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Inspection on 21/10/08 for The Glen Nursing & Residential Home

Also see our care home review for The Glen Nursing & Residential Home for more information

This inspection was carried out on 21st October 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 2 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

Residents rights to privacy and dignity are respected by staff. Visitors to the home are encouraged and made welcome by staff and are invited to attend events. All the people spoken to were very satisfied with the standard of the food served at the home. Individual preferences were known and catered for by care staff and the cook. Residents could choose to have their meals in the dining room or in their own rooms. The kitchen records were well kept and the kitchen clean and tidy. The home has a clear complaints policy that residents and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. The home was clean, tidy and free from unpleasant odours. Residents are able to bring in furniture and personal belongings to personalise their private room. Recent improvements to the overall decor of the home were seen. Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by the manager. The majority of relatives said the atmosphere at the home was warm, caring and friendly, people living there confirmed that they shared this view. Staff were observed to be courteous and appropriately friendly towards residents. One resident described staff as supportive. Residents are seen as individuals and the home tries hard to accommodate their individual needs and characters. The home provides a good induction to all new staff to ensure that they are confident in their role and feel well supported. All staff have attended the majority of mandatory training. Both of these areas ensure that staff can meet the needs of people living at the home.

What has improved since the last inspection?

Since the last inspection the home has undergone a refurbishment and decoration. This has been completed to a good standard. All people who have nursing needs now have been supplied with an adjustable bed which helps in the health and safety of people living at the home and staff. The care planning system on the whole although some minor amendments are still required to ensure that staff have clear guidance on the care needs of the individuals living at the home.

What the care home could do better:

As stated above some minor amendments are required with the care planning process to ensure that they are robust in all areas. Medication storage was viewed during the inspection. This was not satisfactory and this could reduce the effectiveness of some medication. This issue was raised at the lastinspection and now requires urgent attention. It could not be confirmed that all staff had received training in the recognition and prevention of abuse. This is recommended. During the inspection we noticed that some parts of the home were very warm and uncomfortable. Complaints have been received by the home with regard to this matter. BUPA now need to address this issue. The home has not had a manager registered with us for a period of time. Registration with us is required to ensure that managers have the skills and competencies to fulfill their role. This is a breech of the Care Home Regulations. A warning letter was sent to the company in September 2008 detailing this breech. We are currently considering what action to take in response to this breech.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Glen Nursing & Residential Home Shapway Lane Evercreech Shepton Mallett Somerset BA4 6JS     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: Justine Button     Date: 2 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Glen Nursing & Residential Home Shapway Lane Evercreech Shepton Mallett Somerset BA4 6JS 01749830369 01749831390 smithga@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes (CFC Homes) Ltd Type of registration: Number of places registered: care home 58 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 58 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Glen is a service that supports up to 58 older people. The Glen is part of the BUPA Care Homes group. The service is situated in the village of Evercreech, which is a few miles from the town of Shepton Mallet. The home is situated within pleasant grounds in a country setting. The service is split into two wings with those service users who require nursing support in one and those who require personal care only in the other. Care Homes for Older People Page 4 of 30 Over 65 58 0 Brief description of the care home There is a common kitchen and offices in the centre of the two wings. The bedrooms are distributed over three floors and there are two passenger lifts that allow easy access to all floors. Service users are able to visit all areas of the service even if their bedroom is on the opposite wing. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key unannounced inspection was carried out over one day by one inspector. The home does not currently have a manager however the deputy manager was available on the day of the inspection. The inspectors would like to thank the deputy manager and the duty staff for their time and hospitality shown to the inspector during their visit. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. These judgement descriptors for the seven Care Homes for Older People Page 6 of 30 chapter outcome groups are given in the report. Records examined during the inspection were service user care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. The current fees range from 700 pounds to 900 pounds, which does not include hairdressing, toiletries, dental care, optician, physiotherapy, newspapers, transport or chiropody. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the care home does well: What has improved since the last inspection? What they could do better: As stated above some minor amendments are required with the care planning process to ensure that they are robust in all areas. Medication storage was viewed during the inspection. This was not satisfactory and this could reduce the effectiveness of some medication. This issue was raised at the last Care Homes for Older People Page 8 of 30 inspection and now requires urgent attention. It could not be confirmed that all staff had received training in the recognition and prevention of abuse. This is recommended. During the inspection we noticed that some parts of the home were very warm and uncomfortable. Complaints have been received by the home with regard to this matter. BUPA now need to address this issue. The home has not had a manager registered with us for a period of time. Registration with us is required to ensure that managers have the skills and competencies to fulfill their role. This is a breech of the Care Home Regulations. A warning letter was sent to the company in September 2008 detailing this breech. We are currently considering what action to take in response to this breech. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that people have the information they need to enable them to make an informed decision about moving there. People are appropriately assessed before a placement is offered. The home ensures that people have the opportunity to test drive the home. Evidence: The home has a Statement of Purpose and Service User Guide which provide information about the home and services offered. These documents have been updated to reflect the changes in the management structure. The home provides additional information in individual folders which are kept in bedrooms. The information in these folders however has not been up dated. The complaints procedure Care Homes for Older People Page 11 of 30 Evidence: and management structure in these folders should be reviewed and up dated. Care plans were examined at this inspection and these contained documented evidence that people had been appropriately assessed before a placement was offered. Assessments had also been obtained from appropriate health care professionals where available. The acting manager stated that the home were not experiencing any problems in meeting the assessed needs of people currently living at the home. This was also evidenced in care review documentation from individuals care managers. The home has a good supply of mobility and pressure relieving equipment in place and the environment is suitably designed to meet the needs of people. The home encourages people and their relatives and or representatives to visit the home prior to making a decision to move there. The first four weeks are considered a trial period thus enabling all parties to be sure that the home is able to meet the individuals assessed needs. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes care planning systems have improved and now promote a more person centred approach to care. The homes procedures for the management and administration of peoples medication are adequate. The management need to ensure that medication is stored at the correct temperature otherwise it will not work effectively. People living at the home are treated with respect. Evidence: Care plans for three people living at the home were examined at this inspection. The layout of care plans has improved to ensure that they provide clear and accessible information for staff. Staff spoken with confirmed that they were encouraged to read and follow care plans. On the whole the care plans examined contained up to date risk assessments relating Care Homes for Older People Page 13 of 30 Evidence: to the prevention of falls and pressure sores, nutrition, moving and handling needs and environmental risks. Care plans had been raised to address any concerns highlighted. We were informed that one person at the home currently had pressure sores. The care plan for this individual with regard to this issue needs to be reviewed to ensure that clear progression of the wound is documented. This should include regular measurements and tracings of the wound. This will help staff to ascertain if the appropriate dressings and treatments are being used. Care plans contained clear information on the assessed needs of individuals and instructions for staff on how needs should be met, were clear and included the preferences of people as appropriate. The care plan for one individual stated that this individual was at risk of choking. The care plan did not detail the actions staff could take to prevent this from occurring. This was discussed with the interim manager at the end of the inspection who agreed to rectify this issue. There was evidence that care plans had been reviewed at least monthly. The majority of people using the service would be unable to be involved in the care planning andreview process. Relatives or representatives are encouraged to be involved in this process and this was evident at the time of this inspection. Care plans have been updated and included detailed information about people in relation to their social and life history and preferences. This is felt to be a positive improvement as it provides valuable and useful information for staff and promotes a more person centred approach to care. Records examined demonstrated that people have access to a range of appropriate health care professionals. Details of all visits and the outcome are clearly documented in the individuals plan of care. Staff update daily records at the end of each shift so that there is a clear picture as to the health and well being of each person living at the home. Staff spoken with were positive about the the home and stated that they did not experience any problems in meeting the assessed needs of people currently living at the home. Two relatives were spoke with during this inspection and both confirmed that they were very satisfied with the care and support given to their relative. This was also confirmed in the surveys that were received prior to the inspection. We examined the homes procedures for the management and administration of peoples medication. The home uses the monitored dosage system (MDS) with preprinted medication administration records (MAR). All medicines were found to be securely stored and there were no excessive stock levels. All available MAR charts Care Homes for Older People Page 14 of 30 Evidence: were examined and these were found to be appropriately completed. MAR charts have a photograph of individuals to aid identification. Two people were receiving a controlled medication. Stock levels and records were examined and no concerns were noted. Medicines are only administered by the registered nurses on duty. Staff are currently undertaking refresher training with regard medication procedures. On the day of the inspection the temperature of the medication room was found to be high. In excess of 29 degrees. Storing medication at the incorrect temperature may reduce its effectiveness. This was discussed with the CSCI pharmacist on the day of the inspection who advised that due to this any medication that had been stored at the home for over 28 days would have to be destroyed. The manager agreed to complete this without delay. There are currently building works underway to fit an air conditioning unit to the drug storage room to ensure that the temperature is kept within safe limits. Until this has been completed the manager needs to ensure that systems are in place to store medication is kept at the correct temperature. Some prescribed creams for individuals are kept in the individuals bedrooms. Some of these had been marked with a date of opening whilst others had not. This is necessary to ensure that creams and lotions are not applied after their use by date. Those without an opening date need to be replaced. We observed staff interactions with people living at the home throughout the day. Interactions were noted to be kind and respectful and people appeared to respond positively to staff. Staff were observed knocking on peoples doors before entering their bedrooms and staff were observed offering people choices throughout the day. Those people who were able to express a view were positive about the staff. Relatives spoken with said that the staff were marvelous and that they could not do enough to help. When we spoke to staff they said that the atmosphere at the home was positive and that the atmosphere was relaxed. They said that they worked as a team and that this had a positive outcome for people living there. Staff said that they had the opportunity to spend quality time with people living there. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to join in with a range of activities and staff have an awareness of peoples social history and preferences. Visitors are made welcome at the home. The mealtime experience and quality of food is good. People are enabled to make informed choices. Evidence: The care planning system has been updated and reviewed since the last inspection. This has been proactive in ensuring that peoples social historys and preferences are obtained. Detailed information was available in the three care plans examined. Information provides staff with very useful information about peoples lives, interests and preferences. Staff spoken with said that they found this information very helpful and that it gave them a better understanding of the people living there. This is a positive improvement. Care Homes for Older People Page 16 of 30 Evidence: The home employs an activities co ordinator who works 0900 to 1700hrs during the week The home has a programme of activities and a copy was made available to us. This offered a good range of group activities and also offers one to one time with people. Individual records are maintained for people relating to activities undertaken. Surveys returned to us prior to the inspection however stated that people living at the home would appreciate a wider range of opportunities being made available to them. The management need to consider this. The home also displays a list of forthcoming events. Throughout the day we spent time observing staff interactions with people living at the home. The activities co ordinator was not on duty on the day of this inspection but we observed staff spending quality time with people. The atmosphere was relaxed and unhurried and it was apparent that people can choose where and how to spend their day. Relatives spoken with informed us that they were always made to feels welcome at the home and could visit at any time. They told us that they were offered refreshments and could have meals with their relative if they chose to. There is a cost to relatives who would like to have a meal at the home. During this inspection we were able to observe the mealtime experience. The mealtime appeared to be relaxed and unhurried. Staff were observed assisting people in an appropriate and dignified manner. Tables were attractively laid with tablecloths, flowers and condiments. Choices of refreshments were available. The days menu was available on each table. Appropriate protective clothing was available for staff and people living at the home. Vegetables and potatoes are served to the table which allows people an active choice of what and how much they would like. A range of snacks is available at any time. One person who had lost weight recently was observed to have appropriate supplements supplied by staff. People make choices about what they would like to eat from a picture menu book. Staff were observed referring to records to ensure that meals offered were in line with individuals choices and special diets. The lunchtime meal looked very appetising and plentiful. Soft diets had been attractively presented. Hot trolleys are now used to ensure that meals are served at an acceptable temperature. Staff informed us that the quality of food had greatly improved since the new cook had been employed. Care Homes for Older People Page 17 of 30 Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate systems are in place to allow people to raise concerns. The home takes appropriate steps to reduce the risk of harm or abuse to people living there. Evidence: The home has a complaints procedure available in the home. We were informed that the home had received seven complaints in 2008. These complaints have been investigated in line with the homes complaints procedure and appropriate remedial action had been taken. No formal complaints have been raised with the Commission. The home holds regular carers meetings for relatives/representatives where their views are encouraged. Relatives, staff and people spoken with during the inspection, did not express any concerns. Relatives and staff stated that they found the acting manager very approachable and would not hesitate in raising concerns if they had any. At the time of this inspection the home was taking appropriate steps to reduce the risk Care Homes for Older People Page 19 of 30 Evidence: of harm or abuse to people living there. Staff are aware of how to raise concerns and have access to a range of appropriate policies and procedures including whistle blowing and adult protection policies. Not all staff have been provided with training in these areas. A training matrix was supplied during the inspection. This demonstrated that at least 28 staff have not received training in this area. The training matrix supplied did not detail staff start dates. Abuse training is covered during the induction period. It could therefore be formally confirmed how many staff require up dating training in this area. The home follows robust staff recruitment procedures and staff do not commence employment until all required information is received including criminal record checks and vulnerable adult checks. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and well maintained environment and people are encouraged to personalise their bedrooms. The home has recently been refurbished to a good standard. There is a range of specialist equipment available including adjustable beds for all people who have nursing needs. The home takes appropriate steps to reduce the risk of the spread of infection. Evidence: Accommodation at the Glen is arranged over a number of floors. Passenger lifts give access to the first floor. Grab rails are appropriately sited and a nurse call system is installed throughout the home. The acting manager confirmed that the home has sufficient pressure relieving equipment and hoists. All bedrooms are for single occupancy . Bedrooms and communal facilities meet the current National Minimum Standards for size. Profiling beds are now available in all bedrooms. Care Homes for Older People Page 21 of 30 Evidence: In addition to en-suite facilities in some of the bedrooms, the home has an appropriate number of assisted toilet and bathing facilities. During this inspection we were able to view a number of bedrooms and all communal areas. All areas seen were comfortably furnished and well maintained. The home was clean and there were no malodours. It was evident that people living at the home were able to personalise their bedrooms to meet their own needs and choices. As previously mentioned, all areas of the home viewed were clean and free from malodours. There are three cleaners on duty each day in addition to laundry staff. The home takes appropriate steps to reduce the risk of the spread of infection. Staff have access to a good supply of protective clothing and appropriate hand washing facilities and foot-operated bins are in place. During the inspection it was noted that parts of the home were extremely warm and uncomfortable. This as previously mentioned included the medication room however also included some of the bedrooms and corridors. The home has received complaints with regard to this issue. The management need to address this issue and ensure that the ambient temperature in all areas of the home is comfortable and appropriate for the time of year. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels appear adequate to meet the needs of the people living at the home. People living at the home are protected by the homes robust staff recruitment procedures. Newly appointed staff follow an appropriate induction period. The majority of staff have received all mandatory training. Nine staff have an NVQ. Evidence: Staffing rotas were given to us during the inspection. These demonstrated that there appears to be sufficient staff to meet the needs of the people living at the home. People living at the home and relatives spoken to stated that they did not have to wait for too long if they rang the bell for assistance. Some stated that they felt the home was sometimes short staffed when staff went off sick. The staff training matrix was viewed this showed that the majority of staff had completed all mandatory training. It could not be evidenced that all staff have received training with regard to the recognition and prevention of abuse as detailed previously in this report. The training matrix showed that nine staff have completed an NVQ. Care Homes for Older People Page 23 of 30 Evidence: Given the number of staff employed at the home this falls short of the expected 50 percent of staff who should have this qualification. We examined the homes procedures for the recruitment of staff. Four recruitment files were examined for staff recruited since the last inspection. Records were well maintained and contained all required information. There was evidence that staff had not commenced employment until all required information, including criminal record and vulnerable adult checks had been received. We looked at induction programmes for the staff detailed above and there was evidence that staff follow an appropriate induction programme, which is in line with the Skills for Care Common Induction Standards. We spoke with some staff recently employed and they told us that the induction programme covered everything they needed to know. Staff confirmed that they had received the training they needed to enable them to meet the assessed needs of people living at the home. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not currently have a manager registered with us. The home is run with the service users best interests safeguarded by policy, practice and procedures. Attention to the health and safety of service users and staff is of a good standard. A system of staff supervision is in place. Evidence: The Care Home Regulations state that all care homes have to have a manager who is registered with us. This registration process ensures that only people who are fit are employed to manage care homes and ensures that the manager has the appropriate skills and competencies to fulfill the job role. The Glen has not had a manager registered with us for a significant period of time. A letter was sent to the provider on the 12th September 2008 warning them that they were in breech of the regulations. At Care Homes for Older People Page 25 of 30 Evidence: this time a manager had been employed, although the individual had not submitted an application with us. On the day of the inspection we were informed by the deputy manager that this individual had been transferred within the company to another care home. This was confirmed after the inspection by the provider, BUPA. This transfer means that there is a continued breech of the Care Home Regulations. We are currently considering what action to take with regard to this breech. In order to avoid any action been taken by the CSCI a manager must be identified and an application must be submitted with out delay. The home has systems in place to monitor the quality of the services and care offered. Copies of the homes internal quality audits were seen. Regular meetings are held for relativesand carers and staff where views are encouraged. As part of the homes quality assurance programme and as required in the Care Homes Regulations, monthly visits are made by a company representative with written reports completed. Reports were examined during this inspection. We were informed that the home does not act as appointee for any people living there but manages small amounts of spending money for people on request. We looked at the records relating to this and found them to be well maintained. Details of transactions and balances are maintained in computerised format on an individual basis. Statements are forwarded to individuals relatives orrepresentatives as appropriate, on a monthly basis. A system of staff supervision is in place. Documented evidence was available and staff spoken with confirmed that they were supported. We looked at the homes procedures relating to health and safety. This involved a tour of the premises, observation of practices, discussion with staff and examination of records. All were found to be satisfactory Care Homes for Older People Page 26 of 30 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 13 (2) It is required that medication 15/12/2007 is stored at a temperature in line with the manufactures guidelines. Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The home needs to ensure 05/12/2008 that all medication and drugs are stored at the correct temperature at all times. Medication that has not been stored at the correct temperature for over 28 days must be destroyed in line with the homes policy. To ensure the continued effectiveness of all medication. 2 31 8 You must make application to register any person appointed to manage the home at the earliest opportunity to comply with Section 11(1) of the Care Standards Act 2000. To ensure that the home is managed by an individual who is fit to do so and has the skills and competencies to fulfill this role 05/12/2008 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 18 25 The management need to ensure that all staff have recieved training in recognition and prevention of abuse The management need to review the ambient temperature and ensure that this is at a comfortable level at all times. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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