Inspection on 01/10/08 for The Suffolk Private Retirement Home

This inspection was carried out on 1st October 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Suffolk Private Retirement... 01/07/09

The Suffolk Private Retirement... 28/04/08

The Suffolk Private Retirement... 30/04/07

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Suffolk Private Retirement Home 9 Sea Road Felixstowe Suffolk IP11 8BB     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: Julie Small     Date: 0 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 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 35 Information about the care home Name of care home: Address: The Suffolk Private Retirement Home 9 Sea Road Felixstowe Suffolk IP11 8BB 01394282972 01394274485 daverai138@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) SJR Care Limited Type of registration: Number of places registered: 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: Date of last inspection Brief description of the care home Suffolk Private Retirement Home is a care home for older people. The home is located on the sea front at Felixstowe. It can accommodate up to a maximum of 23 older persons. The home has no garden area for recreational purposes, but there is a small paved area immediately outside the front door, where service users sit in fine weather. Immediately opposite is the sea front, which includes an esplanade, seating, and gardens. The home is spread out over five floor levels - a basement comprising laundry, staff area, and storage. The ground floor comprises of a kitchen, 2 lounges, dining room, 2 toilets, and a small office. A further three floors have bedrooms, bathrooms, toilets, a sluice room, and the Manager?s office. Either staircases, or a shaft lift accesses the floors above ground floor level. Details of current fees were noted from the Service Users Guide and ranged from 341 to 420 pounds per week. 0 Over 65 23 Care Homes for Older People Page 4 of 35 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: 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 rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection was undertaken Wednesday 1st October 2008 from 10.15 to 18.45. The inspection was a key inspection which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The manager was present during the inspection and they provided the information that was requested promptly and in an open manner. During the inspection five staff members, four people that lived at the home and one Care Homes for Older People Page 6 of 35 visiting professional were spoken with and observation of work practice was undertaken, which included observation of a house meeting. Records that were viewed included the records of four people that lived at the home, five staff recruitment records and fire safety records. Further records that were viewed are identified in the main body of this report. Prior to the inspection surveys were sent to the home to provide people with the opportunity to tell us about their experiences of the home. Five staff surveys and four relative/visitor surveys were returned to us. What the care home does well: What has improved since the last inspection? At the last key inspection 28th April 2008 the home provided 0 star poor quality outcomes. A random inspection was undertaken 8th July 2008 and the home had met the requirements that were made at the key inspection. The manager and the provider continued to work well with us in improving the service that the home provided. People were supported to ensure that their health, dignity and welfare were promoted in areas such as ensuring that people were supported to change incontinence pads and to keep their spectacles clean. People were protected from the spread of infection by ensuring that the home was cleaned, bins were emptied and hand washing facilities were provided in the laundry. There were no offensive odours. Safeguarding referrals were made when necessary and we were kept informed of the outcomes and actions that were taken by the home, which ensured that the people were protected by the homes safeguarding procedures. People were protected by the homes fire safety routines, which included weekly fire safety checks. There had been improvements in the environment which provided people with a well maintained place to live in. The rotting window frames at the front of the building had been replaced, the fence at the front of the building had been repaired, the falling plaster at the entrance to the home had been repaired, the medication room had been redecorated and refurbished, the lounges had been improved to ensure that people were provided with adequate communal space and some bedrooms had been redecorated, carpeted and new beds had been purchased. Staff were provided with regular supervision to ensure that they were supported in their work role to meet peoples needs. Staff had been provided with training courses on alcohol awareness, nutrition, falls, dementia and eye care to ensure that they were informed of how they should meet peoples health needs. Care Homes for Older People Page 8 of 35 People were provided with activities that were of interest to them and the manager agreed that they would continue to improve the activities programme What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 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. People can expect to be provided with information about the home to enable them to make decisions, to be provided with needs assessments and to have their assessed needs met. The home does not provide and intermediate care service. Evidence: The Statement of Purpose and the Service Users Guide was viewed and it was noted that people were provided with the information about the home that they required to make decisions about the home. The Statement of Purpose included the aims and objectives of the home, the facilities and services that were provided, staffing and provider details, staff qualifications and training, leisure, consultation, fire safety, the number and sizes of rooms, privacy and dignity, complaints and CSCI (Commission for Social Care) contact details. The CSCI contact details needed to be updated to reflect the current details to ensure that Care Homes for Older People Page 11 of 35 Evidence: people were provided with up to date information should they wish to contact us. The Statement of Purpose had been updated since the last inspection to show that the registered manager post was vacant. The Service Users Guide was viewed and included information on the accommodation that was provided, room sizes, the fees for living at the home, staffing arrangements for the home, staff qualifications, complaints, copies of inspection reports and a summary of the views of people that were made in the most recent quality assurance satisfaction questionnaires. The relative/visitor survey asked if they and the person that lived at the home were provided with enough information about the home to enable them to make decisions. One answered always, one answered usually, one answered sometimes and one answered never and commented that they did not make decisions regarding their family member. The records of four people that lived at the home were viewed and each held an individual needs assessment that had been undertaken prior to them moving into the home. The records included care plans which identified how the peoples assessed needs were to be met. The needs assessments identified the needs that each person required regarding their day to day living, such as medication, continence and mobility. There had been no people admitted into the home since the last inspection. The manager was spoken with and stated that they would seek out training that would improve their competence in the completion of effective needs assessments. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to have their assessed needs and how they should be met set out in an individual plan of care, to have their health care needs met, to be treated with respect and to be protected by the homes medication procedures. Evidence: The care plans of four people that lived at the home were viewed and detailed the support that they required and preferred to meet their assessed needs. Since the last key inspection the care plans had been improved and showed the specific support that people required and preferred. The care plans included the support that people required with areas such as with personal care, mobility, when they had chosen to bath and when they had refused the offer of a bath, their preferred form of address and dietary preferences. Since the last inspection the staff team had attended MUST (malnutrition universal screening tool) training and there were MUST assessments in peoples records, which identified the specific support that they required regarding their nutrition. Care Homes for Older People Page 13 of 35 Evidence: There were monthly review notes in the care plans, which were undertaken by the person that lived at the home and a member of the management team. The reviews included the persons views of the support that they were provided with. The manager was spoken with and reported that the management of the home were working to ensure that the care plans for all people that lived at the home were completed in a consistent manner and that they had planned to involve the care staff in the updating of the care plans in the future. Two newly appointed care staff were spoken with and reported that the care plans were detailed and included the information that they required to support the individual people that lived at the home. They stated that they had read the peoples care plans during their induction period to the home. The staff surveys asked if they were provided with up to date information about the support that people required and that the ways that they pass on information about people worked well. Three answered always and two answered usually. The relative/visitor survey asked if their relative or friend were provided with the support that was agreed or expected. One answered always and three answered usually. Peoples care plans that were viewed included risk assessments, which identified potential risks in peoples day to day living in areas such as mobility and methods of minimising the risks. Two risk assessments in one persons records required updating to show the changes in their needs and circumstances to show that risks were monitored and minimised. Daily records were viewed that identified the support that each person had been provided with and observations of their well being and activities for each day. One persons records showed that they had been provided with support from a health professional. However, the methods of supporting the person during the change in their condition had not been included in the care plan, such as in changes in their behaviour. The manager and staff members who were spoken with explained the changes and methods that they had identified to ensure that their changing needs were met. Peoples health care needs were met and the care plans that were viewed identified the health treatment that they had been provided with, such as from the doctor, district nurses, chiropodist and optician. The home maintained records of when people had fallen and the records of one person showed that they had sought advice and support from health professionals regarding their falls. Care Homes for Older People Page 14 of 35 Evidence: The manager explained that they had recently joined the Anglian Water Health on Tap scheme, which offered advice and support regarding the improvement of peoples health care with the regular provision of drinking water. During the inspection the manager and a staff member were observed to receive information from a health professional regarding a visit they had made to a person that lived at the home. The staff member was observed to reassure the person about the visit and they clearly explained the support that the health professional had planned to provide. At the last key inspection it was noted that a persons spectacles were dirty, the home had improved by keeping a record of when people were supported to ensure that their spectacles were cleaned regularly. Since the last inspection staff had been provided with eye care training, which provided staff with the information that people required in areas of their eye care such as cleaning their spectacles and glaucoma. There had been previous issues at the home regarding the provision of personal care, such as continence pads not being changed regularly. Since the last inspection it was noted that the home had maintained records which identified the support that people had been provided with. Actions had been taken regarding the staff that had not supported people with their personal care appropriately. The medication room had been improved since the last inspection, a new desk had been purchased and the room had been redecorated and carpeted. The medication procedures were viewed and clearly identified the homes procedures for the safe handling, storage and administration of medication, which ensured that people were safeguarded. A medication profile was included in each persons care plan, which identified the medication that they had been prescribed and why the medication had been prescribed. Staff training records were viewed and showed staff that were responsible for administering medication had received training to do so. Staff records included a statement from the management team to show that they had shadowed medication administration rounds and had been advised of the homes medication procedures. There had been concerns received from anonymous sources that stated that medication was administered by staff that were not trained to do so. The manager stated that not all staff had been trained to administer medication. They stated that only trained staff administered medication and that members of the management team ensured that they were present at the home to administer medication when Care Homes for Older People Page 15 of 35 Evidence: there was not a trained staff member on duty. The staff rota and the MAR (medication administration record) charts that were viewed confirmed this. The medication room was viewed and the medication was stored securely. There was a medication trolley, which was used during the administration of medication, and it was stored in the medication room when not in use. Medication that should be kept refrigerated was stored in a small refrigerator in the room and the records of regular temperature checks were viewed which ensured that the medication was stored at the required temperature. The medication administration was observed during lunchtime and a newly recruited staff member was observed to shadow an experienced and trained staff member during the activity. The staff member administering the medication clearly explained the procedures for the safe handling and administration of medication and how the MAR charts should be completed, which included when codes should be used if a person refused their medication or if they were not present at the home. One person at a time was supported with their medication and the staff member was observed to check the MAR charts against the MDS (monitored dosage system) to ensure that the prescribed dosage was administered to the correct person and the MAR charts were signed when they had observed the person taking their medication. The MAR charts included a photograph of each person. The MAR charts were viewed and it was noted that there were no unexplained gaps. During the inspection it was noted that staff knocked on peoples bedroom doors and waited to be invited in before entering, which ensured that their privacy was respected. People that lived at the home that were spoken with reported that they felt that their privacy was always respected by the staff. The interaction between staff and people that lived at the home was observed to be respectful and professional. People that were spoken with confirmed that the staff always treated them with respect and one person stated you will get no complaints from us. It was noted that there was lots of laughter in the home and light hearted chatting between staff and people that lived at the home. A visiting professional that was spoken with stated that the atmosphere in the home had improved and that they had observed that people were happy. A staff survey commented now a pleasant and caring lead from acting manager/deputy manager to residents and an apparent effort to improve the day to day running of the home for the residents benefit. 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 can expect to be provided with activities that are of interest to them, to be supported in maintaining contacts, to be supported in making choices in their lives and to be provided with a well balanced and nutritious diet. Evidence: The records of four people that lived at the home were viewed and they included information of contacts that they maintained with friends and family. People spoken with reported that their visitors were always made welcome. At the last random inspection a family member was spoken with and said that they were always welcomed into the home and that they were offered drinks when they visited their relative. The relative/visitor survey asked if the person that lived at the home was supported to keep in touch with them. Two answered always, one answered usually and one answered never and commented that they did not require this support because they visited their relative often. A relative survey commented all staff are very caring toward the residents and also their families, very family orientated. Since the last key inspection there had been the provision of seven staff hours each week to provide activities to people that lived at the home. The manager was spoken Care Homes for Older People Page 17 of 35 Evidence: with and stated that there had been an improvement in the provision of activities and that they recognised that they should continue to look into ways of improving the activities programme to ensure that people were provided with meaningful activities. The use of the two lounges in the home had been changed and the back lounge was a television room and the front lounge was in the process of being furnished to be available for people to use it as an activities room, such as for playing cards or games. People spoken with reported that they were happy with the changes in the use of the lounges and during the last random inspection people were observed to be singing along to music in the front lounge and watching television in the back lounge. During this inspection a quiz had been provided in the morning for those who wished to attend. A group of people were observed to be sitting in the back lounge watching television and chatting and a group of people were observed to be sitting in the front lounge, the seating had been rearranged and a person was observed to be sitting in the window area enjoying the views of the sea. They were spoken with and stated that they enjoyed watching the activities of people through the window and explained the changes that they had recently observed with the sea defences. A staff member was observed to ask people if they wanted to listen to music during lunchtime, which they did and music from the 1940s was played and a person that lived at the home was observed to dance to one of the songs that they liked. Staff were observed to chat throughout the day to people in subjects such as gardening. The home used a local book seller, that delivered books and gifts and people could choose if they wished to purchase them. The records of four people that lived at the home showed where they had participated in activities and where they had declined to join in the activities that were offered. Activities included bingo, swimming, old time musical, going out for a walk, going out to the shops, going out to church and quizzes. The records from a recent staff meeting were viewed and identified that there were two staff members that were undertaking the co-ordination of activities in the home. A staff member was spoken with and explained their plans for providing further activities in the home. People that lived at the home that were spoken with said that there had been improvements in the provision of activities and that they could choose what they wanted to do. The minutes from a recent house meeting were viewed and showed that people were consulted with regarding the activities and food that were provided. The relative/visitor survey asked if people were supported to live the life that they chose. One answered always and three answered usually. One relative survey commented my (the person) is very happy, well fed, a variety of food, drinks, music Care Homes for Older People Page 18 of 35 Evidence: and bingo. Im happy with (the person) care. During the inspection a house meeting was observed, which was held in the dining room and people were provided with a choice of drinks and biscuits. A staff member was observed to sit next to a person that was hard of hearing and they supported the person by telling them what was being said and to speak out when they wanted to state their views. People discussed what activities they wanted in the future and if they liked the activities that were provided. People said that they enjoyed bingo and quizzes and that they had enjoyed the quiz that they had participated in that morning. They said that they had tried scrabble but did not really enjoy it and that they would like to do jigsaws. The manager reminded people that they were having an Avon party the following week and reassured them that their families and friends had been invited by letter. They also planned a Halloween party, which included sculpting pumpkins, fancy dress and a buffet meal and what activities they wished to be provided over the Christmas period which included visiting entertainers, visits from the Salvation Army and going to a pantomime at a local theatre. During the meeting people were asked if they enjoyed their meals and everyone said that they did. They discussed if they were happy with the bell that sounded when their meals were ready. Everyone said that they did, one person said of course we want it and another person stated that they were hard of hearing but they could hear the bell and wished for it to continue. People were asked if they wanted to continue with set meal times or if they did not what they preferred. People stated that they were happy with the set times and a person stated ‘we know where we are then’. The manager reported that they could help themselves to cereal in the morning if they wished to have breakfast earlier and that staff would assist them if they needed help and that they could ask staff at any time if they wanted drinks or food. People were asked to think about what colours they would like for the dining room to be redecorated. The manager was spoken with and stated that some people like to have toast or a sandwich late evening after their evening meal and the manager agreed that they would ensure that they would record this to evidence that people could eat when they chose to. There had been concerns raised from anonymous sources that stated that there were insufficient food stocks available in the home to ensure that people were provided with enough food. During the last random inspection and this key inspection the food storage was viewed and it was noted that there was a large range of food stuff available. The weight charts of four people were viewed and it was noted that they had all gained weight since the last inspection. Care Homes for Older People Page 19 of 35 Evidence: During the inspection people were observed to be offered drinks throughout the day. The menu was viewed and it was well balanced and nutritious. A new cook had been employed since the last inspection and people reported that the meals had improved and that they were all freshly made. People said that if they did not want what was on the menu they were provided with an alternative of their choice. The cook was spoken with and explained that they freshly baked cooked cakes and food and that they were preparing a home made steak and kidney pudding the following day. They reported that they were provided with sufficient food and stock to ensure that they could ensure that the meals that were identified on the menu could be provided. They stated that a range of alternative choices were available if people wished to eat something other than what was on the menu, such as salad, omelette or jacket potatoes. On the day of the inspection lunch was chicken casserole, vegetables and potatoes or tongue salad and home made egg custard. People chose to eat their meal either in the dining room or in their bedroom. The evening meal was sandwiches or chips and fish fingers, which people ate in the dining room, lounge or bedroom. It was noted that most people had eaten all of their meal and people that were spoken with stated that they had enjoyed their food, one person stated oh it was lovely. Care Homes for Older People Page 20 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. People can expect to have their complaints acted upon and to be protected from abuse. Evidence: At the last key inspection it was noted that concerns around care practices that should have been referred to the local authority safeguarding team had not been made and that we had not been notified of the incidents. Since the last key inspection the provider and manager had acted on safeguarding issues, which included making safeguarding referrals, taking action with staff and they routinely kept CSCI (Commission of Social Care Inspection) informed of the outcomes and actions taken. Staff training records that were viewed showed that staff were provided with safeguarding training. A document was viewed that included staff signatures and dates to show that they had read the safeguarding and whistle blowing procedures. Staff that were spoken with explained their roles and responsibilities for reporting issues of concern regarding the well being of people that lived at the home. The manager reported that newly appointed staff were advised on the importance of the whistle blowing and safeguarding procedures. The complaints procedure was summarised in the staff handbook, statement of purpose and service users guide, which provided people with the information that they Care Homes for Older People Page 21 of 35 Evidence: required should they wish to make a complaint about the service that was provided by the home. People that were spoken with reported that they knew what to do if they had a complaint or concern about the service that they were provided with. Five staff surveys stated that they knew what action to take if a person that lived at the home wished to make a complaint. The relative/visitor survey asked if they knew how to make a complaint. One answered yes, two answered no and one did not answer. The survey asked if the home had responded appropriately when they had raised concerns. Two answered always, one answered usually and one answered never and commented that they had not raised concerns. The complaints book was viewed and there was one concern which had been raised from a former staff member regarding issues of confidentiality. The book recorded actions that had been taken, which included advising staff of the homes confidentiality procedure. CSCI had received concerns from anonymous sources and we had contacted the home to look into some of the issues, which included that staff were not trained to administer medication and that there was insufficient food at the home. These issues were recorded in the complaints book and actions that were taken by the manager were recorded. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to live in a clean and generally well maintained environment, where issues for improvement are identified and addressed. Evidence: Since the last inspection there had been significant improvements in the environment, it was noted that were still areas that needed improving, which had been identified and addressed by the provider and the manager. A recommendation was made at the last key inspection that consideration be made to the use of the back lounge for a person that smoked. The back lounge was no longer used as a smoking room and it had been repainted and carpeted and was used as a television room. The room was light and spacious and people were observed to be enjoying each other’s company in the lounge. They stated that they were happy with the room and that they had a choice of lounges that they could use. The front lounge was previously used as the television lounge and it was very crowded, with chairs lined up in every available space. At the random inspection it was noted that the seating arrangements had been improved and there was more space for people to relax in. During this inspection people were observed to be sitting in the room and they stated that they were more comfortable. There was a person observed Care Homes for Older People Page 23 of 35 Evidence: sitting in a chair at the window and they reported that they enjoyed watching the activities outside. The manager reported that they had planned to use the front lounge as an activity room, with tables to enable people to play cards or games at and that they planned to refurnish the room, for which quotes were viewed. Both lounges were clean and tidy and had fresh flowers, which a staff member reported that a colleague bought the flowers to the home each week. People spoken with said that they liked the flowers. The rotting wooden window frames at the front of the house had been replaced, the fence at the front of the home had been repaired and the falling plaster at the entrance of the home had been repaired. Peoples bedrooms that had caused concern during the last key inspection had been redecorated, carpeted and new beds had been purchased. There were further plans to replace some of the older furnishings in bedrooms and quotes were viewed. Peoples bedrooms were clean and tidy and peoples personal memorabilia reflected their individuality and choice. The medication room had been redecorated, carpeted and a new desk had been purchased. The manager explained that there were ongoing plans to improve the environment further, which included redecoration of the staff room, repairs to the roof for which quotes were viewed and redecoration of the dining room. It was noted that the carpet to the entrance hall was stained and it had become frayed, there was no immediate risk to people but the manager was advised that this should be replaced as it may become a hazard in the future. A staff member that was spoken with stated that the provider had recently purchased a new carpet cleaning machine which would enable them to keep the carpets clean. At the previous key inspection it was noted that the bins had not been emptied. During the random inspection and this inspection it was noted that the home was clean and all bins were emptied. A staff member was spoken with and reported that the home had improved and that cleaning equipment was provided as they needed it. The kitchen was clean and well maintained. Two staff members reported that the kitchen floor was slippery when wet, during the inspection it was dry and this could not be checked. The manager was spoken with and reported that the floor had been coated with a non slip substance. There was an area next to the kitchen where hot drinks were made, the area and the milk dispenser needed cleaning, there were marks where the drinks had dripped onto surfaces. Care Homes for Older People Page 24 of 35 Evidence: A requirement made during the previous key inspection was that appropriate hand washing facilities to minimise cross infection be provided in the laundry. At the random inspection staff reported that they had been provided with individual bottles of hand wash gel which they carried with them. Since the random inspection a hand wash basin had been installed in the laundry. The laundry was tidy and there were sufficient washing and drying machines to ensure that peoples clothing was laundered. During the inspection staff were observed to use good infection control procedures which included washing their hands and wearing disposable gloves and aprons when working with food and supporting people with personal care. Staff spoken with had a knowledge of their responsibilities regarding infection control. Communal bathrooms, toilets and the kitchen provided hand wash liquid and disposable hand drying towels which minimised the risk of cross infection. There were no unpleasant odours in the home, however, there was a slight smell of urine in the ground floor communal toilets. The manager reported that the toilets were regularly cleaned and that they were awaiting a visit from a company to offer their suggestions of how they could manage the daily smells in the toilets. Care Homes for Older People Page 25 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. People can expect to be protected by the homes recruitment procedures and to be supported by staff that are trained to meet their needs. They cannot be assured that they are supported by a consistent, fully qualified or experienced staff team. Evidence: A requirement from the last key inspection was that all staff must have a CRB (Criminal Records Bureau) check to ensure that people were safeguarded by the homes recruitment procedures. One person had a CRB check from their previous employment and not all the checks for other staff could be located. At the random inspection it was noted that all staff that were working at the home at that time had evidence of a CRB check in their recruitment records. The manager stated that since the last inspection there had been four staff leave the home and five staff members had been recruited to fill the vacancies to ensure that the use of agency staff was minimal. The staff recruitment records of five newly appointed staff members were viewed, each contained an application form, identification, two written references and POVA (protection of vulnerable adults) first checks. One of the five records viewed held CRB (Criminal Records Bureau) check. The manager reported that the four staff members had applied for their CRB checks and that the staff who had not yet received their checks were supervised when working Care Homes for Older People Page 26 of 35 Evidence: with people. The staff rota was viewed and showed that there were senior staff on duty at all times during the day to enable inexperienced staff supervision and the supervision of staff without CRB checks. The manager reported that there were a further two staff members that had been recruited and that they were awaiting satisfactory references, CRB and POVA first checks. Two newly recruited staff members were spoken with and they stated that they shadowed staff members and that they would do until their CRB was received. The staff survey asked if recruitment checks such as references and CRB checks were undertaken before they started work. Four answered yes and one answered no. The home had improved the staffing rota by increasing from two to three staff working on the early shift to ensure that there were sufficient staff on duty to support people. During the morning of the inspection the manager, deputy manager, three care staff, the cook and the domestic staff were on duty and on the afternoon shift the manager and two care staff were on duty. It was observed that staff were attentive to peoples needs and that call bells were answered promptly. People that lived at the home that were spoken with reported that the staff were available when they needed them and that they worked hard to ensure that their needs were met. The staff survey asked if there were enough staff to meet peoples needs. Three answered usually and one answered sometimes. Staff that were spoken with stated that they felt that the staffing at the home was improving and that they knew that there were further staff that were due to start working at the home. Since the last inspection the home had produced a staff handbook, which included summaries of the homes policies and procedures and the terms and conditions of their employment. The manager stated that the handbook was available to staff for their reference at all times. Since the last random inspection there had been improvements in the provision of staff training and staff had been provided with training courses on dementia, eye care, falls, MUST and alcohol awareness. Training records that were viewed, which included certificates in staff files, showed that were provided with training courses such as the Skills for Care Common Induction Standards induction, medication, manual handling, safeguarding and fire safety. Newly recruited staff had been provided with an induction and their training programme was in the process of being undertaken. Two newly recruited staff members that were spoken with reported that they were working on their induction course and that they had been advised of their responsibilities regarding safeguarding and fire safety when they started working at the home. We had advised the manager of the local authority safeguarding e-learning course and the Care Homes for Older People Page 27 of 35 Evidence: manager reported that they had contacted social care to obtain a password to enable them to access the training. The staff survey asked if their induction covered everything that they needed to do the job when they started. Two answered very well, two answered mostly and one answered partly. Five staff surveys stated that they were provided with training that was relevant to their role, that helped them to understand the needs of people and that kept them up to date with new ways of working. The survey asked if they felt that they had the right knowledge and experience to meet peoples needs. Three answered always and two answered usually. The relative/visitor survey asked if they felt that the staff had the right knowledge and experience to meet peoples needs. One answered always and three answered usually. The home had not met the target of 50 of staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 in care by 2005 as recommended in the National Minimum Standards relating to older people. However, there had recently been large numbers of staff changes and the manager stated that they were committed to ensuring that the staff would be supported to achieve their award. During the inspection an NVQ assessor was observed to be assessing a staff member in their NVQ award. The assessor stated that seven staff members had been registered as NVQ candidates and that they were undertaking their NVQ assessment. Care Homes for Older People Page 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be supported by staff that are appropriately supervised, to be protected by the homes health and safety procedures and the homes finance procedures. They can be assured that the home is run in their best interests. Evidence: The management and administration outcome of the previous key inspection was poor. Since the last key inspection the previous registered manager no longer worked at the home following disciplinary action. The management of the home had been undertaken by the deputy manager and the current manager who was previously a carer, who had achieved an NVQ level 2 in care. They had managed the home in difficult circumstances and had ensured that they had made the improvements that were identified by CSCI and social care and had identified management training that they required to support them in their role. The manager stated that they were due to attend a train the trainer manual handling and risk assessor course and had recently updated their knowledge by attendance on recent training courses such as MUST, falls, Care Homes for Older People Page 29 of 35 Evidence: alcohol awareness and eye care. They had been successful in registering for their NVQ level 4 registered managers award and they were due to meet with their assessor the week after the inspection. The manager also stated that the deputy manager at the home worked well with them and that they undertook the managerial role in their absence. The manager had worked well with us since the last key inspection and the requirements that were made at the last key inspection had been met. The manager had acted on information that we had provided regarding the safeguarding e-learning provided by the local authority for which they had contacted social care to obtain a password to access the training and they had joined the Anglian Water Health on Tap scheme. Staff and a visiting professional to the home that were spoken with were complimentary about the manager and stated that the home had improved since the last key inspection. The manager had not yet made a registered manager application to CSCI. The provider was spoken with the day after the inspection and they reported that the manager would make their application in the near future and once they had started their NVQ award. Five staff records that viewed showed that staff were provided with supervision, where they could discuss issues in their work role. Staff spoken with reported that they felt supported in their work role and that they also attended regular staff meetings where they could discuss their roles and responsibilities and issues in the home. The minutes of a recent staff meeting were viewed and staff were advised on areas such as the introduction of new staff members and their roles and responsibilities in areas such as hygiene, confidentiality, the use of care plans, safeguarding finances of the people that lived at the home and recording. The staff survey asked if their manager met with them to discuss the ways that they were working and to provide them with support. Four answered always and one answered usually. The manager showed us a quality assurance book that they were working on which was called the Blue Cross Mark of Excellence, which included monitoring and review of the home. The manager explained further methods of ensuring that they regularly monitored the home and the views of people were listened to, which included the monthly reviews with individual people and house meetings where people discussed their satisfaction with the service that they were provided with. At the random inspection satisfaction surveys were viewed that had been completed by people that lived at the home regarding the provision of food and activities and improvements to the service had been made as a result of the outcomes of the surveys. Monthly Regulation 26 reports were viewed, which showed that the provider monitored the Care Homes for Older People Page 30 of 35 Evidence: running of the home. The manager stated that the provider visited the home on a weekly basis and that they were always available by telephone should the manager require support. The procedures for the safeguarding of people’s finances were viewed and clearly explained the staff responsibilities in this area. The finances and the records of three people were viewed, records of incoming and outgoing money and receipts for spending were maintained. The actual amount of money was checked with the records and it was noted that they were correct. Staff were advised on their responsibilities regarding health and safety with the staff handbook and the homes policies and procedures, which included COSHH (control of substances hazardous to health), emergency procedures, fire safety, infection control and manual handling. Environmental risk assessments were viewed, which identified possible risks and methods of minimising the risks in areas such as working in the kitchen, storage of flammable liquids and chemicals, waste disposal and the use of portable electrical appliances. People were safeguarded by the homes fire safety procedures. The home had a fire risk assessment and a fire evacuation procedure. Fire safety checks were regularly undertaken on a weekly basis and staff had been trained in fire safety. Care Homes for Older People Page 31 of 35 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 32 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 7 15 One persons care plan and risk assessment must be updated to reflect the changes in their needs To ensure that the persons changing needs are met and that staff are made aware of the support that they require to meet their changing needs 31/10/2008 2 19 23 The carpet to the entrance hall and the stairs should be replaced To ensure that hazards are minimised and that people are provided with a pleasant environment to live in 31/12/2008 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 12 It is recommended that improvements continue to be made in the provision of meaningful activities for people that live at the home. Page 33 of 35 Care Homes for Older People 2 16 It is recommended that a copy of the complaints procedure be sent to family members to ensure that they are aware of the homes complaints procedure should they wish to make a complaint about the service that is provided by the home. It is recommended that the drink making area next to the kitchen is regularly cleaned to ensure that drips from drinks are cleaned and to minimise cross infection. 3 23 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 © (2008) Commission for Social Care Inspection (CSCI). 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