Inspection on 20/11/08 for The Downs Care Centre

This inspection was carried out on 20th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Downs Care Centre 28/05/08

The Downs Care Centre 23/08/06

The Downs Care Centre 05/10/05

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Downs Care Centre Laburnum Avenue Hove East Sussex BN3 7JW     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: Elizabeth Dudley     Date: 2 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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 Downs Care Centre Laburnum Avenue Hove East Sussex BN3 7JW 01273746611 01273737314 thedowns@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Trinity Care (Hove) Limited Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 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 Date of last inspection Brief description of the care home The Downs Christian Nursing Home is situated in a residential area of Hove. The entrance is shared with the South Downs Health Trust, which provides an inpatient facility in a separate area of the building. The home, which was purpose built in 1999, is set out over three floors and a passenger lift enables access to each floor. Nursing and personal care are provided in single room accommodation for up to twenty five residents. All rooms have ensuite facilities and there is a lounge and dining room on the two floors where there is resident accommodation. All areas are accessible for Care Homes for Older People Page 4 of 32 Over 65 25 0 Brief description of the care home those with limited mobility and the home has hoists and bath hoists for those who are less mobile. There are also grab rails and disability aids in the bathrooms and toilets. Well maintained gardens surround the building and the relatives room and garden room provide additional relaxation areas for residents and their visitors. There is a large parking area to the front and side of the building. The home welcomes prospective residents or their representatives to view the premises, discuss their needs with the Registered Manager and spend time with the staff and residents. 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 unannounced key inspection took place on the 20th November 2008 over a period of ten hours. It was facilitated by the appointed manager, Mrs G Whitmore and the acting operational manager. The methodology used to inform the inspection included a tour of the home, examination of documentation, conversation with residents, visitors and staff and general observation of the life in the home, including the meal times. Documentation examined included care plans, medication charts, staff training and personnel files, menus and catering files and health and safety documentation. Care Homes for Older People Page 6 of 32 All residents were seen on the day of inspection and in depth discussions were held with ten residents, three visitors and five members of staff. Prior to the inspection ten surveys were sent out to residents and five surveys to staff to obtain their views on the services offered by the home. Of these, none were returned from residents or their representatives and four from staff. Comments received in staff surveys included We could do with an extra night carer particularly in the early morning to help with breakfasts. we have plenty of good activities in the home but more outings for residents would be welcome. During the day residents and visitors said Its very nice here, staff are kind and its nice and clean. It seems to be a bit calmer here, staff are very welcoming. We are happy with the care given to our (resident). Thanks are extended to the residents, staff and management for their help, courtesy and hospitality during this inspection. The fees currently charged as of the 20th November 2008 range from five hundred and twenty five pounds to eight hundred and five pounds a week. Services not included in the fees such as chiropody and hairdressing are charged separately and details of these are available from the home. What the care home does well: What has improved since the last inspection? What they could do better: 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 Care Homes for Older People Page 8 of 32 240 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. Residents receive sufficient information to enable them to make a decision over whether they wish to live at the home and whether the home will meet their needs and expectations. Thorough preadmission assessments of prospective residents take place before the manager confirms in writing that the home can meet the individuals needs. Evidence: The Statement of Purpose and Service user guide generally reflect the current status within the home including management, staffing and daily life. All residents receive a copy of the Service User Guide, statement of the homes Terms and Conditions of Residence and a contract on admission to the home. The manager confirmed that all residents, irrespective of whether they are funded privately or by Care Homes for Older People Page 11 of 32 Evidence: the local authority, receive these documents. Prior to any resident being admitted, they are assessed by the manager to ensure that the home is able to meet their needs and expectations and the homes ability to do this is confirmed in writing to the prospective resident or their representative. The manager generally takes a copy of the homes brochure and Service User Guide in order to assist the individual in making a decision over whether they wish to live at the home, and both the resident and their representatives are encouraged to visit the home. The preadmission assessment report is used to inform the staff of the individuals needs and to assist them in preparing an initial care plan and obtaining any equipment that may be required. Three examples of preadmission assessments belonging to recently admitted residents were examined. These contained sufficient information to accurately identify the resident,s care needs and to inform staff. Assessing staff should ensure that the reports are signed by the member of staff completing them. Residents are admitted for respite and permanent care but not for intermediate care. 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. Whilst some care plans require some improvement to ensure that residents receive the care appropriate for their needs, residents were content with the care that they receive. Nurses must be vigilant in ensuring that all medication sheets are signed following administration of medication. The standard of medication administration generally safeguards the residents. Evidence: During the inspection seven care plans were examined. Care plans are considerably improved since the last inspection and give details of the current care required, most have been reviewed monthly and include instructions for care staff on the delivery of the care, however there were still some areas which require to be addressed. All care plans required Waterlow scores and skin integrity care plans to be reviewed monthly, and required more information regarding the size of continence aids used, Care Homes for Older People Page 13 of 32 Evidence: size of hoist sling, electric bed pressures according to weight. Not all care plans had evidence of consultation with residents or relatives or anything to say this was not possible. Instructions for care assistants did not always exhibit sufficient clarity. One care plan directed care staff to observe for signs of infection without informing them of what these were, and another said the resident shows inappropriate behaviour without identifying either what form this took or how staff were to deal with it. Moving and handling and continence care plans were not always clear over how residents were to be moved either up the bed or to the toilet, and the sizes of continence aids were not included in most care plans. One care plan stated uses green nappy, which is inappropriate and infantilises the resident. Risk assessments for the use of bed rails were in place, but these had not been reviewed on a regular basis, with one seen not having been reviewed since 2006. Whilst daily records related to the actions required in the care plans, there were some instances relating to doctors instructions or wound care that were not added to the care plan. Two wound care plans were not up to date and there was no wound care plan in place for a resident with an abrasion caused by blistering. The nurse on duty said that these would be put in place. One resident said that I do not see the nurses much as they come in and out quickly and think I am asleep, but I have such pain in my eyes I keep them closed and am not asleep and would love them to stop and talk. There was no information relating to this pain or the resident keeping her eyes closed in the care plan. A pain chart may be required in this instance. Few care plans showed that residents had been consulted about the content or involved in the planning of care. There were few care plans which included the residents preferred times of rising and retiring and these should be added to the recently formed night care plans. It appeared that the standard of general care was improved and residents appeared generally content and comfortable. Recommendations from the bed audit undertaken in March 2008 by the tissue viability nurse have now been addressed. Discussions with the nursing staff identified that multi use night catheter bags are still being used and left in the residents bathroom when not in use, this is poor practice as Care Homes for Older People Page 14 of 32 Evidence: it facilitates the spread of infection and single use catheter night bags should be used in community settings. Records of nursing actions such as turning and administration of fluids in residents rooms were generally up to date, but it was noted that some fluid charts from the previous day had not been totalled therefore staff would not be aware if the resident was not taking sufficient fluids. There was evidence that specialist health care professionals had been accessed for residents as required. Residents spoken with were happy with the care that they received and were generally more positive about the staffs efforts to maintain their dignity and their privacy. One relative spoken with said Its very good here, they get plenty to drink and other relative said It seems to have got a lot better recently, I feel that my (resident) is safe and well looked after. Residents appeared comfortable and content. These improvements were extended to the area of medication administration. The majority of the medication administration charts had been signed following administration of medication, nurses must be aware of their accountability in this field. It is recommended that the manager sets up a method of monitoring that staff are signing the records at each shift. It is good practice to record the dates of opening on eye drops and liquid medication and currently this is not taking place. The cleanliness of the clinic room has improved and permission from general practitioners to give homely medication to their patients is now in place. Two medication rounds were observed and the standard of medication administration generally safeguards the residents. Care plans to identify residents wishes for the place of care at the end of their lives or wishes for intervention were not in place in the majority of the care plans. Staff have not yet taken part in the Liverpool Care Pathway or Gold Standards Framework training (nursing tools to ensure that residents at the end of their lives receive a recognised standard of care and pain control) but some staff are due to commence the Macmillan Foundation in Palliative Care Training which is the precursor to the Liverpool Care Pathway. Compliments and thanks from relatives of residents relating to the end of life care delivered by the home were seen. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a varied programme of activities in the home which provide interest and stimulation for the residents. Residents who remain in their rooms would benefit from increased opportunity to take part in activities. A varied menu is provided but food, and especially pureed meals, is not generally well presented and therefore residents appetites are not stimulated to receive all the benefits of a balanced diet. Evidence: A good range of activities is provided by a full time activities co-ordinator. The activities programme is displayed in the lounges and also a copy is given to those residents who wish to remain in their rooms. Activities provided include art and crafts,music and some gardening and some outings. A newsletter is produced which is given to all residents. Records are kept of the activities provided and many residents spoken with said how much they enjoyed the activities and also how helpful the activities coordinator is, and that she often came around and spent one to one time with them. Those residents who are confined due to health reasons, said that they valued this time, although it could be increased. Care Homes for Older People Page 16 of 32 Evidence: Residents spoken with appeared more confident over the choices available to them in the activities of daily living. More people now thought that they would be able to stay in bed in the mornings and would not be rushed to get up and everyone spoken to said that they could ask for extra hot or cold drinks. The manager says that she is in the process of altering routines of the home in order to make them more flexible for residents and to allow them more choice. One resident said I get up when they tell me, this can be any time, sometimes well before eight oclock and sometimes after. The manager must ensure that all staff are aware of residents preferred times of rising and retiring and that staff abide by these. There are weekly Church of England Services and the minister is a regular visitor to the home. Currently the Roman Catholic minister only visits as required. The manager says that ministers of other faiths can be contacted. There is an open visiting policy at the home and visitors were seen arriving throughout the day. Three visitors were spoken with and comments received included tangible improvement in the home but cannot accurately identify in what areas, somehow it seems more relaxed and staff are not so stressed, ( resident) is happy and well cared for and seems more comfortable somehow. Staff are usually very pleasant, there is still a problem sometimes, my friend seems happy most of the time. I wish they would do something with these meals, sometimes they are fine, but oh dear, other times they leave a lot to be desired, the presentation is often poor and have they never heard of giving people salt and pepper?. The home provides a nutritious and well balanced menu and residents are offered some choice of menu. The manager is planning to provide large photographs of the meals offered to enable those residents who are not sufficiently able, to understand what is available at meal times. Staff no longer go into the kitchen to prepare breakfast and this is got ready by the catering staff and sent onto the units, where staff finish the preparation. Catering staff provide any cooked breakfast required. The manager must ensure that any staff preparing food have the food hygiene certificate. Fresh fruit is now available in the lounges and residents verified that this is offered to them by the staff When they remember, and you dont like to ask. The food is sent up on hot trolleys to the units and dished out by staff. The presentation of this food by the staff is variable. Whereas currently the pureed food is still of a soup like consistency and therefore staff are unable to maintain a satisfactory presentation with this,and apart from one instance where one pureed meal was served in three separate bowls, the meal is generally mixed together. Pureed meals must be served in the correct consistency and arranged attractively to stimulate appetite. Care Homes for Older People Page 17 of 32 Evidence: The courtesy of providing attractively laid up trays with salt and pepper, or afternoon tea served with a small teapot and milk, is not being extended to the residents at the present time. Most beverages are presented to residents in mugs, which some find difficult to hold and many people of this age group prefer a cup and saucer. One resident said If you ask for a cup its a bit of a nuisance. During supper time the pureed meal was not well presented. All the meals were luke warm and residents complained that this meal was tasteless. Both the manager and the operations manager were invited by the inspector to see and taste this meal. They agreed with the inspectors findings. Residents said that the food is often cold or barely warm and their comments included The food has gone down, we all think so, and these sandwiches are funny again. The food has its moments. The meat is often very tough and the food is tasteless a lot of the time. I like the food most of the time and there is always plenty to eat. Cleanliness in the kitchen was much improved and the staff verified that they have the Food Hygiene Certificate and the home is also fully supporting two members of catering staff to attain their National Vocational Award in catering. The home is about to implement a catering programme, Nutmeg, which will increase the awareness of nutrition and catering for the older person, amongst the staff. Staff still appeared to rushed at meal times, staff in the lounges were taking the time to sit whilst assisting residents with meals.However it was noted that in some cases little interaction was taking place. Staff in residents rooms who were assisting residents with meals remained standing whilst doing this. This can make residents feel rushed and uncomfortable. The house keeper was also assisting residents with the meals and said that this was because meal times were so busy and that there were so many residents requiring assistance. 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. Residents are not completely confident about making complaints. Staff have received training in safeguarding those in their care and were aware of their responsibilities towards the residents in the home. The adult safeguarding policy does not conform with the Multi agency safeguarding guidelines. Evidence: Residents receive copies of the homes complaints procedure in their Service User Guide and this is displayed in the main hallway of the home. There have been no further complaints received since the last inspection, prior to this the home had received six complaints . Records are kept of these and any minor concerns that have been received and also of the ways that these have been addressed. Residents previously expressed concern about making complaints. However at this inspection residents said that they were aware of how to make a complaint, and whilst several residents said that the manager has been round to them individually and reassured them about making complaints, some said that they would still worry about making one and also expressed concern over whether the staff would find out one resident said I mean to say, if you make a wave in a small place, the chances are it Care Homes for Older People Page 19 of 32 Evidence: will come back and drown you. The manager said she has addressed the issue of the residents right to complain and the importance of confidentiality at staff meetings. The majority of the staff have undertaken training in the safeguarding of the older person and the manager is fully familiar with the adult safeguarding procedures, however the adult safeguarding policy does not yet conform with the Multi Agency Guidelines although this was made a requirement at the last inspection. 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 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 clean and well maintained home. Improvements in the infection control practices within the home which includes restricting movement of staff and relatives in some areas of the home, will assist the home in maintaining a good standard of infection control. Evidence: The home is well maintained and pleasantly decorated. It is set out over two floors and there are lounge/ dining areas on each floor, with the garden being accessed from the lower ground floor. The garden is set out in a manner which allows all residents to use it. A relatives room and a garden room provide extra communal space. Residents accommodation is provided in single rooms and there is one double room. All rooms have an en suite facility and are provided with lockable drawers for residents possessions. Residents can bring in personal possessions to make their rooms more comfortable. All windows on the upper floor have restricted opening. The restrictors have been maintained in a good state of repair. Water temperatures to residents hot water outlets have been monitored and recorded on a monthly basis with the exception of the current month. These were within recommended parameters. The home has two assisted bathrooms and two shower rooms and all of these are now Care Homes for Older People Page 21 of 32 Evidence: able to be used by residents, the ground floor bathroom having been repaired following the last inspection. There are sufficient aids within the home to enable residents to maximise their independence. Staff said that there is sufficient moving and handling equipment to meet the needs of the residents in the home. The home was clean throughout and staff stated that there are good supplies of disposable aprons and gloves provided. Staff were wearing blue disposal aprons for serving food and the cook said that everyone entering the kitchen has to put on protective clothing. Change in the homes routines whereby staff no longer enter the kitchen to prepare breakfast or return trolleys is helping in the minimising of routes for infection. The home has recently instigated a member of staff in the role of infection control champion. This role requires the member of staff to liaise with the Health Protection Agency and to ensure that the home is working within recognised infection control protocols. It was noted that staff were washing their hands between residents and applying alcohol gel following this. Residents and visitors to the home said This home is always lovely and clean. The home is very pleasant and is always clean and fresh. You can always rely on the cleanliness of the home. 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. There are insufficient staff on duty over a twenty four hour period to satisfactorily meet the needs of the residents in the home in a timely manner. Staff receive training relevant to the needs of the residents in the home. The home operates a robust recruitment system which safeguards the residents. Evidence: Examination of the duty rotas and conversations with staff showed that there are five care staff and one registered nurse in the mornings. One registered nurse and four care staff in the afternoon and one registered nurse and two care staff at night. Whilst this appears sufficient for the number of residents currently in the home, the staffing numbers do not take into account the high care needs of some of the residents. Examples of this being that the housekeeper has to help with assisting residents at lunchtime, and staff saying that they cannot always help residents at the time they call for assistance resulting in some residents having to wait for personal care. At the previous inspection conversations with staff showed that although they said there were generally sufficient staff on duty, they required more staff at busy times of day. During this inspection additional information was given to the inspector that one Care Homes for Older People Page 23 of 32 Evidence: of these five members of staff is providing personal care to one particular resident for six hours. This being part of the care contract funded by the contracting authority. This further impacts on staffing when a member of rostered staff is absent at short notice and therefore the home is left short staffed. The manager confirmed that this was happening. Given the needs of the current residents it would be expected that a minimum of five care staff would be on duty, alongside a registered nurse, with an extra member of staff to help with mealtimes and other very busy periods of the day, in order to ensure that residents needs are being fully met. If this is not possible, then the home should not be admitting residents who require a high density of nursing and personal care, and should be monitoring future admissions and take into account the prognosis of the individuals diminishing abilities. A requirement was made at the last inspection for staffing to be reviewed at peak times of day, this has not been complied with, and a further requirement will be made. The home employs a total of seventeen care staff, six (35 ) of whom have attained the National Vocational Qualification level 2 in Care. A further three are in the process of studying for this qualification. Two members of catering staff are also undertaking the National Vocational Qualification level 2 in Catering. Staff have the opportunity to participate in other training relating to the care and health of the older person including continence care and nutritional needs and a registered nurse has completed an infection control training programme and is now the Champion for this. This role requires her to attend meetings at the Health Protection Agency and to liaise with them, bringing the relevant practice and procedures into the home. At the present time, new staff complete the homes own induction course. At the last inspection the home was considering commencing the Skills for Care, a nationally recognised induction course and precursor to the National Vocational Qualification in care. This has not yet been commenced although the current manager states all staff recruited from now on will commence this. Not all staff have completed their mandatory training. The home now has a nurse who is trained as a trainer for moving and handling. Some new staff have not yet received the moving and handling training and some staff have not received fire training. The home should make this a priority. Registered nurses are encouraged to update their skills and undertake extended roles which include phlebotomy and all have been updated on syringe drivers. The majority Care Homes for Older People Page 24 of 32 Evidence: of the registered nurses have a full range of catheterisation skills. Three personnel files were examined and these contained the documentation and checks as required by regulation. All members of staff have the General social care handbook. Care Homes for Older People Page 25 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. New management is working on improving the lifestyle of residents living in the home. Not all staff have undertaken mandatory training or received formal supervision which would ensure the safety and comfort of residents. Evidence: The home has a new manager in place, Mrs Glynis Whitmore, who commenced in September 2008. She is a registered nurse, with past experience both in the NHS and as manager of other care services, including being a previous manager of The Downs. Recent Qualifications include the Registered managers award, and she is currently applying for registration with the CSCI. Staff and residents spoken with said that there was a better atmosphere in the home, staff seem happy, We are feeling supported, Lets see how it goes, things seem to be organised, my (resident) is happy and we get the answers we need. A new area manager is also in place and was present during this inspection. Care Homes for Older People Page 26 of 32 Evidence: The home has undertaken monitoring of the services it provides, in the past twelve months, the results of this were not yet available. This process includes sending out surveys to residents and relatives for their opinion of the care and services provided by the home, and it is recommended that this be extended to visiting health and social care professionals and any other stakeholders including staff. Not all of the requirements made at the last inspection have been complied with and some not complied with to a standard that is considered acceptable. Further requirements have been made around these areas. The home manages personal allowances for some residents and records showed that this was accomplished in an open and transparent manner. Formal staff supervision has not taken place for all staff, and this should be made a priority to ensure that the services provided by the home meet residents expectations, and that staff have a chance to speak with a senior person about any concerns or training requirements they may have. Regulation 26 visits (monthly visits by the provider or their representative required by regulation) and copies of these were seen at the home. These accurately reflected what was taking place in the home, and the actions taken to amend any issues that have arisen. Policies and procedures seen are corporate and do not necessarily reflect the needs of the home or the area in which the home operates. The manager should amend policies as required to meet the needs of the home whilst working within the corporate remit. Certificates showing servicing of utilities and equipment were in place and in date. All doors to residents accommodation now have automatic closures which respond to the fire alarm. Not all staff have undertaken the mandatory health and safety training and this must be addressed. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 Reg 13(2) That the administration of medication is in accordance with the guidelines and regulations identified in the main body of the report. 01/08/2008 2 15 Reg 16 (2) (i) That the presentation of meals ensures that service users who receive liquidised diets appetites are stimulated by the appearance of the food served. That service users are offered a diet which includes fresh fruit. That meals are served in an unhurried manner. That the temperature of the food served is suitable for the service user. Reg 13(6) That the safeguarding policy meets the reporting protocols as identified in the `Multi agency guidelines. 01/08/2008 3 18 01/08/2008 4 27 Reg 18 (1)(a) That staffing levels are reviewed to ensure that there are sufficient staffing levels on duty at peak times to ensure that service users needs are met. 01/08/2008 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 That care plans are formed 21/01/2009 and reviewed in consultation with the service user or their representative where possible, and that all parts of the care plan are reviewed on a regular basis. Any issues affecting the service user must be care planned. To ensure that all staff are aware of the care required by service users in all the areas where care is required. To ensure that all of the service users assessed health and social care needs are met 2 9 13 That staff are vigilant in signing the medication charts following administration of medication. 31/12/2008 Care Homes for Older People Page 29 of 32 Staff must ensure that service users are safeguarded against medication error. 3 15 16 That the presentation of meals ensures that the appetites of service users who receive liquidised diets are stimulated by the food served. That meals are service in an unhurried manner and that the temperature of the food served is suitable for the service user. To ensure that service users find the menu appetising and appealing and therefore receive a full nutritionally balanced diet. 4 16 22 That the manager ensures that service users are aware that any complaints they may make will be treated in a confidential and transparent manner. To ensure that service users are confident in making a complaint about services which are not meeting their expectations. 5 27 18 That staffing levels are 09/01/2009 reviewed to ensure that there are sufficient staff on duty at peak times to ensure that service users needs are met To ensure that service users needs are met in a timely 01/01/2009 02/01/2009 Care Homes for Older People Page 30 of 32 manner and in a way which meets the service users and their representatives expectations. 6 36 18 That staff receive supervision at intervals directed by the National Minimum Standards To ensure that service users receive the services in a way that meets their needs and expectations and that staff have the opportunity to speak with senior staff regarding their concerns and aspirations. 7 38 13 That all staff receive 20/12/2008 mandatory health and safety training and are updated at the recommended intervals. To ensure the safety of service users and staff. 02/02/2009 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 2 8 9 That single use catheter night bags are used to prevent cross infection. That a process of monitoring medication records to ensure that staff sign these following medication administration is put in place That trays are presented in a well laid out manner with appropriate condiments to enable service users to appreciate the food they receive. That visiting health and social care professionals and staff are invited to give their views on the home and thus contribute towards the quality monitoring process. 3 15 4 33 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!