs competence in dealing with medication should take place, all medicines should be stored in a lockable cupboard and audits of medication should take place, so that discrepancies in medication administration/records can be addressed. To respect peoples individual private space (their own room) and control the spread of infection, peoples own room must be used when the doctor and hairdresser visit. Recruitment procedures were insufficient to demonstrate checks had been done to make sure staff were suitable to care for people so an immediate requirement was made for the service to action this immediately. Demonstrate training staff have undertaken, through certification etc, by having administration systems that are better organised, so that it can be established what training has been done, what needs to be updated and what is planned. Quality assurance and monitoring systems needed formalising to demonstrate stakeholders opinions of the service are listened to and acted on. Establish a system that enables people to be able to access money held on their behalf by the service at all times. 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 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 10 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. On the whole, people were assessed prior to their admission to the service, which enabled staff to be aware of peoples needs so staff know all about them and the support they need. Evidence: When we looked at information in the AQAA it stated potential service users are encouraged to come and spend time at the home before coming to a decision to live there. Also, that admissions are well managed with prospective service users being carefully assessed by experienced and empathetic staff. To confirm this we looked at three peoples files to check a full needs assessment had been undertaken. We concluded a needs assessment was carried out and included an assessment of daily living, personal care, health care and areas of risk. In two files there was no detail of any social assessment and in another only contained brief words Care Homes for Older People Page 11 of 32 Evidence: to illustrate their interests. For people admitted on respite care a review of the original assessment did not take place at each admission and some information was out of date. In one of the files an assessment had been received from the placing authority. We spoke with people that lived there. They said, my son and daughter visited. They studied the girls and thought theyd make a good set, doctor chose for me and family looked round and Ive never regretted it, Ive not really got settled, its lovely - never regretted one day and been in ... months and not regretted it. The survey that was returned by someone living at the home stated theyd received enough information about the home before they went to live there. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were receiving the health and personal care they needed, but care needs to be taken these are met as identified in the plan of care, so people arent placed at risk. The medication practices did not support people in a safe way. Staff attitude and approach to care was based on respect for people, which helps safeguard and promote peoples rights and dignity, but respect for peoples private space is needed. Evidence: The survey returned by someone living at the home stated they usually received the care and medical support they needed. When we spoke with people and their representatives they told us they were pleased with the care and medical support their received. We saw that people were well dressed in clean clothing and attention had been paid to their hair and nail care. This indicated respect and dignity by staff when caring for them. One person commented, even though were old, weve still got our pride. However, when we spoke to people they told us, we use ... room for the hairdresser Care Homes for Older People Page 13 of 32 Evidence: and ... room for the doctors. This does not respect peoples private space or uphold good practice guidelines for the control of infection. We looked at three care plans. A range of risk assessment documents had been used to determine peoples needs including moving and handling, nutrition and falls. From these and the information from the needs assessment, a plan of care had been put together for people to inform staff the help and support people needed. This provided a baseline for staff to measure peoples progress or increasing level of need. However, gaps in reviewing the care plan as required and completing the tasks within the timescales identified were not always carried out and this could place people at risk. For example, the care plan for someone on respite had not been reviewed on their recent admission. The result of this was although the moving and handling assessment didnt indicate the persons actual mobility, the tasks indicated independence, but they were seen being transferred in a wheelchair without footplates. In another care plan, there was contradicting information about when the person needed weighing to monitor their health - the nutritional assessment highlighted weekly, but the care plan stated monthly. Another nutritional risk assessment identified a person had lost weight but because the record didnt identify a specific date when the weights were recorded this could have been over one or two months. One pressure sore risk assessment identified a review of a pressure area was needed after two weeks, but this had been reviewed in three weeks. These gaps were highlighted to the manager to act on and maintain a tighter control in monitoring peoples health so they are not placed at risk. The care plans identified that a range of health care professionals visited people to assist in maintaining their health care needs. When we spoke with staff they showed a good knowledge of peoples diagnosis and could verbally describe the health and personal care needs of the people they cared for. When we observed staff working there was clear and respectful communication between people and staff and staff treated people in a kind, warm manner. They used touch to offer support and this seemed to provide comfort to people. Staff spoke clearly and at a steady pace with people. They encouraged people to be active in their own care and activity. When we spoke to people they were happy for staff to manage their medication for them. When we spoke to the manager they confirmed that it was nurses that administered medication to people. She stated they hadnt received any updated training and an Care Homes for Older People Page 14 of 32 Evidence: assessment of their competence didnt take place. We saw some medication in the locked treatment room that was not stored in locked cupboards, which is not consistent with safe storage guidelines. We looked at the recording and administration of medication on a sample basis for three people to check medication was being given to people in accordance with the doctors instructions. We were unable to do this for two people as there was no record of the amount of the different medications received for those people. The manager said they never recorded the amount received in bottles/boxes from hospital or when people were admitted from home. In addition, where there were handwritten entries of medication received, these had not been verified as confirmation the entry was correct. In the final record where there were some entries of the amount of medication received, we noted discrepancies in all of them. Care Homes for Older People Page 15 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. Each person was treated as an individual. They were as independent as they could be, lead their chosen lifestyle and were given the opportunity to make the most of their abilities. The care home could support people better in following personal interests and activities. People were able to keep in touch with family, friends and representatives. People had attractive meals that were good quality and on the whole, met peoples expectations. Evidence: The AQAA stated the service listen and promote peoples right to live a stimulated, meaningful life where peoples wishes are taken seriously. It stated peoples current favourite activities were scrabble, dominoes, bingo, shopping, visits to garden centres and coffee tete a tetes. When we spoke to staff they said they had entertainers come in, bingo every Thursday and a member of staff is allocated time to carry out activities. We spoke with the member of staff allocated time for activities. They said they did activites on an individual basis and in groups. Examples they gave were making a social occasion of peoples birthdays, arts and crafts sessions, weekly bingo and taking people out Care Homes for Older People Page 16 of 32 Evidence: shopping. These activities were not descibed within the three peoples files we looked at or recalled when we spoke with people. If they were, it would reflect the quantity and quality of activities provided for people. In addition, a social/activity assessment and care plan was not always in place. Where one was, it did not provide meaningful information about how to engage that person in activities that were appropriate for them, so that staff and the service could determine/plan how those needs could be met. The importance of this is demonstrated in the survey returned when they stated there was usually activites arranged by the home they could take part in and then a comment but I cannot take part much since I am now in bed most of the time. We spent some time sitting with a group of people in the lounge where we were able to speak with them and observe their experiences of living in the home and their interactions with each other and the staff. During the observation we found that the majority of peoples moods were positive. Staff made efforts to include as many people as possible in conversation and day-to-day life and people also did this between themselves. Staff spoke clearly and at a steady pace with people and encouraged them to be active in their own care and activity. A friendly, lively and welcoming feel was evident. During the visit an occasion was made for some people by having their hair done by the visiting hairdresser. No other activities were seen during the visit. People told us that they were able to get up and go to bed when they liked within the constraints of group living. There were mixed comments about their daily life and these included, I do nothing during the day, weve housy tomorrow, its lovely here- never regretted one day, Im happy enough, hairdressers day today, Im never bored, I like shopping and go out about once a month with staff and just sit and look at walls and they look back. When we looked at the survey that was returned and spoke to people about the meals that were served it told us that on the whole, people were pleased with them. They said, I like most meals, foods edible, meals outstanding and mediocre. When we spoke to the cook she said in the main home cooking was provided, including cakes and buns. Currently, the dining room was being refurbished so people were eating their meals in their chairs in the lounges on trolley tables. We saw the lunch time meal being served. It was a positive and pleasant event, with food being nicely presented, hot and smelling nice, making the meal appealing for people. Drinks were available. The presentation of meals for people who needed their meals liquidising was good. There was no rush to the mealtime and people were given sufficient time to eat. Staff were patient and helpful and allowed people time to finish their meal. Care staff Care Homes for Older People Page 17 of 32 Evidence: were sensitive to those people who found it difficult to eat their meal themselves and needed assistance. They helped the person at their pace, making them feel comfortable and unhurried. Extra portions were provided as required. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure was in place that enabled people and their representatives to feel confident that any concerns they had would be listened to. Staff had been trained in the recognition and reporting of abuse, so they were able to safeguard people, but the recruitment process was not sufficient to safeguard people. Evidence: Relatives and some people were able to describe how they would raise any concerns they had. They said that any matter they raised was dealt with and they were satisfied with the outcome. People and their representative could access the complaints procedure because it was displayed in the entrance hall. It clearly described the procedure for people should they have any concerns. It was clearly written, easy to understand and explained what the procedure would be and how long the process would take. When we spoke to people and their relatives they said if they had any concerns they would feel comfortable in talking with the manager and that they knew any concerns would be dealt with. When we looked at the complaints record and spoke with the manager it told us no complaints had been made. Care Homes for Older People Page 19 of 32 Evidence: The AQAA confirmed there were policies/procedures/codes of practice in place to protect people from abuse. The manager, through experience was aware of the procedures to be followed in the event of any allegations being made. The service had the local adult safeguarding policy and procedure for South Yorkshire. When we spoke to staff about reporting any allegations they were clear they would report any allegations that were made or incidents of harm they saw. Staff had been provided with training in how people can be safeguarded and to tell staff what to do should an allegation of harm be made or if they saw any incidents themselves. This training had been effective because staff we spoke with were able to describe what they would do should an allegation be made. The service had followed poor recruitment procedures, with staff appointed and starting work without important documentation being received (see staffing). Care Homes for Older People Page 20 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. The refurbishment of the living environment, although ongoing, could be seen that it was going to provide a well maintained, clean, tidy and comfortable environment for people to live and enjoy. Evidence: When we looked at the survey and spoke with people it told us the home was kept clean. They said, Ive brought my own TV, armchair and chest of drawers and I share a room, but theres no-one in at the moment. They said when someone was sharing there was a curtain that was used to maintain their privacy. A number of rooms were of shared occupancy. The AQAA told us there had been extensive refurbishment in the last 12 months. When we arrived it was evident this was still ongoing and included the refurbishment of the back lounge and dining room. People were becoming frustrated about how long this was taking and commented, be nicer when we get back into our own lounge, theyve been decorating now about 2 months and what weve seen so far its beautiful. There were still areas however, that needed refurbishing to make it a better environment for people to live. The entrance hall carpet was stained and had cigarette burns on it and the paper was marked. The manager stated there was a new carpet ordered to be fitted. Care Homes for Older People Page 21 of 32 Evidence: When we looked round the home the physical environment on the whole, was suitable for the needs of people that lived there. There were sufficient bathrooms and toilets for people that were appropriately located and easily accessible, but these could be more domestic in appearance to make them more inviting to use. The toilets had been adapted to assist people with their independence when going to the toilet. Handrails were provided to assist people to move about independently. The front lounge was a pleasant and homely environment for people to live and was well lit. When we looked in some of the bedrooms they were comfortable and some people had personalised these with pieces of their own furniture and possessions. Bed linen was clean and in a good condition. Items of equipment and furniture were still being stored in corridors and toilets because of a lack of storage space, which was unsafe and tidy. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received appropriate support as there were enough staff on duty. They could not have confidence in the staff because sufficient checks had not been done to make sure they were suitable to care for them. Peoples needs were met and staff received training, but this needs monitoring better through a more robust administrative system. Evidence: When we spoke to people and their representatives they had confidence in the staff that cared for them and they said there was usually staff available when they needed them and that they listened and acted on what they said. Their comments included, staff wonderful and good set of girls. When we spoke with staff they said, its a good staff team. They confirmed they were supported by the manager and encouraged to train and update their skills. Five staff had left employment in the last 12 months, which meant generally a consistent staff team was in place, which is important when caring for people. When we observed staff on duty, they worked hard, were patient and showed empathy to people. There was mutual respect between people and staff and their conversations were relaxed and friendly. The staff group were well motivated and enthusiastic about Care Homes for Older People Page 23 of 32 Evidence: their work. The AQAA told us training opportunities were provided that tried to deliver a programme that met statutory requirements and National Minimum Standards. It stated all staff had training in prevention and control of infection, malnutrition care and assistance with eating and two catering staff and twelve care staff had received training in safe food handling. It also stated 40 of staff had obtained NVQ level 2 in Care or above. The manager said there wasnt a member of staff trained in first aid on each shift as there was always a nurse in charge of the shift. She had not conducted a risk assessment to assess whether this would be sufficient to protect people in the event of an emergency/incident. We looked at four staff files for supervision and training records to confirm information in the AQAA and what staff had told us when we spoke with them. There was some evidence that training took place. However, the filing system for keeping these records was haphazard and the service could not evidence through certification all the training staff had completed. The system was insufficient to be able to demonstrate an up to date picture of training that had been completed, any gaps and planned training. The AQAA stated there was a recruitment policy in place and that everyone who had commenced employment in the last twelve months had satisfactory pre employment checks. This was not demonstrated in practice when we looked at three staff records. We noted gaps in employment in two of the files, where there was no written verification of the reason for those gaps. In one file, the member of staff had commenced before a full CRB was issued, but there was no evidence of a POVA first check being received to verify they were suitable to work with vulnerable adults under supervision until a full CRB was received. In another file there was no evidence the person had undertaken a current CRB check and an immediate requirement was issued for the member of staff to be removed from shift until a POVA first check that was satisfactory had been received. The service responded to the immediate requirement, within the agreed timescale and confirmed this would happen. One of the files, showed no evidence of any references being received. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had confidence in the care home and the manager, but there were some shortfalls in meeting the regulations required when managing a care home. People were not able to access money held on their behalf by the service at all times. On the whole, the environment was safe for people and staff, because appropriate health and safety practices were carried out. Evidence: People expressed satisfaction with the service they received, as did their representatives. The manager was experienced in the care of older people and her direction and leadership promoted a relaxed and friendly atmosphere. When the manager was not on duty, responsibilities for the day-to-day operation were carried out by the nurse on duty. The manager was positive about the inspection process and was committed to meeting the National Minimum Standards and Care Home Regulations, although there were Care Homes for Older People Page 25 of 32 Evidence: areas where regulations hadnt been met. When we spoke to staff they said the manager was approachable, professional and they felt confident in her. They said she met with them and gave support and discussed how they were working. The AQAA was completed albeit on the younger adults template. The manager said the owner had checked this with CSCI who had said it was ok to continue to complete. The information gave a reasonable picture of the current situation within the service, but they need to document in each section what they have improved in the last 12 months and identify what they could do better, to identify a plan for improving the quality of life for people. The AQAA stated the home continually promotes safe working practices through frequent spot checks by the manager to assure herself practices reflect the homes policies and procedures. There was no documentation of this. Questionnaires were used to seek the views of people and other stakeholders. Meetings were held for staff and people that lived there, so they could have a voice and say how the home should be run. People and staff felt their views and opinions were taken into account by the manager and owners, but a formalised development plan was not formulated from this. Monies held by the home on behalf of people were unable to be inspected, as no access could be gained, because the owner who dealt with this was not present. This standard had been met at the previous inspection and a review of evidence before this visit identified this had not changed and therefore a further visit was not made to check them. However, it must be noted this highlights people cannot access their own records or money whenever they may wish. The AQAA stated maintenance of equipment was in place for portable electrical equipment, lifts, hoists, fire detection and alarms, fire fighting equipment, emergency lighting, emergency call equipment and gas appliances. It did not confirm the date for servicing of the premises electrical circuits, heating and a contract for soiled waste disposal was up to date. The manager was asked to act on this and verify they were in place with the owner. Fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. The manager had contacted the fire officer who had provided advice about the wedging open of fire doors. We observed staff moving people. On the whole, this was done well, but there was an occasion when a member of staff was seen moving someone without footplates. How Care Homes for Older People Page 26 of 32 Evidence: to move this person had not reviewed (see health and personal care). The manager said she had conducted a risk assessment of the multi-level fenced outdoor area to maintain peoples safety. Handrails were in the process of being erected as part of the refurbishment programme. We did not see any hazardous substances insecurely stored. Care Homes for Older People Page 27 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 28 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 1 29 19 Regulation 19 (1) (b) The identified member of staff must not work on shift until a POVA first check that is satisfactory has been received. So that people are protected by the homes recruitment procedures. 03/02/2009 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 9 13 Regulation 13 (2) There must be a record of the amount of medicines received into the home for people. To ensure there is no mishandling of medicines. 11/04/2009 2 10 12 Regulation 12 (4) (a) It also links to standard 26 and regulation 13 (3) Peoples own room must be used when the doctor and hairdresser visit. To respect peoples individual private space (their own room) and control the spread of infection. 11/04/2009 Care Homes for Older People Page 29 of 32 3 29 19 Regulation 19 (1) (b) Before staff commence employment, the following must be obtained and be demonstrated: 1 Two written references. 2 A full employment history, together with a satisfactory written explanation of any gaps in employment 3 A full CRB that is satisfactory. So that people are protected by the homes recruitment procedures. 12/04/2009 4 29 19 Regulation 19 (10) (a) & (b) Where a member of staff commences work without a full CRB being issued the service must demonstrate: 1 A POVA first check has been obtained in respect of the person 2 All other recruitement checks as required (see above) are obtained. So that people are protected by the homes recruitment procedures. 12/04/2009 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 improving their service. No. Refer to Standard Good Practice Recommendations 1 3 People who use the home for respite services should have their original assessment reviewed before admission, to ensure their needs can continue to be met. People who use the home for respite services should have their original care plan reviewed on admission, to make the 2 7 Care Homes for Older People Page 30 of 32 action staff need to take to meet their needs is up to date. 3 9 Audits of medication should take place so that discrepancies in medication administration/records can be addressed. So that all medicines are stored safely in accordance with good practice guidelines, all medicines should be stored in a lockable cupboard. To make sure a handwritten entry made on a medication administration record is correct, this should be verified by another member of staff. To demonstrate staff are competent in recording, safekeeping and safe administration of medicine received into the care home an assessment of their competence in doing this should take place. This also links to standard 14. The social/activities assessment/care plan needs to contain more detail and be more person centred, so that staff and the service can determine/plan for each person how they are able to make sure all people have the opportunity to take part in social/leisure activities to enjoy a fulfilling quality of life. Further storage space should be provided, so that all areas are kept safe for people to use and look tidy. This also links to standard 30. A risk assessment should be in place to assess whether arrangements in place for providing First Aid to people in the event of an emergency/incident is satisfactory. This also links to standard 30. To support and demonstrate training staff have undertaken, systems needs to be better organised, so that it can be established what training has been done, what needs to be updated and what is planned. This also links to standard 30. So that people are cared for by trained staff there should be a minimum of 50 staff that hold NVQ Level 2 in Care or equivalent. The home should establish a formal way of demonstrating the quality assurance and monitoring systems they use to demonstrate success in meeting their aims and objectives. So people have access to their own financial records and money at all times, systems within the home should be addressed to facilitate this. 4 9 5 9 6 9 7 12 8 9 19 28 10 28 11 28 12 33 13 35 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!