Inspection on 27/02/09 for The Village Care Home

This inspection was carried out on 27th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Village Care Home 11/12/08

The Village Care Home 29/01/08

The Village Care Home 01/02/07

The Village Care Home 23/11/05

The Village Care Home 28/07/05

The Village Care Home 24/11/04

The Village Care Home 30/07/04

The Village Care Home 25/02/04

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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 Village Care Home Hylton Bank South Hylton Sunderland SR4 0LL     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: Clifford Renwick     Date: 2 7 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 Village Care Home Hylton Bank South Hylton Sunderland SR4 0LL 01915342676 01915341427 thevillagecarehome@googlemail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Village Care Home Limited care home 40 Number of places (if applicable): Under 65 Over 65 0 0 40 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 9 9 0 6 The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 40 Dementia - Code DE, maximum number of places: 9 Mental disorder, excluding learning disability or dementia - Code MD, maximum number of places: 9 Physical disability - Code PD, maximum number of places: 6 Date of last inspection Brief description of the care home The Village Care Home provides personal care for 40 older people over the age of 65 years, some of who may have dementia or mental health needs. It does not provide nursing care and any health needs are dealt with by the Community Nursing Services. Care Homes for Older People Page 4 of 35 1 1 1 2 2 0 0 8 Brief description of the care home Registration includes 6 places for people with a physical disability and as such has designated rooms on the ground floor, which offer easy access to the outside grounds. The house is detached Victorian in construction and two storeys high, with bedrooms being on both ground and first floors. Each floor has a variety of lounge and dining areas. In addition to this there is a large conservatory area on the ground floor. The home provides a designated area for the residents to smoke. The upper floor has a sun terrace, which overlooks a patio area. The interior furnishings of the home are in keeping with the period of the house and due to its age many of the rooms are unique in design and layout. The home is sited on the main road into South Hylton Village, which is close to the metro station, enabling easy access to Sunderland city centre as well as Newcastle and Gateshead. There are some small shops in the village, which include a post office, chemist and general dealers, as well as a social club, all of which are in walking distance of the home. A local bus service can be accessed to the city centre and surrounding areas. The scale of charges for the home is #402.00 for residential residents and #442.00 for people suffering from dementia. 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspections may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 1 stars. This means that the people who use this service experience adequate adequate quality outcomes. Care Homes for Older People Page 6 of 35 The last key inspection of this service took place on 13th March 2008. Before the Visit. We looked at. Information we have received since the last visit. How the service has dealt with any complaints or concerns. Any changes to how the service is run. The providers view of how well they care for people from information they provided in the annual quality assurance document (AQQA) that they sent to us. The Visit. An unannounced visit was made on the 27th February 2009. During the visits we. Met with the people who live in the home and also spoke to relatives who were visiting at the time. Spoke with the staff who work in the home.. Held discussion with the manager and also the owners representative who was present during our visit. Observed staff working practices. Looked at information about the people who are receiving support and how well their needs are being met. Looked at other records which must be kept in relation to health and safety and staffing. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it was clean, well maintained, safe and free of any hazards. We also gathered information from looking at, care records to assess how staff supports people with their assessed needs. We also focused upon looking at the records for the 6 people who are currently receiving a service we refer to this as case tracking. And this involves looking at all of the records for a named individual. We told the manager what we had found. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 35 The manager should ensure that the individual assessment of needs for each person is kept up to date and under review in order to enable a written plan of care to be developed. A written plan of care must be in place that demonstrates in detail what actions staff are taking to meet the assessed needs of each person. Once in place the care plans must evaluated on a regular basis to ensure that any progress or regression is recorded and that staff are taking appropriate actions to address this. A plan of activities should be developed and made available to all residents in order that they can receive and take part in activities that interest them and also offer them appropriate stimulation. Menus should be available to residents that show the choices of food available and also the alternatives. When developing the menus additional items such as choice of drinks and desserts should be expanded upon and include more variety. The mealtime practices in dining rooms should be reviewed to ensure that at all times residents receive the support they need to eat their meals. In the first floor dining room staff should consider bringing into the use the small kitchenette for making refreshments. This will assist in maintaining staffing levels on the unit and will avoid any unnecessary delays in providing people with drinks that currently have to be obtained from the ground floor kitchen. Records must be available to confirm when staff have received formal supervision and also when future supervisions have been planned. A planned programme of maintenance should be in place that demonstrates how repairs, decoration and ongoing maintenance matters are to be addressed. The current staffing levels of a minimum of two persons working on each floor should be maintained. And the manager should ensure that any requirements within this report are addressed within the timescales. 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. No one is admitted to the home without an assessment of need being completed this ensures that only people whose needs can be met are offered a place in the home. Evidence: As part of this visit we looked at a number of care files for people who have lived in the home for some time and also for two people who have recently moved in. This confirmed that prior to admission each persons needs were assessed before a place was offered in the home. In discussion with the manager it was confirmed that it is the homes policy to always seek as much information as possible about the individual as this then assists with implementing a personal plan of care. Care Homes for Older People Page 11 of 35 Evidence: Each file also contained a copy of the residency agreement/contract and assessments that related to any risk areas. For some people a copy of the assessment that had been carried out by social services had also been obtained by staff as well as a copy of the initial care plan. The manager confirmed that they always encourage any prospective resident to visit the home with their family before making any decision to move in as they feel this helps the person when making decisions. 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. Personal and healthcare needs are generally being addressed but it is difficult to assess the quality of the care being offered due to the lack of detailed written care plans. Evidence: We looked at several care files as part of the case tracking process and this involved looking at all care records and records that related to health needs. Good records are available that confirm that all residents health needs are being met. Everyone has access to all services provided by the NHS and these records demonstrated when someone had been seen by the G.P. or the community nurse. One person attends a stroke club on a weekly basis and one person has been receiving specialist support in relation to their medication. Care Homes for Older People Page 13 of 35 Evidence: And another person has been receiving specialist support in relation to their sight and as such has been for eye screening. In looking at the care files and some of the documents that support them there are gaps and there is insufficient information to demonstrate what actions staff are taking to meet individual peoples assessed needs. For example their are weight charts in place that record a persons weight on a monthly basis but no recorded actions of what staff do if their is weight loss or weight gain. One person was showing weight loss over a period of 2 months but it was not clear what action staff were to take or whether the weight loss was an acceptable loss and part of a health plan. For one person who has recently moved into the home and who initially spent time in the home as part of a short break. A number of the assessments are incomplete for example the social assessment has not been fully completed. The risk assessment and manual handling assessment has not been completed though there is a completed assessment by social services. No care plan was available to demonstrate how this person was being supported by staff other than a basic care plan that had been provided by social services. Observations made confirmed that staff do have strategies in place for supporting this person with their needs but this is not recorded anywhere and as such it could not be confirmed if staff practices are consistent. There are similar shortfalls with no care plans being available for other people who have a variety of needs some of which are related to loss of cognitive impairment and where consistent support is required by staff. Though staff were able to explain how they were meeting these peoples needs the absence of a care plan could not confirm whether staff were taking the most appropriate actions. One person who is disabled and is spending a short break in the home whilst awaiting accommodation in the community is very independent and staff are supporting this person to maintain their independence. However their are no current care plans in place for the files that were viewed and also Care Homes for Older People Page 14 of 35 Evidence: no evaluations therefore it is difficult to determine what progress has been made by individual people. The manager has a wealth of information about each person who lives in the home as do the staff and they are able to talk about what support is required. In addition to this where assessments have been completed they have identified what individual needs people have. There is also much qualitative information within the files to guide staff in terms of their care practices and developing care plans. However none of this relevant information has been transferred into a current care plan. In discussion with the manager it was confirmed that she is currently in the process of updating all care plans and a range of new documentation is now in place to be used. However little progress has been made since the last inspection and development has been slow in this area. During this visit we also looked at records of medication and the practices that are place for staff administering prescribed medicines. One person self administers their medicines and has signed the appropriate consent forms. Senior staff are responsible for administering medicines and they have received appropriate training as have some of the other staff members who covered this as part of the NVQ Level 3 training. A monitored dosage system is in place and the records are in good order though it was noted that there is no photograph of each resident attached to the administration records. This was discussed with the manager who confirmed that arrangements are in place for a photograph to be taken for both the medicines file and also their own personal care file. Staff issue medicines that are termed as homely remedies and which are medicines that can be bought over the counter and which the G.P has agreed are appropriate for Care Homes for Older People Page 15 of 35 Evidence: people. For one person who is taking a homely cough medicine no record has been entered onto the administration sheet and this was discussed with the manager. Good records are in place for recording those medicines that are referred to as controlled drugs though a new book is now needed. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported to maintain contact with relatives and friends. However the absence of planned and stimulating activities and the lack of planned menus and how meals are provided does not contribute to promoting their health and well being. Evidence: The activities coordinator ceased to work in the home since Christmas so at present there is no person employed to develop and organize activities. At present any activities are organised by staff and an activities sheet is kept for each resident to record what activity they took part in and whether they enjoyed it or not. There is lot more information recorded for those people who live upstairs and have needs related to dementia and impaired memory. And less information for those residents who reside on the ground floor. There were no activities taking place at the time of our visit and there were no external activities planned. Care Homes for Older People Page 17 of 35 Evidence: Discussion with the manager confirmed that improvements are being made with activities and steps are being taken to engage a new activities coordinator. The home are also about to start a 10 week exercise course with an outside instructor who will visit the home on a weekly basis. This will involve exercise sessions being carried out that people can take part in while still sitting in their chairs. The manager stated that Christmas and the New Year holiday period had been busy and all of the residents had had the opportunity to take part in stimulating activities. At present there is no list of planned activities. There are no restrictions on visiting and families can visit when they want and discussion with people visiting at the time of the inspection said that the staff always make them feel welcome. One person continues to go out to church every week and visitor from the church collects them from the home. And as previously stated in this report another person visits a specialist club every week and transport is provided to enable this to happen. Due to the absence of care plans it is difficult to assess how residents are encouraged to make choices and exercise control over their lives. Though in discussion with one person who is independent they confirmed that staff support them to make choices about how they are going to spend their day. Lunch was taken with residents both in the first floor and the ground floor dining rooms and observations made confirmed that some of the practices need reviewing. The meal on the day was fish and chips and peas or egg and chips as an alternative. Both hot and cold drinks were available with the meal and there was a choice of apple crumble and custard or a chocolate ice cream bar for dessert. In the upstairs dining room there was no bread and butter served with the meal and this is normally traditional with a fish and chip lunch. The diluted orange juice had no taste and people were not offered a second cup of tea. For one person it was clear they did not want to eat was offered to them but staff continued to bring the person back to the table. Care Homes for Older People Page 18 of 35 Evidence: Another person said that the dessert was not sweet enough but staff did not respond to this. Staff did not spend a lot of time at the table with the residents so they missed a lot of the cues that people required a little more support/response to what they were saying about the food. There was a lengthy delay in between the main meal and the dessert with meals being sent up from the kitchen as staff had to go back downstairs to collect the dessert. These delays could have been avoided if the heated trolley had been kept upstairs. Consequently as the servings were delayed some people were unable to maintain their concentration and kept leaving the table. Whilst having lunch in the ground floor dining room similar practices were in place in that there were delays in the serving of courses with one resident stating Im sick of waiting. One resident was drifting off to sleep and unable to maintain concentration therefore their meal was cold before they started to eat it. Another person could not distinguish between juice and the meal and was attempting to use incorrect items of cutlery to eat their meal. Again staff did not pick up on these areas and did not offer support where it was needed. At one stage staff were more intent in trying to move the trolley from the dining room and this resulted in asking two residents to move thereby disrupting their lunch. Throughout the meal staff appeared around the door and remained outside of the dining room as opposed to entering and checking to see if anyone required assistance with their meal. At the time of our visit there were no menus available to refer to as these were being revised by the manager. Discussion with the cook confirmed that she referred to previous records held when preparing meals in order to avoid any repetition of meals. Care Homes for Older People Page 19 of 35 Evidence: The staff confirmed that they go around each day and ask the residents what they want to eat from the list of meals that the cook has prepared. The cook stated that recent changes in the home had resulted in more home baking as opposed to shop brought products and also providing traditional home cooked meals instead of using frozen products. It was also confirmed that the cook was also making more milk puddings, home made pies and pasties and home cooked chips. In looking at food stocks in the home it was noted that the home did not have alternative drinks such as cocoa, hot chocolate or malt drinks. Neither were there any choices of cheese or dairy products such as yoghurts. Therefore it is difficult to determine how residents are offered choice at mealtimes when there are limitations as to what they can choose from. While discussing meals with the residents one person said I enjoy the food, it is always nice, theres plenty of it and I never leave anything. Overall we found the mealtime practices to be unsatisfactory in that staff did not play a prominent part in offering support to the residents. And in addition to this the absence of menus and a range of alternative and supplementary food stocks did not demonstrate that residents choices are being fully met. And there was insufficient evidence to demonstrate that peoples nutritional needs are also being met due to the absence of detailed care plans and completed weight charts. It was identified during this visit that a number of improvements with the mealtime arrangements need to be made. 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. Robust procedures are in place that protect residents from the potential of abuse. And furthermore residents are aware that any complaints made will be acted upon quickly and to their satisfaction. Evidence: The home have a complaints policy and procedure and the complaints process is also included in the service user guide. Copies of this are given out to all residents and their families and this ensures that they are aware of the process if they have any concerns about the service. Discussion with residents confirmed that they had no complaints. And discussion with 2 families who were visiting at the confirmed that they are very satisfied with the services in the home. Our knowledge of the service has demonstrated that any concerns raised by residents or their families are dealt with immediately and to the satisfaction of the residents and their families. The home continue to have good policies and procedures in place that deal with Care Homes for Older People Page 21 of 35 Evidence: protecting adults from abuse. All staff are aware of safeguarding adults procedures and all but 5 of the staff team have completed appropriate training with arrangements in place for these staff to receive training. Staff are aware of the procedures to follow in the event of any concerns that are raised in this area. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe, clean and free of hazards and this promotes the general welfare, well being and comfort of the residents. Evidence: During this visit we looked at all communal areas of the home and all bedrooms that are currently occupied by people. We also looked at the laundry facilities and the kitchen and kitchen storage areas. The home do not have their own person to carry out maintenance and there is no maintenance plan in place. Discussion with the manager confirmed that if any major work is required to be done the appropriate persons are engaged to do this. In looking at the building some upgrading with the decor is needed due to natural wear and tear and this was discussed with the manager. Items such as chipped paintwork and scuffed paintwork to walls, stained carpets and an area of staining to the floor in the ground floor shower room were noted. And the Care Homes for Older People Page 23 of 35 Evidence: manager made a list of the items that require attention. Rooms that are currently vacant are being decorated and refurbished and on completion these look good. Apart from those areas noted as requiring attention other areas of the home are in good decorative order and pleasantly furnished. Some refurbishment has been carried out in the laundry room and the room previously used for hairdressing has now been utilised for staff to carry out ironing. And this has provided a good clean work area for the staff. Good hygiene practices are in place in the laundry room with clean and dirty clothes being separated with appropriate storage bins and this removes the risk of any potential for infections to occur. Three rooms that were viewed had a strong unpleasant odour and in discussion with the manager it was confirmed that steps were in place to deal with this. Hot water was tested in bathrooms and this confirmed that hot water was being provided at the safe recommended bathing temperature. Mechanical lifting hoists that are in place have been tested and serviced by the manufacturer as part of the annual service. The lounge and dining areas are in good decorative order and small fish tanks in the lounges serve as a point of interest for the residents. There is also a good sized conservatory that has a range of seating which is now designated as a no smoking area having previously been used as an area in which you could smoke. In this room is a fish pond and also 3 cockatiels and this area also offers views to part of the garden and the main entrance. In discussion with residents they confirmed that this is a nice area in which to sit. In discussion with a resident who was using this room at the time of our visit they said that they enjoyed coming into the room to see the birds. A room previously designated as a staff room is now used by those residents who smoke and this area is separate from other areas of the home so that it does not Care Homes for Older People Page 24 of 35 Evidence: impinge on those people who do not smoke. There is a small kitchen on the first floor and currently this is not used. Though as discussed in sections 12 - 15 of this report. There would be advantages to both residents and staff if this area was used for making drinks and refreshments for the residents who reside on the first floor. A good standard of hygiene is in place and staff work hard to keep the home clean and tidy and free of hazards. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staffing levels are in place to meet the needs of the residents and regular training ensures that staff are kept up to date with best practice. And furthermore robust recruitment procedures ensures that only staff who are suitable to work with vulnerable people are employed. Evidence: In discussion with the manager and looking at staffing rosters it was confirmed that sufficient staff are on duty for the current numbers of residents residing in the home. The staffing levels at present are 3 carers and 1 senior between the hours 8am - 9pm with the manager being supernumerary to the rota. And between the hours 9pm - 8am there are 2 carers and 1 senior carer. Though the number of staff currently provided for each shift is satisfactory this should not be reduced below the current numbers. In addition to the care staff team the manager receives administrative support from two people who are based in the home. Care Homes for Older People Page 26 of 35 Evidence: Staff are also employed to carry out domestic work and cooking. At the time of the visit the laundry assistant was on holiday so this work was being carried out by other staff. Discussion held with the manager confirmed that increased opportunities for training had been made available to all staff. And in addition to this she was in the process of updating everyones training records to ensure that they are fully up to date with all mandatory health and safety training. There is no up to date training plan though there is a training matrix to show what training has been completed and the manager offered the following information. Two domestic workers are currently working towards NVQ Level 2 with some people currently working towards NVQ Level 3 training. Seven of the care staff are working towards NVQ Level 2 and the rest of the care staff team have completed this training. Two care staff are undergoing NVQ Level 3 training and 1 staff member is waiting to start. Senior care staff have completed this training. The manager and 2 staff have received training in the new Deprivation of Liberty guidance that is coming into force under the Mental Capacity ACT. And plans are in place for 2 staff to receive this training within the next week and a further 9 staff to receive the training at a later date. Seventeen staff are working towards updated health and safety training and this includes fire training. Eleven staff have completed training in dementia awareness and 5 people are currently receiving this training. And 2 staff are currently receiving training in the safe handling of medicines. Certificates are available in staff files to confirm where training has been completed. Care Homes for Older People Page 27 of 35 Evidence: Since our last visit some staff have ceased to work in the home and one person was due to leave at the weekend stating that the reduction in their hours was the reason they were leaving. Six new people have been employed in the home and their personnel files confirmed that robust recruitment procedures are in place. In discussion with the manager it was confirmed that she takes responsibility for carrying out health and safety induction training for all new staff. And in addition to this arrangements are in place for an external agency to carry out extended induction that matches the Skills for Care standards. 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. The manager has ensured that good practices are in place to promote the health, safety and welfare of the people who live in the home. Evidence: The manager has worked in this home for a considerable length of time and is also experienced and qualified in caring for older persons. In order to keep her skills and knowledge updated the manager confirmed that she continues to attend relevant training courses. She has recently underwent training on the Deprivation of Liberty Standards that are coming into force as part of the Mental Capacity Act. Good practices are in place to ensure the health and safety of the residents and staff and the manager has ensured that staff have received the necessary mandatory training so that they are kept up to date with best practice. Care Homes for Older People Page 29 of 35 Evidence: As noted in our last visit the manager had not been carrying out regular formal supervisions of staff. In discussion with the manager it was confirmed that this has now commenced. And the manager stated supervisions were carried out with some staff in the last week though the records to confirm this were not available. In addition to this the manager stated that she is training one of the senior staff team in supervisory practices so that they too will able to carry out formal staff supervisions. This will free up some the time for the manager so that she can focus on other areas of work that are currently being developed in the home. Though a number of improvements have been made by the manager in terms of staff training, improvements to the premises and environment there has been little progress made with developing residents written care plans . And this was discussed in more detail in sections 7 -11 of this report. Records are kept of any accidents that occur in the home and also what actions staff take. The number of accidents have reduced in the home and this is good. The manager stated that this is possibly linked to changes that she made with staffing who work on a night shift. And when a number of the accidents occurred due to one member of staff not working in the way that they should have been. A fire safety risk assessment of the premises has been completed and all staff received updated fire instruction training this year. There is a comprehensive polices and procedures file in place for all matters relating to health and safety and the manager confirmed that these have been updated and amended where necessary. The manager stated that she does not receive formal supervision but does receive verbal feedback from the registered provider. And also the registered providers representative who carries out administrative work in the home. Care Homes for Older People Page 30 of 35 Evidence: It was confirmed by the manager that the owners representative completes the regular monthly Regulation 26 reports in which they report on the conduct of the home and keep the owner appraised of how the service is being managed. The reports for January and February were not available during the visit though discussion was held during our visit with the owners representative confirmed what changes had been made in the home. The manager confirmed that the registered provider attended the last staff meeting in January of this year. And some changes were made one of which involved reducing staff hours to reflect the occupancy level in the home. Other changes were made to the catering services and the cooks being informed that they must provide more traditional home cooked meals and make better use of fresh produce and home baking. Overall the manager is working hard to make changes and develop the service. 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 14 A care plan must be put in 30/06/2009 place for each resident. And the care plan must include the detailed actions that staff are carrying out to help people. This will ensure that staff are following consistent care practices when supporting people with their assessed needs. 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 7 All assessments must be kept up to date and when completed should be used to develop the individual plan of care. A plan of activities should be implemented that clearly lists what activities are to take place, when and by whom. In order that residents have the opportunity to receive stimulation through leisure and recreational activities. When developing the activities special consideration needs to be given to those people who have dementia and other 2 12 Care Homes for Older People Page 33 of 35 cognitive impairments so that they too have the opportunity to take part. 3 15 Menus must be implemented and made available to the residents so that they are able to choose what they wish to eat. The practices of how meals are served should be reviewed in order to ensure that the residents receive the support they need when eating their food. The manager should ensure that a plan of maintenance is implemented and which identifies how and when work will be carried out in the home as part of the ongoing maintenance. The manager should ensure that records are available that confirm when staff have received formal supervision, and also when future supervisions are planned. 4 19 5 36 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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