Inspection on 30/09/08 for The Grand Panorama

This inspection was carried out on 30th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Grand Panorama 05/11/07

The Grand Panorama 17/01/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Grand Panorama 57 South Road Weston Super Mare North Somerset BS23 2LU     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: Odette Coveney     Date: 3 0 0 9 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 33 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 33 Information about the care home Name of care home: Address: The Grand Panorama 57 South Road Weston Super Mare North Somerset BS23 2LU 01934417791 01934623207 grandpanorama@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Alutarius Ltd care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May accommodate up to 23 people aged 65 years and over who may require nursing care. May also accommodate one person aged 50 years and over, who has a physical disability (subject to the inspectors agreement). May continue to accommodate those residents aged less than 65 years, who were placed prior to November 2005. Patients with mobility problems must not use those rooms accessed by steps. The registered provider must provide CSCI with a detailed plan for refurbishment within three months of registration, to improve the quality of the accomodation, access arrangements and bathing facilities. Date of last inspection Brief description of the care home Grand Panorama is registered to provide nursing and personal care to up to 23 older people. The converted property is situated on the hillside above Weston Super Mare. Many rooms enjoy panoramic views over the town and the bay. There is a bus stop just outside the home, but a steep drive means that visitors with restricted mobility may find it difficult to reach the building. Internally, the home was in need of major redecoration and refurbishment. Mr and Mrs Coombes, trading as Alutarius Ltd bought Care Homes for Older People Page 4 of 33 0 Over 65 23 Brief description of the care home Grand Panorama in 2007 and work to improve the home has begun. The grounds are being tidied and trees planted along the driveway have been cut back to improve the outlook from the side of the home. Care Homes for Older People Page 5 of 33 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: The quality outcome judgment for this service is 2 stars. This means the people who use this service experience Good quality outcomes. This unannounced key standard inspection, it was carried out in one day over an 8 hour period by one inspector for The Commission for Social Care Inspection. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home. This site visit employed key elements of the national inspection methodology with the Care Homes for Older People Page 6 of 33 objectives of focusing on outcomes for the individuals. This is evidenced through evaluation of key standards and talking with and the observation of individuals who live and work at the home and the views of the registered manager. An opportunity was taken to view the home and a number of the records relating to the management of the home, health and safety and plans of care for three individuals were reviewed. The registration certificate for the home was reviewed at this inspection and the information contained within it was found to be accurate. Six comment Cards were received prior to out visit, five of these were from relatives of those who live at the home and the other comment card was from visiting health/social care professional to the home. Comments made were reviewed during the visit and comments, maintaining individuals confidentiality, were shared with the registered manager and have been incorporated within this inspection report. What the care home does well: What has improved since the last inspection? What they could do better: In order that those living at The Grand Panorama can be assured that staff have the appropriate knowledge and skills and are able to perform their duties in a safe manner it is required that all staff receive manual handling training. Furthermore policies and procedures for the effective running of the service must be reviewed and updated, these records must be available and easily accessible to staff. Those living at the Grand Panorama can be assured that they live in a hygienic environment if the home cleaned the cooker hood and the extractor fan in the kitchen. Furthermore those living at the home would feel assured of their safety in the event of a fire if an automatic fire release guard were fitted to the identified bedroom door. In order that those living at the home can feel assured that the home are committed in providing a well maintained and accessible environment if the Registered Provider Care Homes for Older People Page 8 of 33 submits plans for the ongoing redecoration and renewal of furnishing and fixtures within the home and furthermore if a handrail is fitted to the exterior wall leading up to the home for those with limited mobility. 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 33 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 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Manager takes a lot of care when admitting people into The Grand Panorama in order to ensure that the home are able to meet the assessed needs of the individual. Clear information is not provided about the services and facilities available at the home and contracts containing the terms and conditions of the placement are not provided to individuals who live at the home. Evidence: The Grand Panorama has been registered with the Commission a number of years. The current owners bought Grand Panorama at the beginning of 2007. As part of this site visit we reviewed the Registration Certificate for the service and spoke with th manager about the conditions of registration that were in place. These were that the home may accommodate up to 23 people aged 65 years and over who may require nursing care. And also that the home may also accommodate one person Care Homes for Older People Page 11 of 33 Evidence: aged 50 years and over, who has a physical disability (subject to the inspectors agreement). The registration also recorded that the home may continue to accommodate those residents aged less than 65 years, who were placed prior to November 2005. These conditions remain the same and the individuals to which these conditions relate still reside at the home and their needs continue to be well met at the home. During this site visit we reviewed the statement of purpose and the service users guide. We saw that both of these documents contain information about the facilities and services which are provided by the home, and information about the admission process and how people can make a complaint. However, these documents have not been reviewed since 2006. The information about staffing skills, training and qualifications is incorrect and there is no information about the current registered manager. These documents must be updated to provide clear accurate information for those who live at the home and prospective service users. We saw at this visit that the home has a comprehensive admissions process and no individual is admitted into the home until they have been visited by the home and a full assessment of their needs is undertaken. Pre admission assessments are well recorded and along with the information provided within a care management assessment. This forms the basis for the home to develop the individuals care plan. Care plans are well written and contain sufficient detail in order to direct and guide staff practice. We saw that care plans have been developed and have been based upon individuals expressed wishes and choices which have been recorded. We spoke to someone who had recently been admitted to the home. they told us that they had settled well and had made some friends, they also told us that staff were attentive and kind. We asked to look at contracts for people who live at the home. Contracts contain information about the terms and conditions of the placement. We were told that these were not available and that these documents had not been completed and were not in place. This is not acceptable. All people who live in a care home, whether they are privately funded or not must have a contract in place. This contract outlines the rights and responsibilities of all parties involved. The home are required to provide these contracts for all individuals living at the home, they should explain the contents of the document and demonstrate that all individuals have received a copy of their contract. We have given the home an agreed timescale in which to address this issue and we will contact the home after this date to check that compliance has been achieved. No intermediate care is provided at this home. Care Homes for Older People Page 12 of 33 Care Homes for Older People Page 13 of 33 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. Those who live at the home benefit from the information that has been recorded about how their needs are to be met. This helps ensure that the staff team provides consistent support, in the way that those living at the home prefer. Individuals have access to health care services and individuals are well supported with their medication. Medication practices within the home are good. Evidence: At this visit we reviewed that care plans and all other associated records for three of the people living at the home and we sampled the records for one other person. Since our last visit the home have introduced a new care plan file format for recording information. We saw that care plans had been reviewed a minimum of every month, and had been updated sooner when an individuals needs had changed, in line with expected practice. The care plans we reviewed were well written and contained full information in order to direct and guide staff practice. We saw that information was recorded about individuals communication, practical, personal and emotional support Care Homes for Older People Page 14 of 33 Evidence: needs and recorded individuals likes, dislikes and how they wished to be supported. People living at the home told us that staff assisted them in all areas of their care and gave us a number of examples of this. People told us Staff help me with my stockings as I cant manage those myself, Staff dont rush me, they allow me the time I need to get ready. There are people in this home who share a room, the manager was very clear about the practices in place to ensure the privacy and dignity of people living at the home. Curtains are provided in rooms which are shared to provide some privacy. We also noted that when a person required a hoist in the lounge to transfer them from their chair into a wheelchair a screen was used to provide some discretion and privacy for this person. As part of the review process we looked at how people are supported with their health care. We saw that all of the people living at the home are registered with a local general practitioner and people told us that they see the doctor when needed. They also told us The doctor is very good, he visits me here when I need him. We saw in records that people are encouraged and supported to access primary and specialist health care support as needed such as the optician, chiropodist and dentist. There are also qualified nursing staff at this home who can ensure that appropriate services are accessed as needed. The manager told us that the home had developed a good working relationship with the local GP practice, that the manager goes to the surgery on a monthly basis to check records and to discuss the treatment of people living at the home. This maintains clear communication and continuity of health care for people living at th Grand Panorama. A comment card received from this practice prior to our visit the home reported that the home communicates clearly and works in partnership with them, that their is always a senior member of staff to confer with and that staff demonstrate a clear understanding of the needs of people living at the home. During this visit we reviewed medication practices at the home. We were told that the home have clear policies and procedures in place in respect of this area, however we were unable to see these easily as they are stored on the computer and are not easily accessible. (see the management section of this report for a recommendation about this area). We saw that medication is stored securely in a locked cabinet with only a limited number of staff at any one time having access to this area. we saw in staff training records that staff have completed medication competency training. Records were well written and administration in this area was good. We saw no errors. Care Homes for Older People Page 15 of 33 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 living at the home are given the opportunity to exercise some choice and control over their daily lives.The food in the home is of good quality, well presented and meets the dietary needs of the residents. The staff are experienced and meets the personal preferences for people living in the home. Evidence: Information seen evidenced that the individuals living at the home are provided with a variety of social activities and are able to participate or not. This is dependent on the individuals choice. On the day of the visit an entertainer came in and was undertaking a musical quiz. People were joining in and appeared to be having a good time. Those spoken with said they really enjoyed the varied and interesting activities provided at the home, they told us that the activities coordinator was friendly and supportive and encouraged them to participate with their interests and hobbies. Whilst we were at the the home the operations manager discussed with us the possibility of providing a day care facility at the home for up to eight people, that this facility would have their own staffing arrangements and another activities co ordinator would be employed. We requested that the proposal be given to us in writing, which it Care Homes for Older People Page 16 of 33 Evidence: was on the day. However the information within the letter did not fully satisfy us that appropriate and full consideration had been given to this matter more information is required by us to ensure that those living and working at the home would not be adversely affected by the proposed arrangement. Discussion with the manager, staff members and evidence from the visitors book showed that those living at the home maintain good contact with families and representatives. The level of contact varies for each individuals living at the home, some receive regular visitors and go out with family, and others do not. The home has open visiting arrangements and those living at the home can entertain their family and friends in their own room. Staff support individuals to maintain family links and friendships inside and outside of the home and staff assisting individuals with correspondence and telephone calls if requested. During our visit we spoke with a number of people who live at the home and we also had the opportunity to speak with relatives who were visiting their parents at the home. They explained to us why they chose the home and told us about the care their relative receives. Relatives also told us they told us that they were very happy with the care and attention their father received, that staff were always friendly and engaging. Relatives also told us that the manager of the home was lovely and that nothing was too much trouble for staff at the home. At a brief walk around the building residents were seen spending time in their bedrooms and the communal lounges. Daily records of care showed that people are able to choose when to get up and retire, what to eat and drink and how they were to be assisted with aspects of their life. During our visit we observed people having their meal at lunchtime. The meal was relaxed and individuals were given the meals based on the choices they made after consultation on the meals available to them. We spoke with the cook who demonstrated a sound understanding of the likes, dislikes and special dietary requirements of individuals. We also saw that this information was well recorded in individuals care records. During this visit we saw that staff were friendly, polite and caring in their approach. They were seen to be supportive. We saw them listening to people and answering questions, providing reassurance and information as requested. Care Homes for Older People Page 17 of 33 Care Homes for Older People Page 18 of 33 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. The home has a complaints procedure that meets national minimum standards and regulations, the procedure is available with in the home. People living at the home and their relatives understand how to make a complaint. Staff demonstrated an awareness of the content of the adult protection policy and know what immediate action to take and when and who to refer the incident on to should they have any concerns over the health or welfare of people living at the home. Evidence: The complaints policy and procedure shows a clear time line and action to be taken in event of a complaint. It also directs the complainant to the CSCI and North Somerset Social Services. A copy is made available in the entrance hall of the home, along with copies of previous inspection reports. The Commission has received no complaints since the last inspection. We reviewed the complaints logbook at the home and saw that incidents had been responded to promptly to the satisfaction of those involved. We asked people in the home if they had any complaints or concerns, none were raised to us. People told us that if they had any concerns they would tell either a staff member of the manager. Since our last visit to the service the home contacted us to inform us that they had reported to social service a protection of vulnerable adults issue in respect of two Care Homes for Older People Page 19 of 33 Evidence: people at the home who had had money go missing. Protection of vulnerable strategy meetings were held. The police were involved and the home cooperated fully with the process and ensured that monies lost had been replaced. As a result of the strategy meetings the home were required to take a number of actions to protect people. These included providing a lockable facility for all people living at the home and to update their admissions process to ensure individuals valuables are kept safe. When checked by us at this visit we saw that these actions had been undertaken by the home. During this visit we checked records against cash which was being held by the home for safekeeping. We saw that monies held balanced with records maintained. It is noted that the home are only insured in their safe for a limited amount of cash. One person had an excessive amount of money and they should be supported and directed to put this money elsewhere in order that it is more secure. See management section of this report. Staff spoken to showed an awareness of the policies and procedures in place to protect vulnerable adults. The home also has a clear whistle blowing policy in place. Staff have undertaken training in protection of vulnerable adults. Recruitment practices carried out in the home protect residents from abuse, criminal records bureau and protection of vulnerable adults checks are carried out, and two written references are obtained before staff commence employment. Care Homes for Older People Page 20 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and accommodation provided meets the needs of individuals living at the home, however, the Registered Provider must demonstrate their commitment in ensuring the home is well maintained and accessible. Evidence: The Grand Panorama is a large home with unrestricted views across Weston Super Mare. Those living at the home are able to enjoy these views when sitting in the large conservatory area which is at the front of the house. We saw that a number of improvements have been made at the home since our last visit including new furniture for the lounge and dining room and new blinds for the conservatory area, making these areas more pleasant for those who live at the home. During the registration of the service a requirement was made that the registered provider must provide CSCI with a detailed plan for refurbishment within three months of registration,to improve the quality of the accommodations, access arrangements and bathing facilities. This information was never received by us and must be submitted by the home to demonstrate their commitment and plans for the ongoing improvement of the services provided for those who live at the Grand Panorama. Care Homes for Older People Page 21 of 33 Evidence: Also a condition of the registration report was that patients with mobility problems must not use those rooms accessed by steps. We viewed these areas and saw that the home have installed a wheelchair lift and saw that one of the suites in no longer in use. We discussed accessibility with the manager who was fully aware of her responsibility in this area. An outstanding requirement from previous visits is about the access to the entrance of the home, this has been discussed fully with the home and ourselves and it has been agreed that due to the steepness of the slope leading to the home it would be extremely difficult for the Registered Provider to comply with this requirement. However, arrangements must be made to improve access to the home. The manager confirmed that she has told those living at the home and their relatives that the home would pay for a taxi from the town centre up to the home as this would provide access to the front door. This information should be included within the homes statement of purpose. It is also required that a handrail is fitted along the main wall leading to the house, furthermore seating should be strategically placed in order to provide a resting areas for those with limited mobility. We will be contacting the home once the timescales for action have been reached to ensure that compliance in this area have been achieved. There are adaptations in place throughout the home and specialist equipment including mobility aids, sensory aids, and specially adapted baths. There is a spacious dining area, a comfortable lounge area and a room for activities and craft work. Bathrooms include specially adapted baths to assist those who may have reduced mobility. Toilets are situated in readily accessible parts of the home near to communal areas and bedrooms. The bathrooms and toilets were clean, and were well stocked with hand towels and soap to help minimize risk from cross infection in the Home. At our last visit to the service we made a requirement that action must be taken so that the bathroom identified is free from odour. All bathrooms were seen during this visit and no odours were present. During this visit we saw workmen on site who were in the process of refurbishing a bathroom area, this will provide an improved shower facility for those who live at the home. We also viewed the kitchen and spent time in the lounge and activity area talking with those who live at the home. Lighting within the home is domestic in style and of a good standard, emergency lighting is provided throughout the home, this is checked on a monthly basis. Care Homes for Older People Page 22 of 33 Evidence: We noted that call bells were in place for people living in the home to summon for staff assistance, during our visit we noted that this call bell was responded to promptly by staff. Care Homes for Older People Page 23 of 33 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. The home had sufficient staff on duty and staff are qualified to provide good level of care. Staff are clear regarding their role in what is expected of them. Recruitment practices safeguard the people who live at The Grand Panorama. Evidence: There is a well-established staff team at The Grand Panorama. During the visit the manager and staff were able to demonstrate a clear understanding and knowledge of the individuals who use the service, and of their role in the home. The manager was able to demonstrate that she and the staff team have developed good relationships with those who live at the home and have a sound understanding of their needs, wishes and aspirations. These are well recorded in individuals records Staffing provision appeared to be consistent with levels and skills needed due to assessed care needs of the individuals. The staff team have a varied range of knowledge and skills, they were observed by us to be good listeners, effective communicators and were interested and motivated in meeting the needs of those Care Homes for Older People Page 24 of 33 Evidence: living at the home. The home has a structured induction program. This is to ensure that a new staff member is competent and confident to work with people living at the home and are able to meet their needs. The manager and her team were positive and motivated throughout the inspection process. There was evidence that the manager and her team were committed to maintaining good levels service provided at The Grand Panorama and also to improving services. The recruitment and selection documents for a number of staff were reviewed at this visit, staff files evidenced that full and robust practices are adhered to at the home to ensure that those appointed have the qualities and skills to work within this care environment. Appropriate adult protection checks are taken to ensure the protection and safety of those living at the home. We also reviewed staff training records and saw that since our last visit staff have undergone training in areas such as first aid, basic food hygiene, end of life care and protection of vulnerable adults. We noted that health and safety training is booked for all of the staff team in October 2008, however, we also noted that a number of staff have not completed training in manual handling. In order that those living at the home are supported in a safe and appropriate manner it is required that manual handling training must take place for all staff this will provide staff with the skills to perform their duties in a safe manner. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Manager has the qualities and skills to run this care home, there are good systems in place to monitor the quality of service that is provided to people who live at the home. However policies and procedures are in need of review and these documents must be available to staff. Fire procedures within the home are good, people would be safer if an automatic fire release guard were fitted to their bedroom door. There are appropriate measures in place to protect people in the event of a fire emergency. however one room would benefit from an automatic door release. Evidence: Tereai Mutema is the manager of this service. She underwent her fit persons interview with us in April 2008 and demonstrated that she had the skills and knowledge to undertake this role. Care Homes for Older People Page 26 of 33 Evidence: Mrs Mutema has a number of qualifications that she achieved in Zimbabwe and South Africa this includes a B. A. in Nursing Science. She has held a number of managerial posts whilst working in Zimbabwe, and was able to present the certificate of evidence of her professional qualifications. Mrs Mutema does not currently have the NVQ 4 Registered Managers Award, however she has registered with the local college to commence the award in September 2008. In addition to this she has completed a number of other training courses that are related to the management and care of people who use the service and contribute to her continued professional development. Prior to the site visit the Commission received from the registered provider a completed annual quality assurance assessment. The annual quality assurance assessment (AQAA) is a process that is being used for all regulated services from April 2007. The AQAA is in two parts: Part one is a self-assessment, part two is a dataset. It is a legal requirement for all services to return an AQAA to the Commission. The document received from the registered was fully completed and sufficiently detailed. In response to the question within the AQAA What the service does well, the response from the home was that the care is given in an atmosphere of competence, flexibility, friendliness and goodwill. Within the AQAA the home also told us that it does not discriminate anyone. People with different needs, abilities are admitted. Some people require residential care and some require additional nursing support. The home informed us that their policies on equality, diversity and discrimination have been revised and are continually reinforced for both those who live and work at the home. During our last visit to the service a requirement was made by us that the records of the Regulation 26 visits must be available for inspection. These visits are undertaken by a representative of the Registered Provider on a monthly basis and the reports are evidence of the monitoring processes which have taken place. We saw copies of these visits and saw that the visits were unannounced and covered areas such as the care and welfare of people living at the home, staffing levels and skills are reviewed as well as health and safety. As reported in standards 18 we reported that we checked a sample of individuals monies held at the home for safe keeping and the following recommendation was made. Consideration should be given on how to support an individual with their finances to ensure they are protected and that assistance is in line with their wishes. Staff files also contained evidence of supervision and positive comments were noted in the feedback to staff. Frequency of supervision was generally good and staff had received the required sessions. Areas of discussion included guidelines and policies of Care Homes for Older People Page 27 of 33 Evidence: the home, individuals expectations and an evaluation of their performance and how this can be developed. There was evidence that the home ensures so far as is reasonably practicable. the health and safety of those living at the home, staff and visitors. The home has robust policies and procedures in relation to aspect of health and safety. We reviewed the fire logbook and saw that all of the appropriate safety checks are undertaken on a monthly and weekly basis. We read the homes completed fire risk assessment and saw that this had been well written. When walking around the home we noted a bedroom door being propped open, the person in the room was in their bed and would be unable to close the door in the event of a fire. Staff confirmed that this person wanted their door kept open, and the person themselves also told us this. In order to ensure that people would be safe in the event of a fire it is required that a fire, automatic release devise is fitted to the bedroom door identified during our visit. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 1 14 The registered person shall compile a in relation to the care home a written statement of purpose which includes the matters as outlined in schedule 1. This is to ensure that the information provided within the document is an accurate reflection of the facilities and services provided at the home. 18/12/2008 2 2 5 All individuals living at the 30/11/2008 home must be provided with a standard form of contract for the provision of services and facilities by the registered provider to service users. To ensure that all individuals living at the home are provided with full and detailed information about their rights. 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 22 16 The Registered Provider must submit to us the refurbishment plans for the home. 12/11/2008 Care Homes for Older People Page 30 of 33 To demonstrate a commitment in providing a well maintained envionment for those who live and work at the home 2 22 23 A handrail must be fitted to 28/11/2008 the wall leading up the drive to provide additional assistance those walking up the steep hill who have mobility problems. To support those with limited mobility 3 26 13 The cooker hood in the kitchen must be cleaned to remove grease and dirt. To ensure basic food hygiene principles are maintained 4 26 13 The extractor fan on the 28/11/2008 kitchen wall must be cleaned To ensure basic food hygiene principles are maintained. 5 30 13 The Registered Provider must ensure that staff are provided with manual handling training. To ensure that those living at the home are assisted in a safe manner. 6 37 17 Policies and Procedures must be reviewed and updated to ensure they reflect the service provided at The Grand Panorama 24/12/2008 24/12/2008 24/10/2008 Care Homes for Older People Page 31 of 33 To ensure clear accurate information is provided 7 38 23 An automatic fire door release to be fitted to the bedroom door identified during our visit. To ensure the safety of the person who is bed bound in this room 28/11/2008 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 18 Consideration should be given on how to support an individual with their finances to ensure they are protected and that assistance is in line with their wishes. Seating to be provided at appropriate intervals on the entrance to the home to ensure those those with mobility difficulties have an area to rest. Consideration should be given on how to support an individual with their finances to ensure they are protected and that assistance is in line with their wishes. Policies and Procedures should be readily available to staff in written format 2 23 3 36 4 37 Care Homes for Older People Page 32 of 33 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 © (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. Care Homes for Older People Page 33 of 33 - 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!