Inspection on 19/12/08 for Tyneview Nursing Home

This inspection was carried out on 19th December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tyneview Nursing Home 17/04/09

Tyneview Nursing Home 20/12/07

Tyneview Nursing Home 18/05/06

Tyneview Nursing Home 12/01/06

Tyneview Nursing Home 24/05/05

Tyneview Nursing Home 10/11/04

Tyneview Nursing Home 20/04/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tyneview Nursing Home Cuthbert Street Bensham Gateshead Tyne & Wear NE8 1AF     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: Suzanne McKean     Date: 2 3 1 2 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. 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 34 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 34 Information about the care home Name of care home: Address: Tyneview Nursing Home Cuthbert Street Bensham Gateshead Tyne & Wear NE8 1AF 01914772835 P/F01914772835 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Beverley Anne Tarplee,Mr Martin Lang Name of registered manager (if applicable) Ms Elizabeth Malley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 36 The registered person may provide the following category of service only: Care Home with Nursing, Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category, Code OP, maximum number of places 36 Date of last inspection Brief description of the care home This home is registered as a care home providing nursing and personal care for older people. It is a building that has been converted to its present purpose as a care home. There are three main floors with some further changes of level within these. The home is built on rising ground and the main entrance is at first floor level. It has a passenger lift giving access to all floors. It is situated in an urban setting close to a busy road Care Homes for Older People Page 4 of 34 care home 36 Over 65 36 0 Brief description of the care home junction and is accessible by public transport with several major bus routes running by the home. There are no grounds that can be used as recreational space but it has a small outside area at the front of the building for residents to sit. There is an ample car parking. There are a limited range of facilities, such as pubs and shops, within walking distance of the home and it is a short drive to the town centre. The home is elevated position provides views of the River Tyne and Newcastle to the North and West. The home charges fees of £395 per week with the nursing care element of the care fees being provided in addition to this when applicable. Care Homes for Older People Page 5 of 34 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: Summary: This is an overview of what the inspector found during the inspection. How the inspection we carried out:- Before the visit we looked at, the information we have received since the last visit on 20th December 2007. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service and their relatives, staff and other professionals. The visit: An unannounced visit was made on 19th December 2009 and another visit Care Homes for Older People Page 6 of 34 was made on 23rd December 2009 by the inspector and a regulation manager the total length of the visit was nine hours. During the visit we: Talked with people who use the service, relatives, staff, the manager and visitors. Looked at information about the people who use the service and how well their needs are met. Looked at the records which must be kept. Checked the staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building and parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. Used surveys to find out the views of residents, relatives and staff. We told the manager what we found. What the care home does well: What has improved since the last inspection? There has been improvements in the way the home finds out about the lives of the residents to develop a plan for supporting them to live active and fulfilled lives, further work is continuing. There has been a activities co-ordinator employed although she is not yet in post who will be able to assist in this. Accidents are recorded effectively and accurately and the manager undertakes a monthly analysis of those that occur giving her a basis for looking at ways of reducing the risk of falls and accidents for the people living in the home. There is now a register of staff who are authorised to administer medication. This is so people can be identified should there be any discrepancies and there is a separate stock of dressings for people being admitted in an emergency. All of the alarm/call facilities in the bedrooms, bathrooms and toilets are now accessible and where they are ceiling mounted reach the floor. This will make sure that people can call for assistance should they fall or become unwell. Improvements have been made in some areas of health and safety including tidying of storage areas, repair of the holes in the ceiling, locking of sluices when not in use, recording of weekly and monthly health and safety checks including hot water and risk assessments. The directions from the Fire Safety Officers visit have been carried out. There has been good training in moving and handling, infection control and health and safety provided for all staff. The manager now carries out accident analysis on a monthly basis, this will help to ensure the health and safety of the people who live here. There are now suitable bins, and the cleaning equipment is provided to the domestic staff who are aware of the correct way to use and clean their equipment effectively. The sluices are kept locked. Care Homes for Older People Page 8 of 34 The opportunities for the staff for both statutory and clinical training has been improved for all of the staff. There is a good system in place so that the manager can identify the training needs of the staff and manage the way that they will receive the training. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 9 of 34 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 10 of 34 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 11 of 34 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. Good admission assessments and information gathered before the placement makes sure that the home is prepared for the person moving in and that the person can be confident their needs will be met. Evidence: The home uses an assessment document, which is designed to give a way of recording information about the needs of the people who are considering moving into the home or staying for a short period. The tool assists the staff to find out about all of the aspects of peoples lives and needs. The manager is confident that it gives her the information she needs to make the judgment about offering a place. The manager has shown in the past that she is careful when offering a place to make sure that they can not only meet their needs but that she has considered the residents already in the home. Care Homes for Older People Page 12 of 34 Evidence: The home has four assessment beds and these residents are admitted for a six week placement to assess their long term care needs and their potential for being able to return to their own homes. These people are not able to visit the home prior to admission at present but the Manager is looking into this to see if it would be included in the admission process. Potential permanent residents can visit the home and spend time in the communal areas prior to making the decision to move in but those spoken to on the day had relied on their relatives to make the choice for them. Care Homes for Older People Page 13 of 34 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. People living in the home have their health and personal care needs met, although care plans do not show enough detail of how the care is given and where there have been problems when the resident has been resistive to care because of their illness. Evidence: Each person living in the home has an individual care plan which is developed from the detailed assessment and added to throughout their stay. These care plans show how the personal and health care needs of the resident are to be met. The staff spoken to were knowledgeable about the contents of the care plans. They were able to describe the needs of the residents and were clear about the way that they had to record the care given and the need to report any relevant issues to senior staff. Care plans are in place around both the physical needs and the social care needs of the people living in the home. Necessary risk assessments are completed for a selection of areas including falls, nutrition and deterioration in skin condition. These were being reviewed and the reviews were up to date. Care Homes for Older People Page 14 of 34 Evidence: Some areas of the care plans were comprehensive in there level of detail, however the information about moving and assisting and the instructions about how staff should support the individual were not always in enough detail. They should give clear direction to the staff on how to carry out the procedure. Also food and fluid charts which were being kept for individual residents were not up to date or being completed in sufficient detail to ensure that they were useful as part of the care planning process. There were two residents whos personal hygiene needs were not being met to a good standard, one had material under her nails and another had food on their face. These residents were being bathed or showered but were not compliant with all of the care they needed. When this is the case or if a resident refuses to have their personal care needs met generally this must be fully documented. It should be clear in the care plan the strategies that had been used to show why the resident is not as clean as they could be. A resident survey, completed by a relative, suggested that their relative does not always have their hair combed or their nails cleaned, it is not clear if this is one of the residents observed or another. Residents are supported to access NHS services and facilities as and when they need to. The care plans showed that the specialist advisors are used for individual people living in the home and their advice is followed. The residents and their representatives are supported to take part in making decisions but comments from relatives suggest that this could be improved to make it more effective and formal. Residents said that they felt well cared for by the staff and an example of this was the staff are really good and we have it made here. Residents were dressed for the activities they were undertaking and looked comfortable and tidy. A number of residents were positive about the care they were being given and were very complementary about the staff. The staff were being kind and polite although pressure to achieved the tasks due to being short staffed made them have to work hard and leaving them little time for more relaxed conversation with the residents. The residents are encouraged to maintain contact with their families, friends and visitors and can use either their own rooms or the communal areas. The home manages the administration of prescribed medication appropriately. There are appropriate systems in place to arrange for the ordering of the residents medication and the records were up to date and in good order. The home has a contract for the disposal of the medication which is no longer required and the records Care Homes for Older People Page 15 of 34 Evidence: of this were in place. Controlled drugs are managed appropriately. Specific routes of administration are followed and any omissions or changes to the way that the medications are given are recorded. Care Homes for Older People Page 16 of 34 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. Residents are not fully supported in their daily life experiences and opportunities in a consistent way to support them to live active and fulfilled lives. People living in the home are not fully involved in decision making in their everyday lives. Evidence: Residents have the choice to spend time either in their own rooms or in the communal lounges and during the visits a number of them were in their bedrooms spending time watching television, reading or listening to the radio. There is no formal social programme in place, and on the day of the visit there was little for people to do and most of the staff interaction focused on giving personal care and assisting people to move from lounge to dining room to toilet and back again. Although there is no activities person employed, one has been recruited and is awaiting the appropriate checks before they start their employment. An activity programme is being developed. The manager told us that because the residents do not all like to participate in group activities they try to provide one to one activities. Care Homes for Older People Page 17 of 34 Evidence: The staff have been working on improving the information in the care plans about peoples previous life histories, although this is not yet complete. This will assist the introduction of a more person centered approach to the way residents spend their lives. Some people said that their families are always welcomed and others said they regularly go out with their family. There is now a small patio/garden area to the side of the home. This benefits the residents as their it is the only outdoor area for people to enjoy in the better weather. There is a three-week menu, which offers choice and variety. The meal time was calm and residents were enjoying the meal time experience. The food was tasted by the inspector and the home made soup was particularly nice and very well received by the residents. Most of the residents took their meals in the dining room but a number chose to eat in their own rooms and they were supported to do so. Lunchtime was a busy time. Several people need help to eat their food and the staff sat with them and assisted in a sensitive manner. There is good flexibility in the meal times and the breakfast is available over a period of time allowing for residents to rise at the time they prefer. The main meal is served in the evening and this is effective as a number of the residents have large breakfasts. Cold and hot drinks were readily available throughout the day. There was little information in the home to tell the residents and the staff about the food being served. This would not only inform them but give a good topic of conversation through the day. There continues to be a need to make sure that the food on offer a choice of meals is in written or other formats which are easy to read and understand. Care Homes for Older People Page 18 of 34 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. Good procedures are in place to protect residents from risk of harm and enable their concerns to be effectively dealt with. Evidence: The home has a complaints policy and procedure, which is displayed and given to everyone when they come into the home. All of the people spoken to said they knew who to complain to although they pointed out that there was little to complain about. Records show that there have been four complaints have been dealt with at home level since the last visit to the home. All of the staff have received Safeguarding Adults training either in house or by attending training with Gateshead Council. The registered manager has recently attended training on the Mental Capacity Act. Staff had an understanding of what constitutes abuse and would be able to use the procedures if necessary. There has been a safeguarding alert but the home was not directly involved although they supported the resident and family with the process. Care Homes for Older People Page 19 of 34 Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not offer the residents a clean, safe, comfortable and pleasant environment to live in. Evidence: Following completion of the site visits a letter was sent by us to the registered provider expressing our serious concerns about the poor standards of the environment in the home. The following information was included in this correspondence although neither the following issues or those contained in the serious concerns letter is a comprehensive list and the owner must carry out her own audit of the work that is necessary. This is a converted building with bedrooms over four floors and the main communal lounges and dining rooms on the lower two floors. There are impressive views of the Tyne from the main lounges. Although it is not long since the lounges have been redecorated they are untidy and poorly organised therefore failing to offer a comfortable and homely place for residents to sit. One lounge has a filing cabinet containing care equipment and other various items which could be better stored elsewhere. There was also items such as a basket with combs brushes, a selection of foot plates and a large pop bottle the owner of which could not be discovered. There was also a small fridge on the floor in the corner which belonged to a resident. Care Homes for Older People Page 21 of 34 Evidence: There is a smaller communal area overlooking the car park although few people use this. It is used by the hairdresser and this area had not been cleaned on the day of the visit (Tuesday) since Sunday. There is access to all areas via stairs and passenger lifts. Signs are posted on each floor level so that people can find their way around the home. There are no gardens or grounds that could be realistically used as an amenity area for people living in the home, however there is now a small area of private garden at the side of the home for people to use in the better weather. A loop system is available in the lower lounge, which helps those with hearing problems hear the television, which is at the far end of the lounge. There are adequate numbers of toilet and bathing facilities however not all can be used for people needing assistance. The bathroom on the top floor was not in use and is being used to store equipment. There is a toilet with a hairdressing sink but the water was not running when tried. The bathroom on this floor was being used for storage and the water was running very slowly. Some floor coverings in toilet areas have been renewed but there is remaining work to be carried out. There are two showers and one bath that are currently being used for residents. This is because the others cannot be used for those who needs assistance. This results in the residents having less choice in where they bath and having to go to another floor. The shower rooms in particular were poorly decorated and maintained. One had damage to the seal around the tiles and the repair was damaged and dirty. The shower trap was open and unsecured and there was a very unpleasant odour in the room. The radiator was rusty and the paper dado was peeling off . The shower chair being used in this room was dirty and the wheels were rusty. The bath being used had a very dirty plug and hole which was green and stained, the bath mat was cracked and damaged and could therefore not be adequately cleaned. These areas would not give the people living in the home a pleasant comfortable place to enjoy the experience of bathing. The toilet facilities have not been refurbished and are looking worn. Toilet seats, which were black, are now grey. All other sanitary fittings were worn and not well maintained. The aids and adaptations in the toilets were not all sited in the correct place and some were starting to be loose and unsafe. The positioning of toilet roll holders was poor and did not give the resident the opportunity to maintain their independence for as long as possible. All of the bedrooms are for single use, none have an en-suite facility. People have Care Homes for Older People Page 22 of 34 Evidence: brought small items of furniture and keepsakes with them making the rooms individualised. They reflect their previous lifestyles and religious beliefs. Many of the bedrooms are cluttered with the storage of continence pads and other medical equipment. This compromises the dignity of the occupant of the room as they should have such items as incontinence pads stored discreetly. The furniture and bedding in several of the rooms is becoming tired and worn with bedding becoming faded and thin. Many of the bedrooms are due redecoration as there is damage to walls and paintwork. Some furniture is damaged and needs replacing. Most of the beds are ordinary divans and there are insufficient nursing variable height beds for people to use. The laundry has adequate facilities. However, the area was generally disorganised and the area was not being used as it was planned with clean to dirty as the adjoining door was obstructed. There was a liquid soap and paper towels in this area so staff can wash their hands effectively. The sluices were being kept closed however clinical waste, for example, was not being double bagged to prevent odour and allow staff to carry it safely from where care is being given to the yellow bag. The open sluice hopper was dirty had a commode pot in it suggesting that staff were not using appropriate methods of cleaning them. Some wheel chairs were dirty with food debris and although there is a process to have them cleaned it was not being carried out effectively. Care Homes for Older People Page 23 of 34 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. People living in the home are protected by a good recruitment and selection procedure that is properly followed. Staff are supported through training to make them able to fulfill the role they undertake. Evidence: The home benefits from a stable staff team, many of who have worked in the home for some considerable time. The registered manager is generally supernumerary but does work clinically one shift a week. During the site visit the staffing included two qualified nurses, three carers, domestics, cook, kitchen assistant and handyman. There was one less carer as late reporting of sickness had not been able to be covered. The manager has recently employed someone to organise activities for the people living in the home although they had not yet taken up the post. Four staff files showed that job descriptions and roles are clear and each file had an application form completed. There was evidence of Criminal Record Bureau checks, of Vulnerable Adult checks, and proof of identity. Care Homes for Older People Page 24 of 34 Evidence: A training programme is in place. This provides an overview of training achieved and required. Staff said that they have done or been offered training. Records show that all have had refresher training in Infection Control, Moving and Assisting and Health and Safety and fire safety. Specialist training includes resuscitation, care of the syringe driver and palliative care. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While management and administration of the home is adequate, support for the manager is lacking. The absence of an effective quality assurance process affects the running of the home and quality of care delivered to people using the service. Evidence: The manager is a registered nurse and has many yeard experience both as a nurse and as a manager. The manager is registered with the Commission for Social Care Inspection. She is aware of the need to keep up to date with current best practice and tries to make sure all staff are knowledgeable and trained to care for the people who are using the service. The manager does not hold or have detailed information regarding the homes budgets and this makes it difficult for her to plan the purchases needed or any changes needed Care Homes for Older People Page 26 of 34 Evidence: tot he home. She is confident that she can obtain finances for equipment she needs to meet the needs of the residents but cannot plan ahead for changes which can be predicted. There has not been any recent resident or relatives meeting to ask the people who use the service and their representatives about how they can improve the service. However she said that she speaks to residents and their representatives individually, this was confirmed by the residents spoken to. The comments from people living in the home were generally positive about the staff and the care provision. There was some concern about specific residents needs which have been dealt with in other parts of this report. There were also some negative comments about the building. Records relating to peoples monies were checked. Accounts are held individually. Receipts are kept for all expenditure. Three amounts of money were checked and were correct. Supervision records are very detailed and everyone is now receiving supervision six times a year. During the first visit it was noted that there were some potentially unsafe situations. This included a room where the resident and her family have sited a television on a high chest of drawers, the manager agreed to discuss this with the family and undertake a risk assessment to determine the necessary action. Also there was a sensor pad on the floor of one of the bedrooms which was placed with the cable lying across the path of the resident presenting a very high falls risk. It is acknowledged that the resident had moved from where he was previously sitting, which highlights the risk. This was moved on the request of the inspector. Maintenance records for day-to-day safety were in place including recording of water temperatures, checking window restrictors and general health and safety checks for the safety of staff .the people who live in the home and any visitor. The manager is continuing to carry out all of this work on top of everything else. These checks could be delegated on a weekly basis to other staff in the home. The Fire Officer had visited the home on the 14 December 2008 and had left verbal instructions of what the home must do to make sure it was safe. The manager had carried out these instructions. There is evidence of very good practice sessions for the staff. Care Homes for Older People Page 27 of 34 Evidence: Staff have completed fire training, infection control, moving and handling and health and safety in line with good practice guidance. Accidents are recorded and the manager carries out audits to track trends and look at when accidents occur to prevent them happening again. She has also introduced a monthly Quality Indicator Reports as a way of reviewing the home and as part of the quality assurance process. Audits have been carried out in November 2008 for medicines and pressure ulcer care, this will feed into the quality assurance process. In February 2008 surveys were used as a way of getting the views of the residents this is to be repeated annually and is due to be carried out in the next few months. There are a number of elements in place which could contribute to the quality assurance process, however there is no formal process in place to make sure that the home is operating in the best interest of the residents taking into account their views. Although it is acknowledged that the registered provider visits the home regularly there is no record of the visit and the issues that were looked at or the process undertaken. There must be a visit at least once a month in line with Regulation 26 of the Care Homes Regulations 2001, and the content of this visit is clearly identified. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 12,16 The registered persons must 01/06/2008 ensure that activities and social care plans continue to be developed and interests recorded. This will make sure a person centred approach to care is delivered The registered persons must 01/03/2008 ensure that the menus offer a choice of meals in written or other formats, which are readily available and easy to see and understand. The registered persons must ensure that adapted utensils are available for people to use. This is to ensure they retain their rights to choice and independence. The registered persons must 01/06/2008 implement a planned programme of redecoration and refurbishment for the home. This will make sure the environment remains safe and comfortable for the people living there. The registered persons must 01/09/2008 ensure that the floor coverings in bathroom, toilet Page 29 of 34 2 15 12,16 3 19 13,23 4 21 23 Care Homes for Older People and shower areas are appropriate and kept in good repair. As should sanitary fittings. Outstanding from 28/05/07 5 24 23 The registered persons must 01/06/2008 continue to redecorate and refurbish the bedrooms and provide sufficient adjustable beds for those who require nursing care. This will ensure that people live in safe comfortable rooms, which meet their needs. The registered persons must 01/09/2008 continue to develop the quality assurance programme so the home contuse to be run in the best interests of the people using the service 6 33 24 Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The detail in risk assessments and care plans should be improved to show the specifics of any equipment used and give clear instruction to the staff on how to carry out the procedure. The staff must be able to provide safe and appropriate care to protect both the resident and themselves from harm. 01/06/2009 2 7 12 Care plans and records of 01/06/2009 care should be more detailed in how the residents and representatives are involved in making decisions about the care and their lives. The records should also contain detailed information when the residents refuse care or are resistant due to their condition. Residents or their Care Homes for Older People Page 31 of 34 representatives should be able to participate in the choices of how they live their lives and receive their care. 3 10 12 The residents privacy and 26/03/2009 dignity must be maintained by taking action including, removal of publicly displayed notices which include residents names and storing personal continence items more descreetly. The residents privacy and dignity will be maintained by good practices. 4 14 12 The registered person must find out the wishes and feelings of the resident and then take them into account when planning care. Including resident in the planning of how they will live will offer them choice and maintain their dignity. 5 21 23 There must be appropriate bathing facilities for the number of residents adequate numbers, which can meet their needs. The residents must be given choice and provide them with safe pleasant bathing facilities. 6 26 13 Control of infection practices 26/03/2009 must be improved, including cleaning of bathing areas, wheelchairs, and equipment being used by residents when receiving care. 26/11/2009 26/07/2009 Care Homes for Older People Page 32 of 34 Good control of infection practices will minimise the risk of cross infection to people living in the home. 7 31 26 The registered provider 26/02/2009 must visit the home at least once a month and prepare a report of the visit in line with the regulation. The visit will allow the registered proprietor to ensure that the home is being conducted in the best interest of the residents and in line with good practices. 8 38 13 The registered person must ensure that all parts of the home are so far as practicable free from hazards. The residents should live in an environment which is safe and free from unnecessary hazards. 26/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!