Inspection on 28/01/09 for The Old Parsonage

This inspection was carried out on 28th January 2009.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Old Parsonage 13/02/08

The Old Parsonage 20/02/07

The Old Parsonage 22/05/06

The Old Parsonage 31/01/06

The Old Parsonage 15/07/05

The Old Parsonage 27/01/05

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Parsonage The Street Broughton Gifford Melksham Wiltshire SN12 8PR     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: Malcolm Kippax     Date: 0 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 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 35 Information about the care home Name of care home: Address: The Old Parsonage The Street Broughton Gifford Melksham Wiltshire SN12 8PR 01225782167 01225783245 christine.rch@googlemail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Roseville Care Homes (Melksham) Limited Name of registered manager (if applicable) Mrs Christine Ann Jones Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The staffing levels set out in the Notice of Decision dated 23 December 2004 must be met at all times Date of last inspection Brief description of the care home The Old Parsonage is a care home with nursing that specialises in the care of people aged 65 or over, who have dementia and other needs relating to their mental health. The Old Parsonage is situated on the outskirts of the village of Broughton Gifford. It is a 19th century listed building, which has been converted into a care home. The accommodation is on the ground and first floors, with a passenger lift available. The residents bedrooms are on both floors. There are 14 single rooms and 3 double rooms. The communal rooms consist of two lounges and a dining room. The outside space Care Homes for Older People Page 4 of 35 care home 20 Over 65 20 20 0 0 Brief description of the care home includes a paved courtyard and a driveway with parking areas. The Old Parsonage was purchased by Roseville Care Homes (Melksham) Ltd in December 2004. Mrs Christine Jones is registered as the homes manager. Mrs Jones leads a team of nursing, care and ancillary staff. The fee at the time of the inspection started at £625 a week. A copy of the last inspection report is available in the home. Inspection reports are also available through the Commissions website at: www.csci.org.uk Care Homes for Older People Page 5 of 35 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: Initially, we asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about the homes plans for the future. Surveys were sent to the home, so that these could be given to the people who live there, and to the staff. We received surveys back from four people who live at the home, and from four staff members. We reviewed all the information that we have received about the home since the last key inspection. This helped us to decide what we should look at during an unannounced visit to the home, which took place on 28th January 2009. We made a second visit to the home on 4th February 2009 in order to Care Homes for Older People Page 6 of 35 complete the inspection and give feedback about the outcome. During our visits to the home we met with several of the people who lived there. We talked to staff and to the homes manager, Mrs C. Jones. On 4th February we also met with Mrs Knezevic-Sharp, who is in the role of Responsible Individual from Roseville Care Homes (Melksham) Ltd. One of our pharmacist inspectors looked at the arrangements being made for medication. We also looked at some records and went around the home. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the care home does well: What has improved since the last inspection? What they could do better: Medication arrangements must be improved to ensure the safety of people in the home. Administration records must be accurate. Our pharmacist inspector thought that the overall standard of the medication arrangements had fallen since the last inspection. Care Homes for Older People Page 8 of 35 There are a number of good procedures in place in relation to peoples care, but some could be improved to promote their health and wellbeing. We have made recommendations about the completion of nutritional assessments, and a more consistent approach to recording particular aspects of peoples care. Peoples complaints are being acted on, although the response to these should be more thoroughly recorded and kept in the home to show the process that has been followed. The company has identified areas of the building and the facilities that should be improved, and work has been started on this. We had made a requirement at the last inspection concerning the need for staff to be appropriately supervised and for a programme of formal supervision to be implemented. We were told in the AQAA that a programme had commenced but that it was abandoned due to time constraints. The company needs to ensure that there are sufficient resources provided, so that management tasks such as supervision can be maintained appropriately. We also saw that staff training has not progressed as quickly as it should have done following the last inspection. We were told in the AQAA that this was now a priority and it would continue to improve in the coming year. We made a requirement at the last inspection that there should be a system established for evaluating the quality of the services being provided. A start has been made with this through the use of surveys, although the system has not been developed during the last year as quickly as we expected. The home needs to have a system in place which will ensure that inspection requirements are addressed in a timely way, and that the home is pro-active in identifying and making improvements. The homes fire risk assessment needs to be reviewed. This is to ensure that it is up to date, and people in the home are protected because the appropriate safety measures are in place. 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 35 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 35 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. Changes have been to the statement of purpose and service users guide, so that people have better information about the home and the service that is provided. Peoples needs are assessed before they move in, so that a decision can be made about whether the home will be suitable for them. Evidence: We reported at the last inspection that the written information about the home was not up to date. For example, the statement of purpose had not provided all the information that was required, such as an address for Roseville Care Homes (Melksham) Limited. Mrs Jones told us that the statement of purpose and the service users guide had both been reviewed and updated since the last inspection. We saw that the statement of Care Homes for Older People Page 11 of 35 Evidence: purpose now included the details for the company that owned the home. A fees and services section had been added to the service users guide, so that people knew what the fees covered and what they would need to pay for themselves. The four people who completed surveys confirmed that they had received enough information about the home, before moving in, in order to decide whether it was the right place for them. People had been supported by relatives with completing their surveys. The relatives also commented about their experience of the move into the home. One person commented A very helpful visit and discussion with the manager. Another person told us Having looked at many homes this was the only one I felt my husband would be happy in. Each person who used the service had an individual file which contained their personal assessment and care records. We looked at examples of the records, including those for people who had moved into the home since the last inspection. Initial information had been recorded on a New Client Enquiry form. Peoples needs had then been assessed and recorded on a pre-admission assessment form. The home had received other information about peoples individual needs and circumstances before they moved in. This included, for example hospital transfer letters, and the minutes of review meetings. We saw copies of letters that had been written to peoples representatives about the move, confirming that the home could meet their needs. A Social Information form was being used to record additional information about peoples interests and personal backgrounds. Relatives had been asked to complete these forms prior to the move. This looked like a good way of obtaining the type of information that would help people to settle in. The information would also assist staff with communication and in establishing a relationship with the person who had moved into the home. Care Homes for Older People Page 12 of 35 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. Peoples personal care needs are met. There are good procedures in place, but some could be improved to promote peoples health and wellbeing. Medication arrangements must be improved to ensure the safety of people in the home. Administration records must be accurate. Evidence: We looked at the care records for four people who used the service. Other records were seen in relation to specific areas of personal care. Each of the four peoples records included a series of numbered Daily Care Plans. The plans covered different areas of need, such as mental health, physical health, communication, eating and drinking, and personal hygiene. The desired goal to be achieved in connection with each need had also been recorded. Another section of the plans concerned the type of intervention that was needed. This provided staff with guidance about how they should be supporting people. The plans were being evaluated each month, and changes recorded. Care Homes for Older People Page 13 of 35 Evidence: We asked staff members in their surveys whether there were given up to date information (for example in the care plan) about the needs of the people they supported or cared for. Two staff members responded Always to this question, and another Usually. One staff member responded Sometimes and they commented Could be better communication. Waterlow assessments were being undertaken to identify people who were at risk of developing a pressure ulcer. Assessment forms were also being completed for moving and handling and other risks. In between our visits, Mrs Jones produced a new form for recording risk assessments in relation to the use of bedrails. Mrs Jones said that the use of bedrails had previously been included as part of a general assessment of risks. People who needed more specific nursing care on a 24-hour basis, had additional files that included fluid, food and turn charts. There were two such files in use at the time of our visits. Mrs Jones said that the two people concerned did not have any pressure ulcers, but they were at risk and received care to prevent their occurrence. The turn charts we saw had mostly been completed at the appropriate times although there were some gaps in the recording. Mrs Jones thought that this could be when the person was sitting up and would not be in need of turning. We thought that it would be useful to record when this had happened, so that a full record was maintained, and there could be no misunderstanding about the support that was needed at the time. Charts were being maintained, so that peoples fluid and food intake could be monitored, and they would receive the amounts that they needed. Information about peoples intake was being recorded during the day. There was also a section on the form for recording the total daily amount, although this was not being consistently completed. Peoples Daily Care Plans included information about their needs in relation to eating and drinking. Nutritional risk assessments were not being completed, which we thought could be used to provide more detailed information about peoples needs, and what had been agreed about their food and fluid intake, for example the preferred daily amounts. Mrs Jones said that this was something she would follow up and has since confirmed the type of assessment that will be undertaken. Daily statements were being written about each person. These covered a range of matters relating to peoples health and welfare. Sometimes, the statement was limited to a comment such as Posed no problems, while others were more detailed and objective. There was also information recorded about peoples health appointments with outside professionals. An optician and a chiropodist visited the home regularly. In the AQAA we were given examples of the successes that the home has had with healing pressure ulcers when these have arisen in the past. We looked at records in Care Homes for Older People Page 14 of 35 Evidence: the home, which showed the care that had been provided, including when advice had been taken from the community based tissue viability nurse. We discussed the circumstances of one person who had been receiving treatment for a pressure ulcer, but was currently in hospital. In their surveys, three people who used the service told us that they always received the care and support that they needed. Another person responded usually. A relative commented Very impressed by the dedication of the staff in their physical care and the positive support they provide. Another told us about their close relative in the home He has received great care and has picked up a lot since he moved to the Old Parsonage. During the visits we thought that people looked well supported with their personal appearance and with their choice of clothing. Care staff were heard talking to people in a respectful manner, whilst also appearing to have friendly and informal relationships with them. Staff members mentioned the standard of care when we asked them in their surveys about what the home did well. Our pharmacist inspector looked at the arrangements for medication handling in the home. All medicines were kept securely and appropriately except for the storage arrangements for controlled drugs. The previous inspection pointed out the need for the home to have a cupboard that complies with the current legislation for the storage of controlled drugs, but the drugs were still being kept in an old cupboard that is not legal. Medication administration records were printed by the pharmacist who had just taken over the service to the home and medicines were supplied in a monitored dosage system. There were no photographs with the medication administration records that would aid identification. Two occasions were seen where the medication had been signed for as given to people but had not been. The medication administration chart must only be signed when a nurse has seen the person take the medicine, if the medication is not given for any reason or refused this must be recorded on the chart. One medication had been prescribed as directed; there was no record of the prescribed dose although it was being given once a day. Some people in the home are prescribed medicines to be used as required. One person had a care plan that described when this medicine was to be given but another person did not. Medicines were recorded when they were received into the home, but due to the change in supplier the manager was unable to confirm arrangements for the disposal of medicines no longer required. The home kept clear records of doctors visits and changes to medication. Since visiting the home we have received further information from Mrs Jones about the Care Homes for Older People Page 15 of 35 Evidence: arrangements being made for medication. Mrs Jones said that a new controlled drugs and disposal arrangements were now in place, although they had previously been told by a pharmacist that they were complying with the current regulations. Mrs Jones also confirmed that photographs of people were included on the medication sheets. Care Homes for Older People Page 16 of 35 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 are benefiting from developments in the homes activities, which are now more geared to their individual needs. People are supported with maintaining contact with their relatives. They are offered a varied menu and have meals that they enjoy. Evidence: We observed people expressing themselves in different ways, for example by being able to walk freely between rooms and spending their time in different areas of the home. There was a choice of sitting areas, which had different outlooks. One person was a smoker and they were able to use a room that had been designated for this purpose. Space for outside recreation was limited to a patio area at the rear of the home. We were told that there were plans to extend this space. Peoples contact with the local community was mainly through visitors to the home. It was reported in the AQAA that people from the local community of churches visited Care Homes for Older People Page 17 of 35 Evidence: weekly to sing hymns. The home was located next to an Anglican church. Information we received from the home and in the surveys indicated that peoples faith needs were being met. We met with relatives during their visits to the home. They said that they were made to feel welcome and could visit when they wished to. We were told that there were a number of relatives who visited the home on a regular basis. Information about peoples individual interests and family backgrounds was obtained at the time of admission. The amount of information recorded varied. We thought that this could be discussed further with peoples relatives, so that there is good information available about people, or example in the form of a life history or memory book. The home has developed its activities programme since the last inspection. We had recommended at the last inspection that advice was obtained from a specialist source about activities that are suitable for people with dementia. This was so that the home provided a more varied range of activities that would meet peoples needs. We saw that a resource book of suitable activities had been obtained. We had also recommended at the last inspection that the programme included more one to one activities that reflected peoples individual interests and personal routines. The carer who was co-ordinating the programme showed us a photo album that was being kept of social activities and entertainments. Activities were now being recorded on an individual basis, so that it was easier to monitor who had participated in an activity, and who might benefit from further support with activities. The carer said that there were occasional shopping trips arranged. People mainly participated in activities in the communal areas of the home, although the carer said that time was also spent with two people who stayed in their own rooms. From the records we saw we thought that the needs of these people could be made a higher priority, to ensure that they had regular social contact with other people. We asked people in their surveys whether there were activities arranged by the home that they could take part in. One person responded Always, two people Usually and one person Sometimes. People commented No hobbies, but like to have one to one conversations, and there are now very appropriate activities happening. When we asked people in their surveys if they liked the meals at the home, two people responded Always and two Usually. One relative commented having been present at mealtimes, food is varied, well prepared and presented, looking appetising. Care Homes for Older People Page 18 of 35 Evidence: We met the cook, who told us that there was a set main course for lunch, and that meals were prepared so as to meet peoples individual requirements, for example when they needed a diabetic diet. There was a written menu, which covered a period of four weeks. This showed a varied range of meals being served, including a cooked breakfast, such as poached eggs, scrambled eggs or beans on toast. The cook said that about half the people liked to have the cooked breakfast. It was stated on the menu that a jacket potato or omelette would be available as an alternative to the main course at lunch. The cook said that she had got to know peoples preferences and likes and dislikes, but they were not routinely asked about their choices before the meals. Care Homes for Older People Page 19 of 35 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. Most people in the home are dependent on others to raise any concerns, and there are procedures in place that help with this. Peoples complaints are being acted on, although the response to these should be better recorded. Evidence: A copy of the homes complaints procedure was included in the information pack that is given to people when they move into the home, or to their representatives. A Comments, Complaints and Suggestions procedure was also displayed in the home. Since the last inspection this has been moved from the homes office to the front porch, which was a public area and more likely to be seen by people. People confirmed in their surveys that they knew how to make a complaint and who they could speak to if not happy with something. People told us in their surveys that the staff listened to them and acted on what they said. One persons relative commented Staff always act as appropriate, either straight away or by my subsequent visit - usually every other day. We have had contact with Roseville Care Homes (Melksham) Ltd since the last inspection in connection with two complaints, which were subsequently investigated by the company. We discussed these further with Mrs Knezevic-Sharp during our visit to the home on 4th February 2009. Further information and documentation about the Care Homes for Older People Page 20 of 35 Evidence: investigation of the complaints was available, which we had not previously received. This included a copy of a letter that had been sent in response to one of the complaints. This confirmed that the outcome of the complaint, although it was agreed with Mrs Knezevic-Sharp that some further information should be provided to show how this outcome had been arrived at. The home had a policies and procedures file, which included guidance for staff about the protection of vulnerable adults and about whistle blowing. In their surveys, staff members confirmed that they knew what to do if somebody had concerns about the home. Staff members were undertaking a programme of training at the time of our visits, which included training in the protection of vulnerable adults. Mrs Jones has had experience of making a referral under the safeguarding adults procedures, and of being involved in the process of investigation. Care Homes for Older People Page 21 of 35 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 home environment that is generally suitable and meeting their needs. Some areas are receiving attention, in order to improve the facilities and enhance the environment. Evidence: We had a look around the home with Mrs Jones during our visit on 28 January 2009. There were two lounges being used and people had their meals in a separate dining room. One of the lounges had a television, which meant that the other could be used for activities or quieter events. The accommodation looked clean and there were no unpleasant odours. We asked people in their surveys whether the home was kept fresh and clean. People responded Always to this question. One person commented Never any unpleasant odours, and another Very impressed with standards. We were told in the AQAA and during the visits about work that was taking place and being planned in relation to the building and facilities. Decorating and refurbishment work was taking place at the time of the visits. This included such as things as replacing doors and skirting boards in order to improve the overall appearance of the accommodation. We were told that there were plans to make some major changes to Care Homes for Older People Page 22 of 35 Evidence: the domestic and communal areas, to include relocation of the kitchen. There were also plans for the external space to be improved, so that people had more room for outside recreation. One of the bathrooms in the home was out of use when we visited. Mrs Jones said that a priority was to change this into a walk-in shower room, which would better meet the needs of some people. A plumber was due to visit in connection with the water system, which has been problematic in the past. There was a policy for preventing infection and managing infection control. Mrs Jones reported in the AQAA that the Department of Health guide Essential Steps had been used to assess the way that infection control was managed in the home. A Red bag system was being used for the movement of laundry and soiled items in the home. There was a contract in place for the disposal of clinical waste. Care Homes for Older People Page 23 of 35 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. Peoples main needs are being met. The training needs of staff and some current staffing difficulties are being addressed, to ensure that people benefit from a competent staff team. People are mostly well protected by the way in which staff are recruited. Evidence: Staffing at the time of the visits was in line with the agreed minimum level for the home. This meant that a qualified nurse was on duty at all times, working alongside a number of carers. Additional staff were employed to cover the preparation of meals and the domestic work in the home. We were given information in the AQAA about the staffing arrangements and the deployment of staff. We were told that the staff team was one carer short, and efforts were being made to find a replacement for the deputy manager who had resigned in December 2008. This had meant that the home was also down by one of its qualified nurses. Mrs Jones updated us on the situation during our visits. The vacancies were being covered by agency staff and by members of the permanent staff team who were Care Homes for Older People Page 24 of 35 Evidence: working additional hours. Mrs Jones recognised that this was not an ideal situation but it was a temporary solution to covering the duties. The staffing arrangements were being planned well in advance, which helped to ensure that the necessary duties were being covered. We saw that written rotas were being maintained, which showed the deployment of staff at the time of the visits and for the coming weeks. Mrs Jones was usually covering duties as the qualified nurse when working in the home. We have commented at previous inspections about the time that Mrs Jones has as manager for carrying out non-nursing tasks. A recommendation has been at previous inspections about employing an administration person who could provide support in the home. This recommendation had not been acted on. Mrs Jones said that constraints on her time were currently having an impact on the management tasks and developments that could be completed, including the supervision of staff (see Management and Administration section). We asked people in their surveys whether staff were available when they needed them. Three people responded Always to this question and one person responded Usually. A relative commented There is always somebody who can help if there is a problem, either on the phone or in person. Somebody else commented about their relative in the home He is treated as an individual and not just a patient. We asked staff members in their surveys whether there were enough staff to meet peoples individual needs. One staff member responded Always, and two Usually. Another commented Some members of staff are doing excessive hours to meet these needs. Three staff members confirmed in their surveys that they were being given training that was relevant to their role. A fourth person responded Sometimes. Three staff members said that their induction had covered everything very well. One person responded Mostly. We recommended at the last inspection that a policy is produced which sets out the companys aims and intentions in respect of staff training. We had discussed the need for a programme of training to be in place and had made a requirement in connection with this. When we asked staff in their surveys what the home could do better, one person commented more training, and another regular training updates. We were told in the AQAA that training during the last year had included manual handling and fire. There were plans in hand with a training company to update staff in Dementia Care, Basic hygiene, Abuse, Challenging behaviour and Person centred care. There had been a Care Homes for Older People Page 25 of 35 Evidence: delay in providing this training although when we visited the home we found that a trainer was holding sessions with staff in connection with these subjects. We met the trainer, who said that they were spending a number of days at the home. The training had not yet been completed, and the records showed that first aid was one of the next priorities. Staff had personal files, which included details of the training attended and copies of certificates. The cook we met said that she was due to attend an advanced food hygiene course. She also said that she would be interested in attending a course on nutrition and the needs of older people. The carers were encouraged to achieve a National Vocational Qualification NVQ. At the time of the inspection the percentage of care staff with an appropriate NVQ, or working towards one, was over 50 . The four staff who completed surveys confirmed that their employer had carried out checks, such as Criminal Records Bureau CRB and references, before they started work. We looked at the recruitment files for two staff members who had been appointed since the last inspection. They had been recruited from abroad using an agency. The recruitment procedure included Criminal Record Bureau (CRB) checks. Other information, including references and proof of the applicants identity had been obtained. Mrs Jones said that the new staff were living-in within the home and had started their induction before their CRB and protection of vulnerable adults list (POVA) checks were returned. We confirmed with Mrs Jones, that a POVA First check needed to have been undertaken in these circumstances. We had made a requirement at the last inspection that a record must be kept of the nurses current registrations with the Nursing and Midwifery Council. When we visited the home we saw that this record was being maintained and the nurses registrations were up to date. Care Homes for Older People Page 26 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home that has an experienced and competent manager. There have been some positive developments since the last inspection although there needs to be a more consistent response to the improvements that are required, to ensure that people benefit from a well run home. Evidence: Mrs Jones is a registered nurse who has worked in the home since 1996 and became the manager in 2001. Mrs Jones gained the Registered Managers Award in 2004. Mrs Jones has managed the home well through a time of change in recent years, as we have commented upon in the reports of previous inspections. At the last inspection we reported on a number of shortcomings that needed to be addressed. Some of these have since received attention. The Responsible Individual, Mrs Knezevic-Sharp is now visiting the home regularly and reports about these visits are being completed. This helps to ensure that the company monitors standards in the Care Homes for Older People Page 27 of 35 Evidence: home and can get feedback from people about the service they receive. Information about the home has been updated, and the paperwork in general is being improved. When we visited the home we confirmed with Mrs Jones that copies of notifications that are completed under Regulation 37 of the Care Homes Regulations 2001 should be kept in the home. This was not currently happening. We made a requirement at the last inspection concerning the need for staff to be appropriately supervised and for a programme of formal supervision to be implemented. We were told in the AQAA that a programme had commenced, but that it was abandoned due to time constraints. We saw from records in the home that staff had last received supervision in July 2008, but had since been asked to complete a self-assessment. We asked staff in their surveys whether their manager met with them to give support and discuss how they were working. Two people responded Regularly, one person Sometimes and another Never. Two staff mentioned Better communication when we asked in the surveys about what could be done better. The deputy manager had left in December 2008 and we were told during our visits to the home that the post was being advertised as a matter of priority. Mrs Jones said that the absence of a deputy manager was having an impact on her work and the developments that could take place. A requirement that we made at the last inspection about the storage of medication had not been met. Our pharmacist inspector thought that the overall standard of the medication arrangements had fallen since the last inspection. We also saw that staff training had not progressed as quickly as it should have done following our last inspection. We were told in the AQAA that this was now a priority and would continue to improve in the coming year. We made a requirement at the last inspection that a system must be established for evaluating the quality of the services being provided. Mrs Jones said that quality assurance was undertaken on an informal basis and there was not yet a policy, which was recommended at the previous inspection. We saw that a start had been made with quality assurance, as surveys had been sent out to get feedback from people. These surveys had produced some useful information about peoples views of the admission process what worked well and suggestions for improvements. Mrs Jones completed an AQAA, which showed the homes strengths and the plans for the future. The section on Management and Administration did not refer to a system of quality assurance. It is important to have a system in place which will ensure that inspection requirements are addressed in a timely way, and that the home is proactive in identifying and making improvements. Care Homes for Older People Page 28 of 35 Evidence: Mrs Jones had responsibility for managing the majority of peoples personal money. The financial procedures included the recording of money received and spent, with receipts kept of the money spent. We received information in the AQAA about the arrangements being made for health and safety, and the servicing of facilities in the home. The homes passenger lift had been serviced in January 2009. When going around the home we saw that the hoists had been serviced in December 2008. The portable electrical appliances had been tested, which was a requirement from the last inspection. During our visits to the home we heard that a new maintenance person had been employed in January 2009, and they had started to undertake some regular checks in relation to health and safety in the home. We saw that a fire risk assessment had been undertaken in May 2007. The assessment form showed a review date of May 2008 although there was no record of a review having taken place. This was brought to the attention of Mrs Jones and Mrs Knezevic-Sharp, who confirmed that it would receive attention. It will be important to keep the fire risk assessment under review, so that any changes in the premises and the facilities, for example through building work, are taken into account. Care Homes for Older People Page 29 of 35 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) All controlled drugs must be 30/04/2009 stored in a cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. This requirement was due to be met by 31/05/08. 2 30 18(1) Staff must receive training 30/04/2009 that is appropriate to the work that they are to perform. In order to show compliance with this regulation, a programme of training will need to be provided in accordance with the training requirements assessment that has been produced. This requirement was due to be met by 31/08/08. It has been met in part. 3 33 24 A system must be 30/04/2009 established for evaluating the quality of the services provided at the care home. The system must include consultation with people who use the service, and with their representatives. This requirement was due to be Page 30 of 35 Care Homes for Older People met by 31/08/08. It has been met in part. 4 36 18(2) Staff working at the home 31/03/2009 must be appropriately supervised. In order to show compliance with this regulation a programme of formal supervision will need to be arranged and implemented. This requirement was due to be met by 31/03/08. Care Homes for Older People Page 31 of 35 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 All medication must be clearly labelled with the prescribed dose. To ensure that all medication is administered in accordance with the prescribers instructions. 06/03/2009 2 9 13 Medication prescribed as required must be given in accordance with clear guidelines and included in the persons plan of care. To ensure that the medicine is given correctly and safely. 06/03/2009 3 9 13 The medication administration record must clearly show whether medication has been taken, refused or omitted for any reason. To ensure that an accurate record is kept of all medicines given to people in the home. 06/03/2009 Care Homes for Older People Page 32 of 35 4 38 13 The homes fire risk assessment must be reviewed, and safety measures implemented as necessary. This is to ensure that people are not at risk because the assessment is not being reviewed in accordance with the timescale recorded, and it does not take into account changes that have taken place within the home. 13/03/2009 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 8 That nutritional assessments are completed. This is to help identify people who may be at risk from poor nutrition, and the arrangements that need to made in relation to their food and fluid intake. That the food, fluid and turn charts are completed consistently to ensure that they provide a full record of the care that has been given, and there can be no misunderstanding about the support that was needed at a particular time. The manager should keep a record of the arrangements in place for the safe and legal disposal of medicines from the home. The manager should assess the competancy of staff in the safe administration of medicine. That people are informed of the days menu in advance of the meals. This is so that people know what to expect and are given the opportunity to choose an alternative to the set meal. Full records should be available in the home to show the process of a complaint investigation and the documentation involved. That consideration is given to employing an administrative 2 8 3 9 4 5 9 15 6 16 7 27 Care Homes for Older People Page 33 of 35 person who can provide support to the manager (recommendation from previous inspections). 8 33 That a policy is produced which sets out the companys aims and intentions in respect of quality assurance. This is so that the people who use the service can feel confident that there is a good system in place for improving the home and for taking their views into account. (Recommendation from the previous inspection). Care Homes for Older People Page 34 of 35 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). 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