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Inspection on 03/03/09 for Victoria House

Also see our care home review for Victoria House for more information

This inspection was carried out on 3rd March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Victoria House 77 Victoria Road Rushden Northants NN10 0AS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Irene Miller     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Victoria House 77 Victoria Road Rushden Northants NN10 0AS 01933417950 01933417951 VictoriaRoad.Manager@shaw.co.uk www.shaw.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Paul Bickley Type of registration: Number of places registered: Shaw Healthcare (de Montfort) Ltd care home 47 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: Mental Disorder, excluding learning disability or Dementia - Code MD (Maximum Number of places !2) Date of last inspection Brief description of the care home 77 Victoria Road is a residential care home currently owned by Shaw Healthcare. The home was reopened on 24th November 2008 following extensive refurbishment works. The home provides care for up to 47 people over the age of 65 years. to include up to 18 people with a diagnosis of dementia, within the homes total of 47 up to 5 older Care Homes for Older People Page 4 of 32 Over 65 47 47 0 47 0 0 Brief description of the care home people with mental health needs can be provided with personal care. The Home is situated within walking distance of Rushden town centre, has extensive gardens and all facilities are located on the ground floor. Service Users have easy access to local facilities and amenities. All bedrooms are single occupancy rooms with easily accessible communal areas. The home is made up of several smaller units, each with their own lounge, dining area and kitchenette as well as a central larger lounge. The fees are paid at a rate negotiated with Northamptonshire County Council who funds the placements. The rates are dependent on assessed needs and are in the region of 405.40 or 435.40 per week. This fee covers accommodation, personal care, meals and laundry. Additional costs will include items such as private chiropody treatment and hairdressing, which are external, services which can be arranged. Information about the services provided are detailed in the service user guide and a copy of the most recent inspection report is available in the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of all inspections undertaken by the Commission for Social Care Inspection (CSCI) are based upon seeking the outcomes for people using the service and their views of the services provided. This visit was unannounced and involved one regulation inspector, we focused on the key standards under the National Minimum Standards and the Care Standards Act 2001 for homes providing care for older people. The care records of three people were sample checked which involved looking at their individual care plans (a care plan sets out how the home aims to meet the personal, healthcare, social and spiritual needs of the people using the service), we looked at risk assessments and other care records to establish how the home works with health and social care professionals to meet the needs of the people using the service. Care Homes for Older People Page 6 of 32 We spoke with people using the service to determine how they view the care provided at the home, and discussions with staff gave an insight into the support and training provided at the home, observations of care practice gave an indication on the quality of the service provided at Victoria House. Records in relation to the homes maintenance, management and quality assurance systems and staff recruitment and training were viewed. Prior to the inspection we sent out to the home a selection of satisfaction surveys to be distributed by the provider to people using the service their relatives and friends, staff and visiting healthcare professionals. We received eleven completed surveys from people using the service of which nine had been completed with the support of a member of staff. We received four completed surveys from relatives and six surveys from staff. Below is comments received within the surveys from people using the service: I cant remember receiving a contract, my daughter dealt with all the paperwork, didnt know there was a contract . I am happy with the support received, staff come as soon as they can, I understand they are busy, sometimes they are short staffed, care staff do as I ask, all the care staff are kind and caring. Comments from relatives: Helpful staff, I am always telephoned when ..... is anxious or unwell, I have no complaints only gratitude, medical attention has always been appropriately sought,my ..... is safe here is kept clean and fed well, I am informed as to how ... is ...is kept from harming themselves due to their disability, the staff are patient, they could do with more staff in the dementia unit as when the people are required to be put to bed the remaining residents can be at a bit of a risk as they do tend to wander. Comments received from staff: the home provides warm friendly environment, staff shortages can be a problem, some shifts are short staffed, could do with more in depth training to understand dementia, could do with extra staff, better training, better rates of pay training is offered but is often cancelled, we have regular supervision, the managers door is always open, we have good communication between team leaders and staff, the manager is always available to discuss problems. What the care home does well: Documents relating to the management of the home and the range of services provided (The Statement of Purpose and Service User Guide) are made available for people looking to find a home that will meet their needs, and copy of the latest CSCI inspection report is made available. The care plans viewed had records of pre assessments having been carried out which formed the basis of the care plans in place, and people spoken with confirmed that pre assessment visits had taken place. Risk assessments were available that identify people at risk of developing pressure area sores due to frailty, immobility and poor nutritional intake and pressure area relieving equipment was seen to be in use. There was monitoring records were in place such as turn charts for people who require repositioning in bed and fluid charts for people who need their dietary intake closely monitoring. Records were available of visits by health care professionals to generally review the medical care needs and respond to episodes of illness. The medication records and storage systems are well managed. Within the each of the care plans viewed there was information on the hobbies and interests of people using the service this provides a forum for staff to engage with the person and provide person centred care and within the care files there were records of when individuals had been involved in activities provided at the home. One of the people whos care we looked at enjoy their independence and required minimal support from staff, in discussion with the person they expressed satisfaction living at the home saying they were very happy at the home, that they liked to go out daily to the local shops, and enjoyed having visits from their family, they spoke of visiting a relative which involved catching a train. The person said that the staff were very good in providing support to enable them to continue to visit their relative. Within the care file a risk assessment had been completed which balanced risks with the right to exercise choice and control over their lives. The home has recently employed an activity coordinator staff and visitors were observed spending time with people living at the home engaged in social activities. There were records within the care plans of contact with relatives and visitors, and there is no restrictions on visiting times. People spoken with expressed satisfaction with the meals provided by the home. A cooked breakfast is available each morning. There is a copy of the homes complaints procedure on display and the procedure is also within the homes statement of purpose and service users guides which are all available within the front entrance of the home. The registered manager operates an open door policy. In discussion with staff they were aware of their responsibility to ensure that people are safe and training had been provided on safeguarding vulnerable adults. The home has a fully equipped hairdressing room with back basins and hairdryers, a smoking room is available which is fitted with an extraction facility. The gardens are Care Homes for Older People Page 8 of 32 situated all round the building and is secure this enables people using the service including people living with Dementia to fully access the garden from all living areas. The registered manager holds the relevant management qualifications and has the necessary skills and competence to ensure that the home is well managed. There is an established senior team in post, and staff training is given high priority. Regular audits of care practices and quality assurance systems take place which feeds into a process of continually reviewing the quality of service provided by the home. On the day of inspection the atmosphere within the home was warm and welcoming and and staff were observed to treat people with respect and visitors were seen to be welcomed into the home. What has improved since the last inspection? What they could do better: Within each of the care files viewed there was a copy of the homes service user agreement however the agreements were still in the name of the previous home which people had been transferred to whilst refurbishment work had taking place at Victoria Road, the agreements now need to be updated to reflect the current terms and conditions of occupancy. Within one of the care plans viewed there was information that the person could be resistive to accepting personal care, in such instances the care plans would benefit from being more detailed such as identifying the triggers to challenging behaviour and strategies for staff to adopt to ensure that health and welfare needs of people are met. Records of the involvement of other healthcare professionals need to be robust, within Care Homes for Older People Page 9 of 32 one of the care plans viewed there was a record that a Community Psychiatric Nurse (CPN) needed to be contacted urgently due to an increase in aggressive behaviour towards staff and other residents,however there was no further record to demonstrate that this had been acted upon. There was an entry that a persons blood sugar levels were increasing and for staff to closely monitor however based upon this information the nutritional assessment within the care file had not been updated to reflect the increased risk in the persons health status and associated nutritional needs. On the afternoon on the day of the visit a new person was admitted into the dementia care unit, in discussion with the staff they expressed some concern as to how they were to have the time to welcome the new person and provide the individual emotional support required when a new person is admitted into the unit. Consideration needs to be given to having additional staff on duty when a new admission is planned to take place. There is a complaints procedure in place which is on display within the front entrance of the home, it is important that all concerns, compliments and complaints are brought to the attention of the registered manager. We found within one of the care files a letter that had recently been sent to the home from a relative expressing concerns about the wellbeing of their relative living at the home, the registered manager was unaware of this. Two of three staff recruitment files viewed had the necessary documentation to evidence that appropriate recruitment procedures are followed which included having obtained two written references, clearance with the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA 1st) list prior to the members of staff commencing working at the home. However one member of staff had taken up employment at the home whilst the home was awaiting clearance through CRB, the company had carried out a POVA 1st check. In discussion with the registered manager it was explained that staff should only take up employment at the home once the full CRB clearance has been obtained, and that only in extreme circumstances should staff commence working at the home pending clearance with CRB. In such an event the registered manager must be able to evidence that a clear POVA 1st check has been carried out and that the member of staff will work at all times under strict supervisory arrangements with a named supervisor until the CRB clearance has been completed. This is to ensure that people using the service are protected from potential abuse. During the visit some staff expressed their concern about staffing levels on the dementia unit, it was noted that on the afternoon on the day of the visit the staffing ratio on the dementia care unit was two staff to sixteen people and that during the afternoon a new person to the home was admitted into the dementia unit. In discussion with the staff they were aware how daunting it can be for a new person entering a home especially for a person living with dementia, and said they do their best to offer their support but found it difficult given the high dependency of people already residing within the unit. The concerns of the staff were echoed within one of the relatives surveys which was returned to CSCI, within the survey we ask the question how do you think the home can improve ? within one of the surveys a comment was entered stating they could do Care Homes for Older People Page 10 of 32 with more staff in the dementia unit as when the people are required to be put to bed the remaining residents can be at a bit of a risk as they do tend to wander. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 11 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that prior to moving into the home a full assessment will be carried out to ensure that their needs can be met. Evidence: The homes statement of purpose and service user guides had recently been updated to reflect the current management arrangements of the home and the homes aims and objectives and both documents were available within the front entrance of the home. The most recent inspection report was available within the front entrance of the home. During the visit a new person was admitted to the home, unfortunately due to limited understanding and communication difficulties this person was unable to share their experience of moving into the home. We spoke with the persons relatives who stated that they had been provided with the opportunity to view the home prior to the person Care Homes for Older People Page 13 of 32 Evidence: moving in. We asked if the family had been provided with sufficient information on the range of services at the home and they confirmed that the placement had been chosen in the main through Northants County Council and that they were happy with the choice. Within the care plans viewed there were records of pre assessments having been carried out which formed the basis of the care plans in place, and people spoken with confirmed that pre assessment visits had taken place. Within each of the care files viewed there was a copy of the homes service user agreement however the agreements were still in the name of the previous home which people had been transferred to whilst refurbishment work had taking place at Victoria Road, the agreements now need to be updated to reflect the current terms and conditions of occupancy. Comments from people using the service received via the satisfaction surveys about whether they are aware of having a contract with the home were, I cant remember receiving a contract, my daughter dealt with all the paperwork, didnt know there was a contract . Such comments indicate that people using the service need to be more informed about the contacts that are set in place once their admission to the home is made permanent. Care Homes for Older People Page 14 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal needs of people using the service are identified, however ensuring that information within the plans is current and in sufficient details to inform the staff on the care and support required would ensure a more consistent approach to meeting needs. Evidence: We looked at the care plans of three people using the service, one person with a diagnosis of dementia whos first language was not English and had reverted back to using their native language, one person who was frail and immobile and required full assistance with daily living and personal care from care staff and one person living at the home with mental health needs. The person living with dementia and who had reverted back to their native language was at times finding it difficult to accept staff assistance especially in the area of meeting their personal hygiene needs. The care plan had within it information that this person could be resistive to accepting personal care in further discussion with the staff it was established that depending on how staff approached the person depended Care Homes for Older People Page 15 of 32 Evidence: on how this support was received. In order for a consistent approach to the care and support required for this person the care plan would benefit from being more detailed such as identifying the triggers to challenging behaviour and strategies for staff to adopt to ensure the persons health and welfare needs are met. There were records within this care file that a Community Psychiatric Nurse (CPN) had been involved with the care of this person and had advised that an interpreter be sought, however within the care file there was no further record to demonstrate that this had been acted upon. In discussion with the Register Manager they confirmed that a member of staff from another home within the company who spoke the same language had visited the person. Within the care plan review notes there was a recent entry that the CPN needed to be contacted urgently due to an increase in aggressive behaviour towards staff and other residents, this was discussed at the time of the inspection with the registered manager who said that they were not aware of an increase in aggression in this person and said that he would investigate this further. There were records within the care plans of risk assessments being carried out to identify people at risk of developing pressure area sores due to frailty, immobility and poor nutritional intake. Pressure area relieving equipment was seen to be in use and monitoring records were in place such as turn charts for people who require repositioning in bed and fluid charts for people who need their dietary intake closely monitoring. Records were available of visits by health care professionals to generally review the medical care needs and respond to episodes of illness. Comments received via the surveys returned from people using the service and their relatives were the staff are helpful , I am always telephoned when ..... is anxious or unwell, I have no complaints only gratitude, medical attention has always been appropriately sought. Within one of the care files viewed within the medical services intervention record for one person there was an entry that their blood sugar levels were increasing and for staff to closely monitor this. It was noted that the nutritional assessment review (evaluation) had a record of this change, however the actual nutritional assessment had not been updated to reflect the change and increased risk in the persons health and associated nutritional needs. Care Homes for Older People Page 16 of 32 Evidence: The medication records and storage systems were sample checked and were well managed. Care Homes for Older People Page 17 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the activities provided by the home matches the expectations of people using the service. Evidence: Within the each of the care plans viewed there was information on the hobbies and interests of people using the service this provides a forum for staff to engage with the person and provide person centred care. Within the care files there were records of when individuals had been involved in activities provided at the home. One of the people whos care we looked at enjoy their independence and required minimal support from staff, in discussion with the person they expressed satisfaction living at the home saying they were very happy at the home, that they liked to go out daily to the local shops, and enjoyed having visits from their family, they spoke of visiting a relative which involved catching a train. The person said that the staff were very good in providing support to enable them to continue to visit their relative. Within the care file a risk assessment had been completed which balanced risks with the right to exercise choice and control over their lives. Care Homes for Older People Page 18 of 32 Evidence: The home has recently employed an activity coordinator,and during the morning staff and visitors were observed spending time with people living at the home engaged in social activities. There were records within the care plans of contact with relatives and visitors, and there is no restrictions on visiting times. On the afternoon on the day of the visit a new person was admitted into the dementia care unit, in discussion with the staff they expressed some concern as to how they were to have the time to welcome the new person and provide the individual emotional support required when a new person is admitted into the unit. Staff said that they had recently spoken with the registered manager about these concerns and in discussion with the registered manager he said that plans were in hand to recruit more staff and to bring in additional staff at peak times of the day. The lunchtime meal on the day of the visit was cottage Pie, with mixed vegetable and there was an alternative of poached cod, People spoken with expressed satisfaction with the meals provided by the home. A cooked breakfast is available each morning. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place for people to raise concerns or complaints, it is important that all concerns and complaints are brought to the attention of the registered manager to ensure that they are acted upon. Evidence: There is a copy of the homes complaints procedure on display and the procedure is also within the homes statement of purpose and service users guides which are all available within the front entrance of the home. There were no recorded concerns or complaints to view, in discussion with the registered manager he stated that there had not been any complaints raised since the home had reopened, that he has an open door policy. Within one of the care plans viewed there was letter dated February 09 that had been sent to the home by a relative raising concerns about the wellbeing of their relative living at the home. This was brought to the attention of the registered manager who was unaware that a letter had been received it is important that all concerns and complaints are brought to the attention of the registered manager to ensure that they are acted upon. The Commission for Social Care Inspection have not received ant concerns or complaints about the home. Care Homes for Older People Page 20 of 32 Evidence: In discussion with staff they were aware of their responsibility to ensure that people are safe and training had been provided on safeguarding vulnerable adults. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from living in a home that is well maintained and furnished and decorated to a high standard. Evidence: Copies of relevant documents were submitted to CSCI in a timely manner to support the application to reopen the home and a site visit took place on 12th November 2008 by CSCI the home reopened on 24th November 2008. The refurbishment involved redeveloping the whole building to incorporate 47 bedrooms which are situated on one floor, all rooms are single occupancy and have en-suite facilities. The bedrooms viewed were decorated to a high standard all had a different colour scheme, there was evidence of bedrooms being personalised with ornaments, pictures and small items of furniture. The building is fully accessible throughout and there was no restriction of freedom of movement, entrance and exit doors are alarmed to alert staff to people exiting the building. The home is split into six units that each have dedicated lounges and dining areas, and access to a small kitchenette to provide a domestic atmosphere. Care Homes for Older People Page 22 of 32 Evidence: Each unit has its own facilities including assisted bathrooms, additional toilets, and a quiet lounge. There are also general communal areas where people can socialise. Shower rooms, bathrooms and toilet facilities have fixed or mobile hoists to assist people with mobility problems. The gardens are situated all round the building and are secure this enables all people using the service to access the garden from the corridors. The home has a fully equipped hairdressing room with back basins and hairdryers. A smoking room is available which is fitted with an extraction facility. The main kitchen was viewed which was clean and well managed. The gardens are secure and people using the service can gain access to the garden from all corridors and lounge areas. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health safety and welfare of people using the service would be better protected through having robust recruitment records in place and staffing levels that enable flexibility to be promoted. Evidence: Three staff recruitment files were viewed of which two of the files had the necessary documentation to evidence that appropriate recruitment procedures had been followed. This included clearance with the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA 1st) Register prior to the member of staff commencing working at the home, and the home obtaining two written references from previous employers. One member of staff had taken up employment at the home whilst the home was awaiting clearance through CRB, the company had carried out a POVA 1st check. Due to the nature of the position the member of staff were employed at the home it was unlikely that they would have been in a position of lone working or providing personal care. In discussion with the registered manager it was explained that staff should only take up employment at the home once CRB clearance has been obtained, and that only in extreme circumstances should staff commence working at the home pending Care Homes for Older People Page 24 of 32 Evidence: clearance with CRB and in such an event the registered manager must evidence that a clear POVA 1st check has been carried out and the member of staff work at all times under strict supervisory arrangements with a named supervisor until the CRB clearance has been completed. This is to ensure that people using the service are protected from potential abuse. During the visit a group of staff expressed their concern about staffing levels on the dementia unit, it was noted that on the afternoon on the day of the visit the staffing ratio on the dementia care unit was two staff to sixteen people and during the afternoon a new person to the home was admitted into the dementia unit. The person required a member of staff to spend time with them in order to provide comfort and reassurance. In discussion with the staff they were aware how daunting it can be for a new person entering a home especially for a person living with dementia, and said they do their best to offer their support but found it difficult given the high dependency of people already residing within the unit. In further discussion with staff they expressed concern that they were unable to utilise the extra lounge facility on the dementia unit as it was felt safer to have all the people together within one lounge to ensure they were appropriately supervised. The concerns of the staff were echoed within one of the relatives surveys which was returned to CSCI, within the survey we ask the question how do you think the home can improve ? a comment was entered stating they could do with more staff in the dementia unit as when the people are required to be put to bed the remaining residents can be at a bit of a risk as they do tend to wander. The following is comments received from the staff surveys returned to CSCI were the home provides warm friendly environment, staff shortages can be a problem, some shifts are short staffed, could do with more in depth training to understand dementia, could do with extra staff, better training, better rates of pay training is offered but is often cancelled, we have regular supervision, the managers door is always open, we have good communication between team leaders and staff, the manager is always available to discuss problems. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of people using the service, and ensures that their health, safety and welfare is promoted and protected Evidence: The registered manager holds the relevant management qualifications and has the necessary skills and competence to ensure that the home is well managed. There is an established senior team in post, and staff training is given high priority. Regular audits of care practices and quality assurance systems take place which feeds into a process of continually reviewing the quality of service provided by the home. Some concerns around staff recruitment practices and how the home responds to concerns and complaints were highlighted during the inspection visit and it is antiscipated that the registered manager will take the appropriate action to address requirements and recommendations have been made following this visit. Care Homes for Older People Page 26 of 32 Evidence: On the day of inspection the atmosphere within the home was warm and welcoming and and staff were observed to treat people with respect and visitors were seen to be welcomed into the home. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Care plans must reflect the current needs of the service users. Ensuring that care plans are current and in sufficient detail would ensure that staff are fully aware of the needs of people using the service. 30/04/2009 2 29 19 Only in extreme 30/04/2009 circumstances should new staff take up employment prior to the home obtaining full CRB clearance. In such an event a POVA 1st check must be carried out and the staff member must work alongside a named supervisor. This would further protect the health, safety and welfare of people using the service whilst awaiting the CRB clearance. Care Homes for Older People Page 29 of 32 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 3 38 13 Only in extreme 30/04/2009 circumstances should new staff take up employment prior to the home obtaining full CRB clearance. In such an event a POVA 1st check must be carried out prior to the staff taking up employment and the staff member must work alongside a named supervisor. This would further protect the health, safety and welfare of people using the service whilst awaiting the CRB clearance. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 The Service User Agreements should be updated to reflect the current situation to include the terms and conditions of occupancy. Personal care plans and associated assessment records should be updated as and when changes occur. This would ensure that information on the health, safety and welfare needs of people is current. All complaints and concerns should be brought to the attention of the registered manager immediately. This is to ensure that they are responed to in line with the homes complaints procedure. Staffing levels should reflect the dependency levels of people using the service and serious consideration should be given to allocating additional staff at identified peak Page 30 of 32 2 7 3 16 4 26 Care Homes for Older People 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 times of the day. This will ensure that the health and welfare of all people using the service is continuously promoted and protected. 5 27 Staffing levels should reflect the dependency levels of people using the service and serious consideration should be given to allocating additional staff at identified peak times of the day. This will ensure that the health and welfare of all people using the service is continuously promoted and protected. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. 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