Inspection on 29/08/08 for Tusker House

This inspection was carried out on 29th August 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tusker House 27/09/06

Tusker House 11/01/06

Tusker House 26/07/05

Tusker House 08/02/05

Tusker House 05/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tusker House 57 Pine Avenue Hastings East Sussex TN34 3PP     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: Deborah Calveley     Date: 2 9 0 8 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 32 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 32 Information about the care home Name of care home: Address: Tusker House 57 Pine Avenue Hastings East Sussex TN34 3PP 01424421573 01424427578 paulawoolgar@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Paula Woolgar Type of registration: Number of places registered: Mrs Paula Woolgar,Mr Michael Goonane care home 72 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Service users must be older people aged sixty-five (65) years or over on admission Service users with a dementia type illness only to be accommodated That two specific service users under sixty-five (65) years of age can be admitted to the home The maximum number of service users to be accommodated is seventy-two (72) Date of last inspection Brief description of the care home Tusker House is a large detached care home situated in a quiet residential area of Hastings, East Sussex. The property provides two-storey accommodation for older people with dementia with level access and passenger lifts. It has enclosed garden areas for service users and plans to increase the accessible garden space and create level access. The home has been assessed by Occupational Therapist?s in September 2005 and is working through making further improvements to the environment. Most Care Homes for Older People Page 4 of 32 Over 65 0 72 Brief description of the care home double bedrooms are used as single use only. The home is close to the local shops and services of Ore village and Hastings town centre is close by. The home has a large amount of internal Communal space. The home currently has its own dedicated training officers and is a certified NVQ training centre. There are charges highlighted in the contract, for extras including personal items and min bus outings provided by the home, along with newspapers, perfumes, chiropody, and hairdressing. Where necessary families are encouraged to purchase personal toiletries, as these are not routinely provided within the fee. Basic items for personal care are provided by the home in exceptional circumstances. Inspection reports are not routinely sent out to families and advocates after each publication although a copy is kept in the office area of the home and can be obtained via the manager. A service user guide is sent to any interested person [or their representatives] looking to move into the home. Care Homes for Older People Page 5 of 32 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Tusker House will be referred to as residents. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 29 August 2008. There were fifty residents living in the home on the day of which five were case tracked Care Homes for Older People Page 6 of 32 and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. The range of fees charged as of the 1st April 2008 are 366-540 per week. As stated inn the brief description extras include hairdressing, newpapers and toiletries. Four members of care staff and the cook were spoken with in addition to discussion with the manager deputy manager and office manager. Telephone contact was made with two visiting professionals following the visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment was received from the Manager completed in full prior to this key inspection. What the care home does well: What has improved since the last inspection? What they could do better: The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed. The care documentation in respect of individual health and safety risk assessments need to be improved/developed to ensure residents receive appropriate and person centred care that meets their assessed needs and to minimise any risks. From direct observation and from feedback recieved from residents relatives and the staff the residents living in the home would benefit from more activities and mental stimulation. Comments recieved included I am always bored in the afternoons and this is when I become very stressed and anxious, more afternoon entertainment is needed I would like to go out on outings with the staff or perhaps we could have some entertainment in the afternoons, My mother is only able to take part on a one to one basis and I am not sure that this happens. Care Homes for Older People Page 8 of 32 The recruitment practice needs to be improved with the required checks being completed before they are deployed to work in the home and an appropriate record of identification also needs to be retained in the home along with a recent photograph to ensure residents are safeguarded. Some areas of the homes infection contol measures need to be improved and these include provision of bins with appropriate lids and the cleaning of equipment used on residents. As discussed during the site visit, the staff that serve and assist residents with their meals need to recieve food hygeine training. 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission, although people are not assured in writing that their needs will be met. Evidence: There is a Statement of Purpose and Service Users Guide in place which contains a good level of information about the home and the services it provides. There is also a brochure which is bright and colourful and contains photographs of the home and grounds. Copies of these were available on request. It would benefit visitors and prospective residents if these were more readily available. The Statement of Purpose was up to date and contained in essence the information required, it was discussed that more information about staff training would be beneficial to prospective residents Care Homes for Older People Page 11 of 32 Evidence: and their families so as to reassure them that their needs can be met by suitably quality staff. From viewing the contracts it was evidenced that the contract arrangements were clear and transparent, however the room seen and to be occupied needs to be included. There is a copy of the terms and conditions of residency included in the homes information documents. Five residents care plans were identified for viewing which included the latest admission to the home and the records relating to the admission procedures followed were reviewed. This confirmed that pre admission assessments are completed and provide a clear assessment of prospective residents care needs. These are completed by one of the management team and discussion with the manager confirmed that these are used to ensure new admissions to the home are appropriate and that the home have the staff equipment and environment to meet their care needs. Prospective residents are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. It was noted that the home does not confirm having regard to the assessment that the home can meet the assessed needs of the prospective resident. This was discussed with the manager who was advised that this should be completed in writing in accordance with the required documentation. The manager was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and ensures that the carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for dementia. Trial visits to the home can be arranged, the manager confirmed that residents are invited to a trial period to ensure suitability of the home, this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Care Homes for Older People Page 12 of 32 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. The care documentation provides a good framework for the delivery of care and provides clear guidance to care staff on all the care needs of the residents. However robust systems for risk assessment need to be introduced to ensure individual person centred care is delivered safely. The homes practise ensure residents medicines are stored and administered safely and residents are treated with respect and have their privacy and dignity maintained. Evidence: The care documentation pertaining to five residents were reviewed as part of the inspection process. These were found to include plans of care, personal histories and individual personal risk assessments. On the whole the care documentation demonstrated that the care was reviewed and evaluated on a regular basis. Discussion took place regarding the key worker of individual residents ensure that they cross reference newly identified needs. The daily notes are written by the member of staff whom delivered the personal care and support and any changes are handed over to Care Homes for Older People Page 13 of 32 Evidence: the next shift. The risk assessments that monitor changes to residents health needs are not routinely used and the use of moving and handling, nutrition and continence risk assessments are needed to ensure the continued safety and well being of the residents. This was discussed in full during the site visit. Whilst these shortfalls did not impact on the positive outcomes of the residents at this time due to the knowledge the staff have on individual residents, the home needs to ensure that the shortfalls are addressed to protect the residents and promote their health and well being. Following the site visit contact was made a health professional who works closely with the home regarding the continence practises, she was complimentary regarding the practices in the home. The clinical room is also the staff office and there are suitable storage facilities for medication stocks and dressings, a medicine trolley is stored in a lockable cupboard when not in use. From direct observation the morning medications were administered safely and were in line with the homes policies and procedures. There is a small fridge and temperatures of the room and fridge are to be recorded daily. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication including insulin administration. The systems for recording and checking controlled drugs were found to be thorough. Advice regarding the safe storage of controlled medication in line with the new legislation is to be sought from their pharmacist. The Medication Administration Charts (MAR) were viewed, there were no gaps identified and were completed competently. The MAR sheets include the codes use by staff for the non administration of prescribed medicines, and records kept of dates and reasons for non administration. The comparison signatures of staff able to administer medication were available and current. There are photographs of residents on individual MAR sheets, however they are not all a true reflection of the residents and a recommendation of good practise is that all photographs are dated and reviewed regularly. There are no residents that self medicate their own medication. It was confirmed that all staff that administer medication receive training and that the staff that administer insulin receive guidance and training from the district nurse who is attached to the local surgery. Feedback from a health professional was positive regarding the home and confirmed that advice was sought as and when required. Staff were seen to be respectful and considerate to all residents whilst attending to their needs. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. Care Homes for Older People Page 14 of 32 Care Homes for Older People Page 15 of 32 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. Links with friends relatives and the community are encouraged and choices made are respected. Residents receive a wholesome and appealing diet. Evidence: There is an activity co-ordinator who works two days a week and whose sessions are enjoyed by the residents when they take place. There is no formal activity programme, and the sessions include arts and crafts, quizzes and music. From discussion with the staff and information taken from the Annual Quality Assurance Assessment (AQAA) , physical Motivation classes take place monthly by an outside provider, a performance company visit monthly and twice a week, the home is visited by Alfie the PAT dog and cuddle bunnies. The care plans viewed evidenced the residents participation in activities and a social history that is completed with help from the families wherever possible. Feed back from staff and families indicated that they felt there could be more activities, and comments included:some days when we are busy the residents sit in the lounge with music on in the back ground with little stimulation I am always bored in the afternoons and this is when i become very stressed and anxious, more afternoon entertainment is needed I would like to go out on outings with the staff or perhaps Care Homes for Older People Page 16 of 32 Evidence: we could have some entertainment in the afternoons, my mother is only able to take part on a one to one basis and I am not sure that this happens. Residents would benefit from a more defined activity programme which is linked to their care plan and their preferences. Routines were observed to be flexible with residents having breakfast from any time between 6am and 7.30 am, dependent on the capability of the residents. Refreshments are served mid morning and staff were observed offering refreshments at various times throughout the inspection. lunch is served at 12 midday and this is routinely kept to, however if a resident has an appointment, lunch will be kept. Residents rooms were found to be individual and personalised and each resident has their preferred term of address recorded in their care documentation and this preference was respected. Residents were seen to have their choices respected through out the day with their decisions being responded to appropriately. Decisions such as the choice of a bedroom key are recorded in individual care-plans along with activities and their dietary preferences. There is a 4 weekly menu that demonstrated a varied and nutritious diet The cook was knowledgeable regarding the residents preferences and the specialised meals required. There is no choice offered for the midday meal but if a resident does not want what is offered an alternative is cooked for them, the staff say this works well as residents living in the home find it very difficult to choose and then do not always remember what they chose. However from direct observation not many residents ate much of the smoked fish and mashed potato on the day of the inspection. A discussion took place regarding the benefit of keeping a record/diary of the residents intake of food, this is a good tool to use as it alerts staff to appetite traits and early intervention. The kitchen was very clean and well organised the catering team have a robust cleaning schedule and complete the safer cooking, better business book. The last Environmental Health Inspection was very positive. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. Evidence: The home has a clear and uncomplicated complaint policy that evidences regular review. There have been no complaints made to the home since the last inspection. There have been two anonymous concerns communicated directly to the Commission and these were looked at during the inspection and discussed in full with the Management team. One relative and two residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively The homes policy on safeguarding adults is included in the staff induction programme and then regularly updated. Video training is provided and followed by written test papers for the whole of the staff team. Staff spoken with were able to discuss whistle blowing procedures and the homes policies and procedures regarding raising a safeguarding alert. Care Homes for Older People Page 18 of 32 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 provides a comfortable clean and safe environment for those living in the home and those visiting. Residents are enabled and encouraged to personalise their room and the rooms are homely and reflect the residents personalities and interests. Good practice by staff was observed in respect of infection control measures during the visit and there were gloves and aprons freely available in the home. Evidence: The AQAA stated and the home manager confirmed that the home continues to follow an improvement programme that has benefited the residents and visitors to the home and is providing a welcoming and comfortable environment. It is acknowledged that there are areas in the home that still need to be decorated and refurbished. The tour of the home evidenced that the home has a large main lounge which leads in to a conservatory on one side and into a large dining room on the other. A further small lounge and dining area are also provided for the residents who prefer a quieter area. These communal areas are pleasantly decorated and well furnished with plenty of natural light. The majority of the furniture in the home is of a good quality and suitable for the residents who live in the home. Residents who expressed an opinion spoke positively about the home, many have decorated their rooms with their own Care Homes for Older People Page 19 of 32 Evidence: possessions, pictures and ornaments with the help of their families. The gardens are accessible, safe and attractive. There are adequate communal bathrooms and shower rooms in the home some with specialist equipment, which enables frail residents and those with a physical disability to enjoy the facilities available However not all the bathrooms were attractive and inviting and are in need of redecorating and repair, the bath sides on two baths were broken. This was discussed in full. Specialised equipment to encourage independence is provided e.g. handrails in bathrooms, hoists, wheelchairs and lifts to all areas of the home. Whilst call bells are provided in all areas not all were attached and in reach of the residents, however whilst it was identified that they are not always accessible to residents it is acknowledged that not all residents will be able to use a call bell, so there is a need for individual risk assessments concerning call bells and a document to ensure that all residents in their rooms without access to a call bell are checked regularly. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights in some rooms. Water temperatures are controlled and monitored monthly and a record kept, random temperatures were taken and were of the recommended level. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing-electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. The records in the home and the AQAA confirmed they were up to date. The tour of the home confirmed that staff are aware of the fire safety policies, no doors were found inappropriately wedged open. Polices and procedures for infection control are in place and it was confirmed that they are updated regularly. The home was clean and free from offensive odours on the day of the inspection. The sluice was seen and was filled with equipment thus making it difficult to work in and there was no bin for the disposal of pads or used gloves and aprons. There needs to be a cleaning rota for the equipment used such as hoists, as they were found unclean and a possible source of cross infection. Bins throughout the home were found without lids thus making them a risk to residents picking things out of them and a source of cross infection. The fixtures for shower heads need to repaired or removed to guard against legionnaires disease. People who use this service experience good quality outcomes in this area This judgement has been made using available evidence including a visit to this service Care Homes for Older People Page 20 of 32 Care Homes for Older People Page 21 of 32 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. There are sufficient suitably trained staff on duty to ensure that residents receive the level of care and support they need. The recruitment practices at this time did not ensure all the necessary checks are completed before an individual starts working in the home. Evidence: At the time of the inspection visit, 50 residents were living at Tusker House. The staffing rota was viewed and the staffing levels were seen to be sufficient to meet the needs of the residents at this time.The manager confirmed that the staffing arrangements are flexible and respond to residents dependency. The day staff spoken to said that there was enough staff to look after the residents to a good standard. A selection of staff recruitment files were viewed and the files are well organised. There was evidence of fully completed application forms, two references, contract and terms and conditions of employment. However on the files seen it was noted that staff were employed and working in the home before applying for and recieving a Protection of Vulnerable Adult (POVA) check. Discussion took place regarding the importance of obtaining a POVA before commencing work and of ensuring that the Criminal Record Bureau (CRB)Check is Care Homes for Older People Page 22 of 32 Evidence: obtained from the home and not transferred from the previous employment. The office manager had genuinely misunderstood the rationale and therefore a requirement has not been made under the protection outcome area this time. All staff files need to contain a coloured identification photograph. There is an induction programme specific to the home in place and the Skills for Care induction programme is in place for all new staff which leads into the the National Vocational Qualification (NVQ)training, Tusker House is a NVQ registered training centre, 55 of care staff have either a National Training Qualification or are working towards one at this time. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the manager. Staff and the training matrix seen confirmed that compulsory training such as moving and handling, adult protection, first aid and fire safety are being undertaken on a regular basis. Care Homes for Older People Page 23 of 32 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 overall management of this home is good with effective systems in place to protect residents. Evidence: The manager has worked in the home for 26 years and for the last 11 years as both the registered provider and registered manager. She has both an NVQ 4 in management and in Care. The management team consists of a deputy manager, office manager and a training manager. They work closely together in the efficient running of the home. The deputy manager also has a Registered Managers Award Qualification and NVQ 4 in Management, and has also assisted with the setting up of a NVQ assessment centre in the home Residents were observed throughout the inspection to walk in and out of the managers/staff office when they wanted advice or support and were always made to feel welcome. The tour of the building took place with the manager and residents joining in which demonstrated that the residents are comfortable and feel at home. There are systems in place to monitor the quality in the Care Homes for Older People Page 24 of 32 Evidence: home and include the use of questionnaires. The appointed manager confirmed that these are audited reported on and responded to. It is recommended that the use of questionnaires is expanded to staff and visiting professionals A detailed survey of resident’s and their representative’s views take place twice a year with the results published in the home’s service users guide and on the main notice board. The staff confirmed that staff meetings take place regularly. The registered manager has involvement with a small number of resident’s personal allowances, these arrangements have been found to be transparent and open with an accurate running total maintained. In the main families maintain residents monies and are sent clear itemised bills for any expenses incurred by the home, such as hairdressing and personal toiletries which families are encouraged to purchase as stated in the contract. Staff supervision is undertaken regularly and their supervision notes are kept safely. staff spoken with said the supervision sessions were helpful. The AQAA filled in by the home prior to the inspection confirmed that all necessary health and safety checks have been carried out including regular servicing of all equipment e.g hoists and lifts. The policies and procedures in the home are comprehensive and clear and they are updated regularly. staff have access to the policies and confirmed that they used them if necessary. Two polices were viewed and were found current, with clear, easy to follow guidelines and were informative. Due to the size of the home it is a recommendation that first aid boxes are spread out throughout the building. There are no outstanding recommendations or requirements from the last environmental health inspection which was very positive. All staff have received training such as first aid, health and safety, fire, and moving and handling. The fire risk assessments and procedures are in place and regularly reviewed and updated. Good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents Care Homes for Older People Page 25 of 32 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 26 of 32 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 3 14 That the registered person 01/11/2008 confirms in writing that having regard to the assessment made on any prospective service user that the home can meet those needs. To ensure that residents and relatives can make an informed choice of where to live. 2 8 15 That the registered person ensures that nutritional and moving and handling assessments are completed for all residents and linked to the care plan. That suitable risk assessments are completed in all areas of risk and cover the of risk of falls to promote resident safety. That appropriate risk assessments are in place with an action plan for those 01/12/2008 Care Homes for Older People Page 27 of 32 residents that do not have the capacity to ring the call bell. Than an appropriate risk assessment is in place regarding the continence management of all residents with reference to maintaining the skin integrity. To ensure that the residents health needs are promoted and protected by appropriate risk assessments 3 9 13 That the registered person ensures that the temperature of the clinical fridge and the medical storage room are recorded daily to ensure that the medication and dressings are kept at the correct temperature as directed by the pharmacist. that the medication both topical and ingested and dressings are stored at the temperature directed by the pharmacist. 4 12 16 That the Registered Provider 30/11/2008 ensures that service users are supported and enabled to participate in activities that meets their expectations, preferences and capabilities. 01/12/2008 Care Homes for Older People Page 28 of 32 To ensure that the residents lifestyle matches their expectations and their intrests and needs. 5 21 23 That the Registered Provider 03/12/2008 ensures that there are suitable and well maintained bathing facilities available for use in the home that advice is sought regarding the broken shower heads The bathrooms viewed were not attractive and welcoming and many had broken sides and hanging shower heads. 6 22 16 That the Registered Provider 30/11/2008 ensures that the specialist equipment in the home is available to all service users and in good working order. This pertains to: The call bell facility is to be in reach of service users staff and visitors and those service users that do not have the capacity to use this facility an appropriate risk assessment and action plan is to be in place. To ensure residents safety is promoted. 7 26 13 That the Registered Provider 03/12/2008 ensures that the all staff follow the homes policies and procedures in the standard of cleanliness and infection control measures this pertains to Care Homes for Older People Page 29 of 32 That the soap dispensers and paper towels are full and ready for use that all bins have an approprite lid that the sluice is clear of stored items that all equipment is clean and hygenic to protect ans promote residents safety. 8 29 19 That the registered person operates a thorough recruitment procedure that includes the appropriate checks being completed before any person is deployed to work in the home. That a photograph of each staff member is retained in the home along with evidence that each persons ID has been checked That residents are protected by thorough checks of all staff. 25/09/2008 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 1 That the Statement of Purpose and Service User Guides includes more detailed information regarding the staff training. That the pre- admission assessment for residents is completed with more detail than the tick box seeen in use. That the identification photographs of residents on the Page 30 of 32 2 3 3 9 Care Homes for Older People medication charts are dated and updated regularly. 4 5 6 29 33 38 That staff files need to contain a coloured identification photograph. That the use of questionnaires is expanded to staff and visiting professionals. That first aid boxes are spread out throughout the building. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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