Inspection on 10/12/08 for Victoria House

This inspection was carried out on 10th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Victoria House 16/06/08

Victoria House 21/02/07

Victoria House 22/11/05

Victoria House 12/07/05

Victoria House 03/11/04

Victoria House 14/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Victoria House 22 Nelson Place Ryde Isle Of Wight PO33 2ET     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: Janet Ktomi     Date: 1 0 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. 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 33 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 33 Information about the care home Name of care home: Address: Victoria House 22 Nelson Place Ryde Isle Of Wight PO33 2ET 01983614515 01983613370 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Judith Garvey Type of registration: Number of places registered: Venetian Healthcare Ltd care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: This home is registered for up to 22 persons in the old age category including: 5 persons over the age of 65 years with a physical disability; 1 person over the age of 65 years with dementia. Date of last inspection Brief description of the care home Victoria House is a well-appointed care home, which occupies a fine elevated site in Ryde. It boasts sea views from all the rooms at the front of the building. Whilst the home has a number of double rooms they are presently used as singles. The home has a passenger lift that provides access for residents to all levels of the building. The home offers a varied programme of social and recreational activities including music and art activities. For those that like animals the home has a cat and a parakeet. The home has its own transport and outings are arranged to the theatre and other places Care Homes for Older People Page 4 of 33 Over 65 1 22 0 0 0 1 Brief description of the care home of interest on the Island. The home predominatley offers long term care however short stay and respite may also be offered if a suitable room is available. There are extra charges for items such as chiropody, hairdressing, toiletries, which are not included in the fee. Information about current fees can be obtained from the manager. Care Homes for Older People Page 5 of 33 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: The home was previously inspected in June 2008 and had a Random Inspection in August 2008 to follow up on the requirements made in June 2008 and to access compliance with the statutory requirement notice issued at that time. This report contains information from the random inspection in August 2008 as well as other information gained prior to and during an unannounced visit to the home undertaken on the 10th December 2008. All core standards and a number of additional standards were assessed. The visit to the home on the 10th december 2008 was undertaken by one inspector and lasted approximately seven hours commencing at 9.30 am and being completed at Care Homes for Older People Page 6 of 33 4.30 pm. The inspector was provided with free access to all areas of the home, documentation requested, visitors, staff and people who live at the home. The registered manager completed an Annual Quality Assurance Assessment (AQAA) prior to the key inspection in June 2008 and was therefore not required to complete one prior to this key inspection. Surveys were sent to the home for distribution to staff and people who live at the home. Four completed surveys were received from staff, five from people who live at the home and two from health professionals who have contact with the home. The registered manager was present for the Key inspection in December 2008 and some additional information was provided by the deputy manager following the inspection visit. What the care home does well: What has improved since the last inspection? Following the inspection in June 2008 nine requirements were made. The home has complied with these. The home now has a comprehensive pre-admission assessment and procedure which ensures that the home will only admit people whose needs it can meet. The needs of all the people living at the home have been reassessed and copies are available in the home. The home now has a new care planning system in place. All care plans are now in the new format which provides a comprehensive care planning procedure. Risk assessments are in place within care plans. The home has addressed the issues raised in June 2008 in relation to medication. A new issue in respect of medication was identified in December 2008. This being staff were not observing some people take their medication which was being left with them at the dining room table. The home have informed the commission that this practice was stopped on the day of the inspection. The home supports a person who is receiving oxygen. The home now has guidelines in place for the person and the management of the oxygen. The home now ensures that all the required pre-employment checks are undertaken before staff commence working at the home. New staff who have not previously worked in a care role and do not have an NVQ have completed an external induction course covering all mandatory training. The home has now formalised the systems it uses for quality assurance and copies of the reports following the visits to the home by the provider to assess the quality of the service (regulation 26 visits) are available in the home. Care Homes for Older People Page 8 of 33 Some staff training (medication and fire awareness) has occurred. The home is currently producing a training plan for 2009. All substances hazardous to health are now stored securely. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 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. All people are assessed prior to moving into the home to determine that their individual needs can be fully met. People or their representatives are able to visit the home prior to their admission to assess the quality, facilities and suitability of the home. Evidence: The registered manager explained the homes admission procedure and the preadmission assessments for two people admitted shortly before the inspection visit were viewed. The inspector discussed admissions with care staff and with people living at the home. Information from completed surveys is also considered. When the home was inspected in June 2008 it was identified that two of the three people whose care plans were viewed did not have evidence of a pre-admission assessment. Both these people had complex needs and were supported by external Care Homes for Older People Page 11 of 33 Evidence: health professionals. A requirement made at the previous inspection in February 2007 and was repeated in June 2008 that the home must be able to demonstrate that an assessment of needs has been carried out by a suitably qualified person and assessments must be carried out by the home. This requirement was included in the statutory requirement notice issued to the home following the inspection in June 2008. The home voluntarily agreed not to admit new people following receipt of the statutory requirement notice. A random inspection was undertaken in August 2008 and at that time no new people had been admitted to the home. The inspector was shown the new care planning system including the pre-admission assessments that would be used when the home admitted people. It was identified at that time that action had been taken to meet the requirement however as nobody had been admitted to the home it was not possible to fully assess this. The home contacted the commission in September 2008 as they had been contacted by a relative wishing to admit a person who had previously had respite care at the home. The home was reminded that the agreement not to admit was voluntary however if they did admit and the home was again found to be providing a poor service when next inspected then this would reflect negatively on the Responsible Individual and the Registered Manager. At this inspection it was identified that the home had admitted two people, one in October and the other in November. One person had been admitted for long term care and the other for respite care. The pre-admission assessments and other information for these people was viewed and the registered manager explained the homes admission procedures. The manager stated that if an initial enquiry from either social services or from a person or their family indicates that the home would be able to meet the persons needs the manager will arrange to visit the person, either at their home or in hospital. The homes assessment tool is completed including where appropriate members of the persons family and professionals involved in their care. The person is provided with information about the home and where practicable would be invited to visit the home before making a decision as to whether to move in or not. When the person is unable to visit the home a relative would be invited to view the available room and facilities at the home. As identified at the random inspection in August 2008 the home now has an assessment tool that covers all the relevant areas necessary for the home to decide if it is able to meet a prospective persons needs. The two pre-service assessments Care Homes for Older People Page 12 of 33 Evidence: viewed had been well completed and contained all the information necessary for the home to determine if it is able to met a persons needs. The information in the preadmission assessment linked into the care plan and risk assessments for the person. There was evidence for the person who had been admitted in October that the placement had been reviewed and the care plan updated as her dependence levels had decreased. The other person admitted had only been at the home for two weeks and was preparing to return home the week of the inspection visit. The registered manager was clear about the level of care needs the home can accommodate and the need to ensure that any required equipment is available before a person moves into the home. Discussions with people who live at the home confirmed that people or their relatives have visited the home prior to a person moving into the home. Discussions with care staff confirmed that they felt they had enough information about new people admitted to the home. We received surveys from people who live at the home and they all stated that they had received a contract and had had enough information about the home before they moved in. The home does not provide dedicated accommodation for intermediate care or specialist facilities for rehabilitation therefore standard 6 is not applicable. The home can provided respite care or short stays if a suitable room is available. Care Homes for Older People Page 13 of 33 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. The home has met previous requirements in respect of care plans and the health and personal care, which a person receives is based on their individual needs. People are treated with respect and their dignity and privacy are maintained. The home has met previous requirements regarding medication but must ensure that staff who administer medication observe people taking their medication and that it is not left with people to take at a later time. Evidence: Four care plans were viewed, two for people admitted to the home in the two months prior to the inspection visit and the others for people who had been living at the home for a longer time. The inspector discussed with staff and people who live at the home how care needs are met. The inspector spoke with visitors and a health care professional who were visiting the home during the unannounced inspection visit. Information from the random inspection visit in August 2008 and from surveys received is also considered. Care Homes for Older People Page 14 of 33 Evidence: At the time of the previous inspection in June 2008 a requirement was made that care plans must contain sufficient detail as to the care/assistance that should be provided and must include a nutritional and pressure area needs assessment. The report following that inspection also identified a lack of manual handling assessments and where manual handling information was present the information was not clear. Also identified was a lack of falls risk assessments and people were not being weighed regularly. A letter was received at the commission from the provider stating that a new care planning system was being introduced. The random inspection in August 2008 evidenced that a new care planning system was being introduced and that approximately half the care plans had been rewritten in the new format and that the deputy manager was in the process of transferring the other care plans over to the new system and completing reassessments for all people who live at the home. Training for staff was being organised around the new care planning system. All care plans are now in the new format. People have a detailed plan of care that related to the persons assessment. The care plans follow a comprehensive format and are individualised and person centered being written in plain language providing detailed information as to how needs should be met. Plans are reviewed on a monthly basis and additionally if needs have changed. Care plans contained relevant risk assessments and management plans including nutritional, manual handling, pressure area, falls and any individual risks. Most people had been weighed monthly although one person whose plan was viewed had not been weighed in October and it was not clear why this was. The registered manager was made aware of this and stated that she would ensure the person was weighed. Care plans contained individual manual handling assessments. Most people who live at the home do not require manual handling although the home does have manual handling equipment if required. Care staff were observed completing care plans and daily records during the visit to the home. Care staff stated in surveys and to the inspector that they have enough information about the people they are to care for and understand how the new care plans work. The inspector observed in the lounge that many chairs had pressure relieving cushions and equipment identified in care plans was seen in bedrooms ie pressure mat and an air pressure relieving mattress. The inspector was able to talk to people who live at the home who stated that they felt Care Homes for Older People Page 15 of 33 Evidence: they received the care and support (including medical care) that they need. Survey comment cards were received from two health professionals. They were both positive about the health care the home provides responding always to all questions and adding that carers always assist with our advice and requests re patient care. The other health professional added similar comments saying they ask for appropriate and timely instructions and good level of individual care, appropriate and timely use of medical services and have managed a couple of very difficult cases and coped very well. The inspector spoke with a visiting health professional during the inspection visit and she was positive about the home. Five comment cards were received from people who live at the home, all stating that they always receive the care and support, including medical care, they need and one adding the comment the care is very good and I receive very good care. Similar comments were made by people the inspector spoke with during inspection visit. Relatives were equally positive stating that the home meets the needs of their relative, keeps them informed and that staff have the correct skills and experience to look after people properly. Records were available to demonstrate that people have access to a range of services such as GPs, Dentists, Chiropodists and District Nurses. Daily records indicated that care staff noted health needs and responded to these. The home completes body maps to indicate if marks or injuries have been noted on people. Some seen had noted marks/bruises but not been dated therefore it would not be possible to identify how or when an incident may have occurred. People stated to the inspector that they felt staff always treated everyone with dignity and respect. Observations of staff interactions indicated that people are treated with respect and their right to dignity maintained. All bedrooms are for single occupancy providing privacy for personal care. Care staff stated in surveys and to the inspector that they had sufficient time to meet peoples needs and discussions indicated that they had a good understanding of individual peoples needs and how these should be met. At the inspection in June 2008 a requirement was made in relation to medication as it had been identified that a higher dose of a pain relieving medication than was on the medication administration sheet was being given and there was no prescription for oxygen a person was receiving. At the random inspection in August 2008 evidence was seen to confirm that the medication dose had been changed by health professionals and that the GP had orgnaised the supply of the Oxygen. Care staff were also required to have medication training following the inspection in June 2008. Care Homes for Older People Page 16 of 33 Evidence: On this inspection nobody was self administering their medication with the exception of one person who had been assessed as competent to self administer oxygen on a regular timed basis. Care staff confirmed that they had undertaken medication training and this information was also provided by the deputy manager to the inspector following the inspection visit. Medication was all seen to be stored securely. With the exception of liquids and some medication that cannot be stored in blister packs the local pharmacist dispenses medication into blister packs. The home uses the medication administration records supplied by the pharmacist. These were viewed and had been fully completed. The inspector noted that at lunch time several people had pots containing medication left with them at the dining room tables. The registered manager stated that these people chose to have their medication after their meal, some being chew-able tablets and anti-indigestion medication. Following discussion about the potential dangers of leaving medication with people in a communal area the registered manager agreed to discontinue this practice and to administer such medications to people following their meal when they would be ready to take it. It was also noted at the inspection in June 2008 that the cupboard where stocks of creams are stored was not locked. On the random inspection in August 2008 and the key inspection in December 2008 this cupboard was locked and all medication stored securely. Care Homes for Older People Page 17 of 33 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. The routines for daily living living and activities made available are flexible and varied to suit peoples individual needs. Family and friends are able to visit. People receive a balanced diet in pleasing surroundings at times convenient to them. Evidence: The inspector spent time talking with people, observed part of the lunchtime meal and met with visitors. The inspector discussed activities with people who live at the home, staff and viewed information about activities in care plans. People living at the home are able to spend their time in the home where they wish, people were seen sitting in both of the homes lounges and others chose to spend time in their bedrooms. The home has pleasant views from the larger lounge over the gardens to the sea. The gardens are accessible to people and people stated that they had enjoyed spending time there in the warmer weather. The inspector did not visit the gardens but they appeared to provide safe paths with seating available. People confirmed to the inspector that they are given choice over what time they get up and go to bed, as well as choice as to how and where they spend their time and Care Homes for Older People Page 18 of 33 Evidence: what they have for their meals. Bedrooms seen contained personal items brought into the home. Care plans and assessments include information about leisure activities, hobbies and interests, catering and religious needs. The home provides a range of activities with three visits per week from Independent Arts who provide a varied programme including crafts, music exercises, music entertainers and reminiscence/discussions. The list for December 2008 was seen on the wall outside the dining room. The home also has a visiting aromatherapist whom the inspector met on the day of the unannounced inspection visit. The home has a range of seasonal activities planned to celebrate Christmas with Carol singers etc organised. Service users confirmed in their comment cards that activities are available. One stated I enjoy the activities arranged by the home. The inspector was able to meet several visitors. Visitors are able to visit at any time and complete a visitors book on entering the home. Should a private place other than a persons bedroom be required then the home has a small lounge that could be made available or the dining room outside of meal times. The home has a dining room with sufficient seating should everyone living at the home wish to eat in the dining room. On the day of the unannounced inspection visit most people had their lunchtime meal in the dining room with a few choosing to remain in their bedrooms for their meal. People living at the home informed the inspector that they enjoyed the food at the home. People stated that if they did not like what was available they would say and that an alternative would be provided. People confirmed that they are provided with fresh fruit and vegetables, supplies of fresh fruit being seen. Drinks and snacks are available throughout the day with people confirming this as well as the inspector observing people being given hot drinks during the visit to the home. The need for special diets or supplements is recorded pre-admission as are peoples likes and dislikes about food. On the day of the unannounced inspection visit the registered manager was cooking the lunchtime meal. In the afternoon an applicant for the vacant cooks position came to the home for an interview. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse. Evidence: The inspector spoke with visitors, people who live at the home and staff. Information from surveys is also considered. The home has a clear complaints policy and procedure. Visitors and people the inspector spoke with stated that they did not have any concerns or complaints, however they stated they would raise any concerns if they had any and were confident that the home would sort out any issues. Discussions with staff confirmed that they were aware of what to do if a person or their relative complained or raised an issue. Five completed service user comment cards were received and these all stated that they knew what to do if they had a complaint. No concerns were raised in comment cards or to the inspector during the visit to the home. Comment cards from the health professionals stated that they had not had any concerns raised with them and had no concerns re the home. The registered manager stated that the home had received one complaint since the previous inspection in June 2008. This had been recorded and the inspector viewed the records relating to this. This was not so much a complaint as an issue being raised Care Homes for Older People Page 20 of 33 Evidence: which had been recorded and resolved to the satisfaction of the family. The home has a policy and procedure relating to safeguarding adults and ensuring people are not at risk of abuse. This links to the locally agreed procedures. The previous report following the inspection in June 2008 stated that staff were aware of what could constitute abuse and would approach the manager if they had such concerns. The report also identified that it was not possible to assess what training staff had undertaken in respect of safeguarding. The deputy manager provided the inspector with information about staff training following this inspection visit. This identified that a new care worker who had not previously worked in care had undertaken a full induction with specific training provided by an external agency. This had included working with vulnerable adults as well as other core skills. The training information also identified that with the exception of one staff member all staff have an NVQ (three at level 2 and twelve at level 3). All these staff will have undertaken safeguarding training as part of their NVQ in care. It is recommended that care staff undertake safeguarding update training linking into training in relation to the new Mental Capacity Act as part of the training planned for the coming year. Care staff the inspector spoke with confirmed that they were aware of what might constitute abuse and the action they should take including contacting external agencies such as social services and the commission if they have concerns or the manager does not take the necessary action. People living at the home stated they felt safe and had no concerns in respect of safeguarding. The homes procedures in respect of recruitment and peoples personal finances should protect people. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, safe, well maintained home that meets their individual and collective needs. Evidence: Although the inspector had previously visited the home to undertake the Random Inspection in August 2008 there had not been a need to view the premises at that time. The report following the key inspection in June 2008 had not identified any concerns in respect of the homes environment. The registered manager showed the inspector round the home to-wards the start of the unannounced visit to the home. All areas of the home viewed were found to be clean. The home employs two cleaners who stated that they have enough time to complete the cleaning and have all the necessary cleaning and infection control products and equipment. The home has an ongoing programme of improvements and maintenance. The home has a handy-man three days per week. The home was warm, bright, clean and homely. Furnishing was of a very good standard and appropriate to the needs of the people who live there. The home has amaple communal space with two lounges and a large dining room. Externally there is a pleasant garden and to the front of the home a patio area. Care Homes for Older People Page 22 of 33 Evidence: The home has one bedroom registered as a twin room however this, as with all the other rooms is used as a single room. Bedrooms are provided on the ground, first and second floor, all accessible via a passenger lift. Some bedrooms are en-suite, others have washbasins. Many bedrooms have views over the garden to the sea with some rooms having panoramic sea views. Bedrooms viewed were highly personalised with pictures, televisions, small items of furniture and family photos. It was evident that people are encouraged to bring in personal items on admission. The home has appropriate bathrooms and WCs with all the necessary equipment to support people. Equipment and information on infection control was available to the staff. Practices observed during the the visit indicated that staff were aware of infection control procedures. Hand gel is available to staff and visitors. The homes laundry was viewed and is appropriate to the size of the home. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs appropriate numbers of care staff that should ensure that the needs of people living at the home are met. A very high number of staff have an NVQ in care with many having a level 3 qualification. Full recruitment procedures are completed prior to new staff commencing work at the home. Staff have not received all required mandatory training to update them with the skills they need to meet peoples needs. Evidence: Staff files were viewed, the inspector spoke with the care staff, registered manager and people who live at the home. Information in comment cards and additional information provided by the deputy manager following the inspection is considered. All comments from people who live at the home were positive about the care staff. People stated that there were sufficient staff and that staff are available when they need them. Interactions observed during the inspection were warm and friendly with care staff clearly having a good knowledge of the individual people who live at the home. Surveys completed by people who live at the home stated that staff listen and act on what they say. Additional comments including the care and support is wonderful, the staff listen to us always, we have an excellent staff. Another saying the staff listen to what I say and act very well, everyone is always very helpful and Care Homes for Older People Page 24 of 33 Evidence: willing to help at all times. The health professionals who completed comment cards were also positive about the staff as were visitors and relatives the inspector met. Duty rotas were seen during the visit to the home. These demonstrated that sufficient staff are on duty at all times. Care staff are supported by an administrator, cleaners, cooks and a part time handy man. When neither is at the home the manager and deputy provide an on call service to staff in the home. Care staff stated that the home does not use agency staff and that they will cover additional shifts if required due to sickness or holiday of existing staff. During the unannounced inspection visit the staff on duty corresponded to the duty rotas. Care staff stated that they have enough time to meet peoples needs. The report following the inspection in June 2008 identified that the home had a high number of staff with a NVQ in care. The home employs sixteen care staff of whom twelve have an NVQ level 3 and three have an NVQ level 2. Only one staff member does not have an NVQ and the deputy stated that this person should be doing their NVQ level 2 in the new year (2009). The deputy manager provided this information to the inspector following the inspection visit. Following the inspection in June 2008 the home was required to ensure that all staff complete mandatory training in manual handling and health and safety. Many staff have been employed at the home for a number of years, the home has a consistent staff team and therefore staff may have completed initial mandatory training but have not undertaken update training. Evidence was seen at the inspection visit that staff have all completed update training in fire awareness (via an in house CD and computer assessment) and in medication training via Lloyds pharmacy. However other update training has not occurred. The deputy manager stated that the provider has requested that she complete a training matrix and costings which will be completed by January 2009. Following the key inspection in June 2008 the home was required to ensure that all the necessary checks are in place for staff prior to employment. The random inspection in August 2008 identified that missing references from the inspection in June 2008 had been located and the file for another new staff member was viewed and seen to have all the necessary pre-employment checks in place. At this inspection a further two new staff had been recruited and their staff files were viewed. These both contained evidence that a thorough pre-employment procedure had been completed with all the necessary checks having been undertaken. The home Care Homes for Older People Page 25 of 33 Evidence: was required to ensure that it had an induction programme in place that met the skills for care guidance and that records must be maintained of induction. One new staff member had not previously worked in care and the home organised for her to attend a comprehensive induction training provided by another provider. This covered manual handling, core skills, working with vulnerable adults and care skills. The manager stated and staff confirmed, that new staff work supernumerary for their initial shifts. Care Homes for Older People Page 26 of 33 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. The homes management team has addressed the issues raised in the previous report however this is not yet fully sustained and embeded in practice. Evidence: The inspector discussed the homes management arrangements with the registered manager and viewed records and documents relating to the homes management. The inspector spoke with people who live at the home, care staff and met the homes administrator and viewed records he maintains. Information from the random inspection carried out in August 2008 and from surveys received is also considered. Care staff stated both to the inspector on the day of the unannounced inspection visit and in completed surveys that they receive formal supervisions. However as this is not a core standard records of these were not viewed on this occasion. Various records were viewed during the inspection visit. All records were appropriately Care Homes for Older People Page 27 of 33 Evidence: stored with access only available to people who should have access. Records were well maintained and stored securely. The registered manager was on duty on the day of the inspection. The home is currently recruiting a second cook and on the day of the unannounced inspection the manager was cooking the lunchtime meal. The registered manager confirmed that the plan is still that she will retire in April 2009 and the deputy manager will then become the registered manager. Following the inspection visit the deputy manager telephoned the inspector to provide information about training and confirmed that she would be commencing the new management and leadership award (replacing the previous Registered Managers Award) in the new year. All comments in the surveys received and from people and staff at the home were positive about the registered manager and the homes management team. Care staff, people who live at the home and visitors were all clear that they could discuss any concerns with the homes manager. Following the inspection in June 2008 the home was required to ensure that it had a system of quality assurance that involves an audit and annual development plan and which incorporates the views of residents and others who are involved in the home. The home was also required to ensure that records of Regulation 26 visits (these are visits undertaken by the provider or his representative to monitor the home) are maintained at the home. At the random inspection in August 2008 the registered manager showed the inspector the file for the Regulation 26 reports and the one completed in July 2008 by the provider was viewed. On this visit the reports were viewed and there was one for each month. The provider is using the Commissions Regulation 26 report format which should ensure that all areas necessary are included in the visits to the home and the reports. In August 2008 at the random inspection the inspector was shown the surveys that had been completed in February 2008 by people who live at the home. The registered manager stated at that time that she had read the surveys and taken action on an individual basis where issues had been identified however she had not correlated the surveys and provided overall feedback to the people who live at the home. The home undertook further quality assurance work in September 2008 with the inspector being shown the surveys completed at this inspection. The survey results had been collated and a copy of the overall results provided to the people who live at the home. The registered manager had also completed a response to the survey and there was evidence that action had been taken on an individual basis to address any issues raised. The survey responses were overall positive about the service. This agreed with the responses from the completed surveys received at the commission in December Care Homes for Older People Page 28 of 33 Evidence: 2008 which were positive about the service and were received from people who live at the home, staff and external professionals. The inspector also viewed audits undertaken of the medication in the home. The home does not become appointee or directly responsible for peoples personal finances with people either managing their own money or this being done on their behalf by a relative or representative. The inspector met the homes administrator and viewed invoices which clearly showed exactly what was being added to bills. These were itemised and stated what additional services had been received such as chiropody and hairdressing. A requirement was made following the inspection in June 2008 that all substances that are hazardous to health must be stored safely. During the random inspection visit in August 2008 and the key inspection visit in December 2008 all substances hazardous to health were stored safely. A requirement was also made in June 2008 that all staff must have fire training and that fire drills must occur. The random inspection in August 2008 identified that there is no set pattern for fire alarm checks and that these are carried out weekly. The alarms are activated by the manager from a different point in the home and the staff (who are unaware that a check is to occur) then have to check the fireboard to identify the point of the alarm and take action to check if real or a false alarm. This effectively constitutes a drill as opposed to alarms just being checked at a routine time every week and no action or notice being taken by care staff. The manager confirmed at the key inspection in December 2008 that the same procedures continue and the record of fire tests was viewed. These confirmed that tests are occurring on a regular (virtually weekly) basis. Care staff and people who live at the home confirmed that these occur. It was also identified in August 2008 at the random inspection that the majority of the homes staff had viewed the homes fire training DVD and then completed a computer assessment (test). At the key inspection in December 2008 the inspector was shown the certificates and test scores for all staff at the home. The registered manager stated that if a staff member had not achieved the required pass score then they had watched the DVD again and received additional training before repeating the test. A requirement was made in June 2008 that the registered manager must ensure that all staff complete mandatory training in health and safety. Care staff confirmed that they had undertaken manual handling, infection control and health and safety training however they have not received updates in 2008. The new staff member who did not have previous experience in care work or an NVQ undertook a full induction which Care Homes for Older People Page 29 of 33 Evidence: included these topics. The provider has requested the deputy manager to produce a training plan and budget costings for 2009. The inspector was shown the initial list and following the inspection had some discusions with the deputy manager about training including mandatory and service specific. An amended requirement is therefore made that all staff must receive updates in health and safety training as well as other training necessary to ensure that peoples needs will be met and they will not be placed at risk. During the key inspection in June 2008 the records for the servicing of equipment and services (gas, electric etc) were viewed. The report recorded that fire equipment was tested in February 2008 and appliances in March 2008. There was therefore no need to view these again in December 2008. Care Homes for Older People Page 30 of 33 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 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must ensure that staff who administer medication observe people taking their medication and that it is not left with people to take at a later time. To ensure people get their medication at the correct time. 10/01/2009 2 30 18 The registered person must ensure that all staff recieve annual updates to mandatory training and all other training necessary for them to meet peoples needs. So that people will be safe and their needs met. 01/06/2009 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 32 of 33 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 33 of 33 - 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!