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Inspection on 15/01/09 for The Devonshire Nursing Home

Also see our care home review for The Devonshire Nursing Home for more information

This inspection was carried out on 15th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The standard of care planning in the home is very good, all care plans are comprehensive and include the current and changed needs of the residents and clearly document the care to be given to meet these needs. Care plans showed evidence of regular review, and had been formed in consultation with the resident wherever possible. Residents appeared well cared for and residents nursed in bed were comfortable with care plans showing evidence of nursing intervention. A General Practitioner visiting the home commented on the good standard of care given in the home, the expertise of the staff and his satisfaction regarding the manner in which the home looked after the residents. There is a good ratio of staff on duty for the number of residents in the home and during the daytime hours this includes three or four registered nurses in the mornings and two in the afternoons. The home experiences a low staff turnover which enables residents to benefit from continuity of care from staff with whom they are familiar. The standard of catering in the home was described by several residents as excellent. Residents said that they had choices at each meal including breakfast and that if they did not like what was offered on the menu, the cook would do something specifically for that resident. Staff training is to a good standard and registered nurses are encouraged to fulfil their training requirements. All staff have mandatory health and safety training. There was a relaxed and friendly atmosphere in the home and care staff were seen to treat the residents with empathy and respect.

What has improved since the last inspection?

The manager states that improvements have been made in the home in the past twelve months and these include a new call bell system and staff training records. The AQAA stated that refurbishment and decoration of the lounge has taken place and some new carpets have been put in resident`s rooms. Monthly reviews of new staff now take place during their three month probationary period, prior to them commencing formal supervision.

What the care home could do better:

On the day of the inspection the home was administrating medication to one part of the home using a `pre potting up` system. This was apparently due to the difficulty using medicine trolleys as there is no shaft lift in this part of the home. This practice is unsafe for residents and is not permitted. Discussions were held with the manager and immediately following the inspection the CSCI was informed that a safe method had been put in place. Therefore no requirement has been made. A recommendation has been made that two registered nurses check and sign handwritten drug prescriptions on the medicine administration records.Whilst the provider visits the home several times a week, there is no evidence of any written regulation 26 reports (monthly reports required by regulation) and no evidence of interviews with residents or staff. A requirement has been made for both formal regulation 26 visits and reports to take place. Staff must be reminded to shut or lock doors where it is the policy of the home to do so. Sluice and cellar doors were found open on the day of the inspection.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Devonshire Nursing Home 95 - 97 Carlisle Road Eastbourne East Sussex BN20 7TB     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: Elizabeth Dudley     Date: 1 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Devonshire Nursing Home 95 - 97 Carlisle Road Eastbourne East Sussex BN20 7TB 01323-736983 01273736983 nursing@devonshirenh.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Bernard Edward Clarke,Mrs Barbara Ann Clarke,Mrs Caroline Mills care home 42 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 42 0 old age, not falling within any other category physical disability Additional conditions: 0 42 The maximum number of service users who can be accommodated is: 42 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Physical disability - PD Date of last inspection Brief description of the care home The Devonshire is registered to provide nursing care for up to 42 residents, older people over 65 years and individuals with physical disabilities. The home is situated in a residential area, close to Meads village in Eastbourne with local shops and amenities, including public transport nearby. The home is made up of two buildings linked on the ground floor by a corridor. The building has been adapted and converted with limitations on the allocation of some rooms due to the physical restrictions of the building. There is a shaft lift in one part of the home and a stair lift in the other, with Care Homes for Older People Page 4 of 31 Brief description of the care home prospective residents offered rooms in the part of the home that is appropriate to their assessed needs. There are lounges in each part of the home, with dining areas and sufficient space for social and religious activities. There are attractive gardens to the rear that are accessible to wheelchair users and are used by residents when the weather permits. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection took place on the 15th January 2009 over a period of eight hours. The manager Mrs B Wild facilitated the inspection. In order to form the judgements made in this report, evidence was obtained from examining documentation and records in the home. These included four care plans, medication records, menus, health and safety documentation, staff personnel files and other records necessary to ensure the smooth running of the home and to meet regulation. Prior to the inspection, surveys were sent out to residents and staff. Of these, fourteen service user and eight staff surveys were returned, and comments received were very Care Homes for Older People Page 6 of 31 positive. Residents and their relatives said that Staff are always willing to help, We always have a choice of menu and the meals are excellent. The staff are very caring and professional. First class home, very caring and consistent staff. Clean home, food excellent and good activities and I have never had to make a complaint. A lively programme of activities. Food well prepared and cooked and a good standard of cleanliness. Matron always gives first class advice One negative response was received with the respondent saying that staff are noisy at night, and sometimes things get forgotten. It would be nice to have more fresh air and exercise. Staff stated that they had a good training and induction and that the manager was responsive and We try to create a homely atmosphere for residents because it is their home. The Annual Quality Assurance Assessment (AQAA), a self assessment required by regulation which shows what the home has achieved in the past twelve months and plans for the next twelve months, was received by the date we asked for it. It contained accurate information about the home. Current fees for the service range between seven hundred and twenty one pounds and nine hundred and eighty seven pounds per week. Extra services such as hairdressing and chiropody are not included in the fees, and details of this can be obtained from the manager. What the care home does well: What has improved since the last inspection? What they could do better: On the day of the inspection the home was administrating medication to one part of the home using a pre potting up system. This was apparently due to the difficulty using medicine trolleys as there is no shaft lift in this part of the home. This practice is unsafe for residents and is not permitted. Discussions were held with the manager and immediately following the inspection the CSCI was informed that a safe method had been put in place. Therefore no requirement has been made. A recommendation has been made that two registered nurses check and sign handwritten drug prescriptions on the medicine administration records. Care Homes for Older People Page 8 of 31 Whilst the provider visits the home several times a week, there is no evidence of any written regulation 26 reports (monthly reports required by regulation) and no evidence of interviews with residents or staff. A requirement has been made for both formal regulation 26 visits and reports to take place. Staff must be reminded to shut or lock doors where it is the policy of the home to do so. Sluice and cellar doors were found open on the day of the inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information presented to prospective residents enables them to make a fully informed decision over whether the home can meet their needs. People who wish to live at the home receive a full preadmission assessment to ensure that the facilties, staff skills, and equipment, are sufficient to meet their care and social needs. Evidence: The home produces a Statement of Purpose and Service User Guide which meet the regulations, and contain sufficient information to ensure that both prospective and existing residents are aware of the services offered by the home. Prior to any resident being admitted to the home, they are visited by the manager and an assessment undertaken to ensure that the home can meet their needs and Care Homes for Older People Page 11 of 31 Evidence: expectations. Prospective residents receive a full information pack which includes the Statement of Purpose, Service User Guide, monthly menus and sample contract. They are invited to visit the home and following their decision to live at the home, are admitted for a months trial period. On admission they receive a copy of the homes Terms and Conditions of Residence and visited by the cook who ascertains their food preferences. The majority of residents spoken with said that they, or their representatives, had received full and sufficient information about the home. Three preadmission assessments were examined and these contained sufficient information to enable staff to commence the care planning process and to ensure that the skills of the staff and the equipment available at the home could meet the care needs of the prospective residents. The home admits residents for permanent, respite and continuing care, but not for intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a high standard of care planning which ensures that residents receive the appropriate person centred and holistic care for their needs.The present methods of administering medication in one part of the home does not fully safeguard the residents. Evidence: A total of four care plans were examined, and these showed a very good and informative standard of care planning. All care plans had been reviewed on a monthly basis and included all information necessary to ensure that the residents had care appropriate to their needs. There was evidence that the majority of residents or their representatives had been consulted over the care planning process. Care plans were person centred and contained clear directions for carers on how to address the residents current and changing needs. Daily care records viewed showed that the delivery of care was in line with the care Care Homes for Older People Page 13 of 31 Evidence: required as documented in the care plans. Good Risk assessments were in place in areas where restraint is required such as the use of bed rails and reclining chairs. There was evidence of involvement of other health care professionals including the Wound Care Specialist Nurse, Speech and Language Therapist, Physiotherapist and General Practitioners. The home uses a selection of nursing tools to assess residents needs including the Malnutrition Screening Tool, which is used to assess nutritional requirements. Discussions were held with the manager regarding the inclusion of electric mattress pressures and hoist sling sizes in the care plans. Residents spoken with said They look after us very well here. The staff are charming and give us excellent care. All residents said that their call bells were answered promptly and residents in the lounge were wearing call bells around their necks wander bells to enable them to summon assistance easily. A hairdresser and chiropodist visit regularly. Residents who were nursed in bed appeared comfortable, with staff assisting them to change position as required by their care plans, throughout the day. A visiting General Practitioner said that there was a good standard of care given in the home, and was very positive about the home and the knowledge of the staff. Whilst there was evidence that staff were generally vigilant in signing for medication on administration and in the storage and recording of controlled drugs, the method of medication administration, which is in line with the homes policies, does not safeguard the residents. Medications for one area of the home are pre-potted i.e. put into pots with residents names on them before being transported to the resident. Due to the absence of a shaft lift on this side of the home, a single medicine trolley cannot be used and the clinic room is on the top floor. The manager has been aware that this is unsafe practice and has been considering various solutions to address this. Care Homes for Older People Page 14 of 31 Evidence: A requirement has not been made as subsequent to the inspection, the CSCI was informed that the home has now ordered medicine trolleys to be kept on each floor and will commence using these. Until these are delivered, the manager has devised a method of transporting medication without necessitating pre-potting, which will ensure the safety of the residents. This has now commenced at the home. It is considered good practice to ensure the safety of residents by handwritten prescriptions being countersigned by two registered nurses. A recommendation has been made regarding this. Currently, registered nurses are not signing the medication charts following administration of prescribed creams and ointments. This was discussed with the manager who gave assurances that this would commence. Medication policies include a policy for self medication for those residents who wish to retain control of their medications. Appropriate risk assessments are in place but currently no residents self medicate. Residents who require continuing and end of life care are admitted to the home. The manager has completed the Gold Standards Framework and is currently undertaking training in the use of the Liverpool Care Pathway ( these are both nationally approved nursing tools to ensure that residents reaching the end of their lives receive a recognised standard of care and pain relief). The Gold standards framework is currently being used in the home, and other staff will be encouraged to participate in this course. Registered nurses have frequent update in the use of syringe drivers and other methods of controlling pain. The wishes of residents for their end of life care were present in some care plans examined, and the manager said that this would be extended to all care plans. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident that any complaints they may have will be addressed in an open and transparent manner. Staff are aware of their role and responsibilities in safeguarding those in their care. Evidence: The home has a varied activities programme and employs an activities co-ordinator to implement this. Leisure activities include some outings, visiting entertainers, and one to one sessions with residents. The opportunity for residents to participate in religious services takes place once a month, and this is supplemented by ministers from various churches visiting the home. Two residents in the home play the piano, both at the religious services and to provide entertainment for residents, and one resident, a former music teacher, is encouraged to retain some of her previous pupils and gives music lessons from her own piano in her room. Visitors are welcomed at any time and local school pupils visit the residents. Care Homes for Older People Page 16 of 31 Evidence: Residents surveys received prior to the inspection and residents spoken with said that a well rounded programme of activities is offered, There is usually something to do and staff come and talk to us. The manager gave assurances that staff are encouraged to spend time with those residents who are not so cognitively able and on this particular day were sitting in the lounge and did not appear to have any interaction in the life of the home.Subsequent to the inspection the provider stated that: The residents do have plenty of interaction every day. On the day of the inspection, the activities organiser had spent some time carrying out one to ones (conversation with individual residents) and the staff do spend time chatting to the service users. All of the residents spoken with confirmed that they have choice in their activities of daily living; which included their preferred times of rising and retiring. Care plans include social activity care plans and these showed residents preferences and the activities in which they had participated. A varied menu is provided which is formed in consultation with residents. The menu shows a choice of food at all main meals. Staff were seen to be showing two residents a choice of meals at lunchtime and taking the time to discuss the meal with the residents. It was noted that the cook then prepared a different meal to that on the menu for one resident, who had decided that they did not wish to have their previous choice. Residents can have a cooked breakfast if they wish and residents said that they are always consulted about what they would like for breakfast the following morning. Residents can take their meals either in their rooms or at tables in the lounge, with some residents having meals at small tables by their chairs. All of the meals, including pureed meals were well presented and attractive. Residents said that the standard of catering was good and comments received included: Excellent food, always a choice and if you decide you dont want what youve chosen on the day, you can have something else. Its never a problem if you dont want whats on the menu.I love the food here but have put on so much weight, I must start saying no. The cook has undertaken the food hygiene course and courses relating to the nutritional needs of the older person, and 50 of the staff have also undertaken these courses. Care Homes for Older People Page 17 of 31 Evidence: The kitchen was very clean with a good range of frozen and fresh food. Documentation as required by the Environmental Health Authority was in place and in date and the last Environmental Health Authority report described the catering and facilities as excellent. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident that any complaints they may have will be addressed in an open and transparent manner.Staff are aware of their role and responsibilities in safeguarding those in their care. Evidence: The home has a comprehensive complaints policy and surveys received and residents spoken showed that residents were aware of how to make a complaint, with residents saying that they would be comfortable doing this and confident that any complaint or concern would be dealt with in an confidential and transparent manner. There have been no complaints received, either by the home or the CSCI in the past twelve months. The manager has a confidential file for records of complaints and how they are rectified and subsequent to the inspection the provider informed the CSCI that any minor concerns raised by residents, and the actions taken to address these, are detailed in the communication sheet in the residents care plans Senior staff have received adult safeguarding training given by the local authority and it is intended that care staff will commence this. Currently all staff receive their adult safeguarding in house, from an adult Care Homes for Older People Page 19 of 31 Evidence: safeguarding trainer, and it also forms part of the induction course. Staff spoken with were aware of what constitutes abuse and of their role in protecting those in their care. There have been no adult safeguarding issues at the home in the past twelve months. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a pleasant, well maintained and clean home. Practices within the home ensure that incidences of infection are minimised. Evidence: The communal space provided consists of two residents lounge/ dining rooms and a pleasant well maintained rear garden, which has seating areas for the residents. The home was previously two houses that has resulted in only one half of the home having a shaft lift, the other half is served by chair lift. Residents in this side of the house are thoroughly assessed relating to their mobility requirements prior to being admitted to this part of the home. Service users accommodation is over two floors and consists of single rooms. The manager stated that furniture in residents rooms is gradually being replaced. Residents can bring their own possessions to personalise their rooms and also some furniture, following discussion with the manager. The rooms have a lockable drawer for residents personal possessions and they can Care Homes for Older People Page 21 of 31 Evidence: have a key to their room if they wish, following a risk assessment. One room did not have a restricted window opening, but information was received the day following the inspection, to say that this had been put in place. Portable electric radiators were being used in some rooms on a temporary basis due to some residents being affected by the extremely cold conditions. These had been fully risk assessed. The manager stated that the temperatures of residents hot water outlets are monitored regularly, but there were no records of these in the building at this time. She gave assurances that the temperatures were within recommended parameters and said that she would ensure that these records remained in the building. There are five assisted communal bathrooms within the home, and many of the rooms have an ensuite bathroom. There was evidence of suitable appliances and equipment to enable residents to maximise their independence, including full body hoists and other moving and handling aids. The home has several cleaners working on a daily basis, and the results of this were evident, with the home being very clean and no odours present. Good infection control practices were seen and over 75 of the staff have infection control training. Policies and procedures relating to infection control are in the process of review but there was reference in some care plans to current practice in infection control. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff with suitable training on duty over a twenty four hour period. Residents are safeguarded by robust recruitment practices and the standard of staff training. Evidence: The duty rota and conversation with staff and residents showed that there are sufficient staff on duty over a twenty four hour period to ensure that residents needs are met, and staff are fully supported. The home employs more registered nurses on the day time shifts than is normally seen in a home with this number of residents.This is very good practice and ensures that the health care needs of the residents are fully met with support being given to care staff and care records being kept up to date. The level of housekeeping staff on duty during the day is above that usually seen in a home of this size and this enables care staff to fully concentrate on the care of the residents. Management is to be commended at keeping this high standard of staffing levels. Care Homes for Older People Page 23 of 31 Evidence: Staff spoken with said The home always has sufficient staff, We are never short of staff. On the occasions that agency staff are required, the home uses a specific agency and staff that are familiar with the home. The turnover of staff at the home is low, therefore residents are benefitting from continuity of care from staff with whom they are familiar. New staff undertake an induction course local to the home and also commence the recognised Skills for Care induction course. This is followed by ongoing training which includes both mandatory training and other courses such as Falls Awareness and Pressure Damage Prevention, and other courses relating to the care of the residents in the home. Staff also have the opportunity to study for the National Vocational Qualification level 2 or 3 in care. At present ten members of staff (44 ) have attained this qualification and there are two carers currently studying for this. Registered nurses undertake the homes own induction course on their commencing work at the home, and also have the opportunity to participate in further training. Training for registered nurses planned for this year includes The Ageing Process, Updates in Medication Administration, Dementia Care Training and Anaphylaxis and Resuscitation training. The manager and senior staff have received training in both the mental capacity and deprivation of liberty acts and are in the process of cascading this to other members of the team. Four personnel files were examined. Generally these contained all information and checks as required by regulation. One member of staff did not have evidence of a Criminal Records Check in the file, but evidence showed that it had been obtained. The member of staff subsequently brought their own copy into the home for the records. It is recommended that the manager ensures that two written references for those members of staff employed prior to the Care Standards Act in order to ensure that records are up to date. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems ensure that the home is run in a manner which ensures that residents needs and expectations are met. Staff training, risk assessments and health and safety records ensure that residents safety is upheld. Evidence: The manager has been in post for a number of years and is a registered nurse. She has undertaken the appropriate management training and is registered with the CSCI. Residents said that there was a good atmosphere within the home, that they saw the manager frequently and she was very involved in ensuring that their care and the standards in the home met their needs and their expectations. Those residents spoken with described the staff as Caring Very nice and Polite I Care Homes for Older People Page 25 of 31 Evidence: am in good hands here and the manager is very good. Staff said that the management of the home was good, that they found the manager very approachable and that the home was run in a way that ensures that care and needs of the residents were The most important thing. The AQAA (an annual self assessment required by legislation), was received by the date it was required and gave accurate and clear information about what had occurred in the home in the past twelve months and the plans for the next twelve months. The home runs a quality monitoring system and elicits the views of residents and staff on a twice yearly basis. Residents can also make their views known at residents meetings, which are held two monthly and also by talking to the manager at any time. There was evidence that changes to routine or improvements to the home are made following residents comments. Policies and procedures have recently been reviewed and the manager is in the process of consolidating these to ensure that they reflect the current practices in the home. Staff have supervision on a two monthly basis, they said that this was very useful and that they welcomed the opportunity of having this and being able to discuss their progress and future training needs. Staff meetings are held at regular intervals and the minutes of these meetings showed that staff are encouraged to speak out and to raise their points of view about any issues in the home. Whilst the provider visits the home several times a week, there was no evidence of any specific regulation 26 visits or reports ( Monthly visits by the provider and reports generated from these visits) A requirement has been made relating to this and it is recommended that the provider reads the relevant CSCI guidance on the formation of the reports. The home does not act as appointee for any resident or keep any money for residents use. Records relating to residents, staff, and systems around the home are up to date and, where necessary, kept in a confidential manner. All certificates relating to the servicing of utilities and equipment are in date with risk Care Homes for Older People Page 26 of 31 Evidence: assessments as required. Staff have received mandatory training which includes moving and handling, first aid and fire training. It was noted that a door to the sluice, which it is the homes policy to keep closed, had been left open, and that at one stage a member of staff had left the door to the cellar steps open. This was discussed with the manager who gave assurances that this would not reoccur. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 36 26 That the provider or responsible individual visits the home on a monthly basis in accordance with regulation 26 and provides the reports of this visit to the home. Where a provider is not in day to day charge of the home monthly visits and reports are required by regulation to evidence that the provider is aware of practices within the home and the safety of the service users. Discussions with service users and staff should take place. 28/02/2009 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 9 That two nurses countersign hand written prescriptions on the MAR charts Page 29 of 31 Care Homes for Older People 2 29 That the manager obtains references for those members of staff who were employed prior to 2002 to ensure that all records are up to date. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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