Inspection on 12/09/08 for Wantage Nursing Home

This inspection was carried out on 12th September 2008.

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.

Other inspections for this house

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wantage Nursing Home Garston Lane Wantage Oxfordshire OX12 7AR     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: Delia Styles     Date: 1 2 0 9 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Wantage Nursing Home Garston Lane Wantage Oxfordshire OX12 7AR 08453370445 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Abdul Razak Okoro Type of registration: Number of places registered: Sanctuary Care Ltd care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 50. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Wantage Nursing Home is a new purpose built home operated by Sanctuary Care Ltd. It is located on the same site as Wantage NHS Community Hospital in a residential area in the outskirts of the market town. It is within easy reach of the shops and facilities. The home provides nursing care and accommodation for up to 50 older people. Residents rooms are on the ground and first floor and all have ensuite facilities. There Care Homes for Older People Page 4 of 30 Over 65 0 50 50 0 Brief description of the care home is a dining room, kitchenette and sitting rooms for communal use on each floor. The building is well designed and spacious and has adapted bathrooms and up to date equipment to assist residents. There is an attractive enclosed garden at the rear of the home, with patio areas and lawns accessible from the ground floor. Care Homes for Older People Page 5 of 30 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: This was the first inspection of this new care home. The inspection included an unannounced visit to the home that lasted 6 hours. The key standards for older peoples services were assessed. Prior to the visit, the manager completed an annual quality assurance self-assessment about the home and the service it provides. Questionnaires (surveys) were distributed to residents, visiting health and social care professionals and staff. Ten surveys from residents, 2 from health care professionals and 3 from staff were received and their views are reflected in this report. Residents and family visitors were also spoken to during the unannounced visit. Discussions took place with the deputy manager, nursing, care and ancillary staff. Care practice was observed. A tour of the premises and examination of a sample of the records that the home is required to keep - for example, residents care plans and medication records Care Homes for Older People Page 6 of 30 was also undertaken. The homes approach to equality, diversity, privacy and dignity of residents was considered throughout the inspection process. The current range of fees for the home are from 547.00 pounds to 990.00 pounds per week What the care home does well: What has improved since the last inspection? What they could do better: Though the care plans and assessment information about residents is mostly detailed, the way in which staff assess and plan for the social, recreational and psychological aspects of care could be improved with more information about peoples skills, interests and abilities and how these could be supported and developed with them in home. Regular written evaluation of the care given - describing the extent to which the planned care has met residents needs and expectations - should be developed to show that people are consulted about their care and any changes that are agreed to meet Care Homes for Older People Page 8 of 30 their changing care needs. The home is short of cleaning staff and is actively advertising and recruiting to fill staff vacancies. Meanwhile, nursing and care staff are undertaking some of the cleaning to ensure that the standard of hygiene is maintained. The home should ensure that there are always enough permanent and bank or agency staff for housekeeping duties. Some residents room doors were propped or wedged open. Room doors have automatic hold open magnetic devices fitted, so that when the fire alarm sounds, the doors will close as a safety measure to delay the spread of flames and smoke. The doors should not be wedged open as this will prevent them closing automatically and could put residents and staff at risk in a fire. The fire protection agency should be consulted about an approved type of automatic door closer that could be fitted to doors, if residents want their to have their room doors partly opened when in their rooms. 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 30 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 30 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. There is information available to potential residents and their diverse social and care needs are identified with them, prior to their move to the home, to ensure that their care needs can be met. Evidence: The home has information available in the form of a Statement of Purpose, Service Users guide and colour brochure. The deputy manager and senior staff member visit potential residents before they move into the home to assess them. Where possible potential residents and their family may visit the home prior to moving in, though many move following a stay in hospital. All residents have contracts or statements of their terms and conditions of residence if they are sponsored by the local authority. However, the survey responses from residents indicated that the majority (nine of the 10 received) were unsure or Care Homes for Older People Page 11 of 30 Evidence: answered no to the question Have you received a contract?. One person referred to the fact that the homes Statement of Purpose refers to the contract but they had not received one. The home should ensure that every resident has a written contract (if purchasing their care privately) and a statement of terms and conditions, at the point of moving into the home. All the survey respondents felt that they had received enough information about the home before coming to live here. The home does not offer intermediate care for those in need of intensive rehabilitation and so Standard 6 does not apply. The assessments seen for a sample of current residents were detailed and informative and gave sufficient information for staff to start to draw up initial care plans and prepare for peoples admission. Assessment documentation includes a section about symptoms associated with dementia. Care Homes for Older People Page 12 of 30 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. Peoples personal, health and medication care needs are met. The home communicates and works well with health and social care professionals to maintain and improve residents wellbeing. Evidence: A sample of 5 residents care plans was examined. Most were detailed and included a lot of assessment information and risk assessments (including the MUST tool - a means of assessing peoples risk of malnutrition - and risk of falls). One persons assessment and care plans were less detailed; the deputy manager acknowledged this and said the person had been admitted for respite stay at short notice. There were no specific care plans for peoples psycho-social care and activities, though a folder recording peoples inclusion and enjoyment in the activities on offer each day was available in the ground floor dining room. The planning and evaluation of residents social care needs should be improved as this is an important part of holistic care. Care Homes for Older People Page 13 of 30 Evidence: In the care plans examined, the daily record comments written by staff did not refer to the numbered care plans so the comments were general and non-specific.There was evidence of regular reviews of care but no specific evaluation of care interventions. For example, the care plans for a resident admitted with difficult behaviour (with the exception of some suggestions made in their night time care plan) do not suggest interventions that may be tried to reduce this behaviour that was clearly distressing other residents. Similarly, there is no specific direction or suggestion for staff interventions with another person who is constantly wandering. In practice, staff spoken with and observed during the visit were seen to be skilled and patient in their interventions with residents, especially those with dementia. Staff should improve the way in which they evaluate and document residents care and support, to show that the care given has met the assessed needs of residents. The deputy manager said they have very good support from an assessment centre in Oxford, the psycho-geriatrician and locally-based community psychiatric nurse (CPN), about the care and support of residents with dementia. A health care professional wrote in their survey that staff show respect for individuals and try to engage those with dementia. They (staff) provide attentive personal care. The home is next door to the local PCT community hospital and the homes staff and hospital staff communicate well together about training and clinical topics relevant to residents care. One visitor commented about how much better her relative looks since admission to the home. Two local GPs from local surgeries in the town provide medical cover and visit on Tuesdays and Thursdays respectively each week. There was evidence that arrangements are made for residents to have eye and hearing tests, physiotherapy (private) and chiropody. The home has a treatment room for consultations, chiropody and physiotherapy to take place in private. The home is purpose-built and has a good supply of disability aids and equipment to assist residents. Beds are of a variable height and with integral protected bed rails (if needed to protect residents from falls). The deputy manager confirmed that they have ready access to specialist pressure-relieving equipment, such as air mattresses, to help prevent skin damage for those residents assessed as at risk from pressure ulcers (bed sores). The medication administration records (MAR) for the sample of residents whose Care Homes for Older People Page 14 of 30 Evidence: records were examined, were largely up to date and signed by the staff member who had administered the medicines. All MARs had a recent photo of the resident attached as an added safeguard for staff to correctly identify residents when giving out their medicines. Residents or their representatives had signed permission slips for the use of residents photos in their care and medication records. A handwritten alteration on the MAR for a residents inhaler was not countersigned by a second nurse, which is best practice as a precaution to make sure the person writing the changed instructions has written them correctly and clearly to avoid medication errors that could be potentially harmful. There was one dose of medication that had not been signed for, so presumably had not been given, and there was no code letter to indicate the reason why this was so. The nurse on duty said she would immediately check this with the staff member responsible. The homes own senior manager visit report for August shows that there are external monitoring systems in place to spot check the medication and care plan records to make sure they are complete and up to date. Overall, the home has good procedures in place and staff spoken with are aware of, and follow these. The deputy manager said that they are in the process of changing to a local pharmacy for the supply of prescribed medication to the home to a local supplier. The pharmacist has arranged for training for the nurses in the different medication ordering and supply systems that this will entail. Being purpose built, all the rooms are single and with en-suite facilities. Sanctuary Care vision statement states We believe that people should be looked after with the utmost dignity and respect... we place great emphasis on the importance of maintaining the dignity and privacy of the individual. Staff were observed to be respectful toward residents and to protect their dignity. Residents and relatives spoke to on the day said that the staff are kind and caring and always asked them what they would like to do and gave them a choice. Care Homes for Older People Page 15 of 30 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 home offers a good range of activities and opportunities for people to take part in meaningful and enjoyable pastimes that suit their personal preferences and abilities. Mealtimes are relaxed, social occasions. The food is varied, nutritious and meets peoples needs and expectations. Evidence: The home has two part-time activities workers with a range of skills and who work on both floors of the home. They arrange a programme of activities that include games, craft sessions, quizzes and showing of popular films. Recent activities had a theme based on the Beijing Olympic Games. Peoples care records include a personal profile that outlines their family and social contacts, former employment, hobbies and interests so that staff have a greater understanding of residents likes and dislikes when they are unable to communicate these for themselves. On the day we visited, organised activities included art and craft work (completing an attractive collage of flowers and leaves), listening to music (in the ground floor lounge Care Homes for Older People Page 16 of 30 Evidence: dining room area) and a showing of a film - Brideshead Revisited - in a first floor lounge. Though it has not been open long, the home already has an active relatives group who are planning to set up a Friends of Wantage Nursing Home to raise funds for amenities and outings for residents. The gardens are attractive, with landscaped borders and lawns and bright summer flower containers on the patios. Garden furniture and sunshades provide seating and shade for residents to use in good weather. The deputy manager said they are looking at having shared use of the minibus from another Sanctuary nursing home in Oxfordshire, to take residents out on trips to local places of interest. The town has a local museum and garden centre nearby that are easily accessible for short trips out. The home has had difficulty in arranging for local churches to visit the home to hold regular Holy Communion for those residents who would like to attend, but this has just been done and there will be a monthly service. Ministers of various Christian denominations regularly visit residents in the home who belong to their congregations. Relatives spoken with during the day were seen to be made welcome by staff. The homes staff confirmed that there are no restrictions on visiting though the home will support the right of residents not to receive visitors if they do not wish to. There is a varied menu with a four weekly rotation and that is changed to reflect seasonal changes. There is an emphasis on using fresh produce and home-baking. Lunch (served between 12.30 and 1.30 pm) on the day of this unannounced visit was fish and chips (or mashed potato) with fresh vegetables and followed by fruit pie and custard. There is a choice at supper of a light cooked meal or home-made soup and sandwiches. Staff were observed to be discreetly helping those people who needed assistance with eating their meals. Mid-afternoon tea, biscuits and doughnuts were offered. The evening meal - high tea - is served from 5 pm to 6 pm and supper drinks and snacks are available in the evening. Care Homes for Older People Page 17 of 30 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. Residents feel safe and listened to. The homes policies and procedures are available understood and consistently applied. Evidence: The home has a complaints policy and procedures in place. The deputy manager said that they have had no complaints to date. She emphasised that the open door policy for the home means that residents and staff are encouraged to bring any concerns to managers at an early stage so that they can be followed up and resolved promptly. Staff spoken with confirmed that they have attended training sessions about safeguarding of vulnerable adults and this is included in the induction training programme. All staff receive a Sanctuary Care staff handbook that sets out the standards of conduct expected, confidentiality and whistle-blowing to report any instances of poor practice or suspected abuse of residents. The home has information about the local multi agency strategy for safeguarding vulnerable adults that staff have access to so that they know how to report any suspected or alleged abuse appropriately. Further information can be found on the website at www.oxonsafeguardingadults.org.uk. Residents and relatives spoken with during the visit were clearly at ease with staff and Care Homes for Older People Page 18 of 30 Evidence: it was apparent felt confident about approaching them with queries and for information. One resident wrote in their survey I would like to say this is an excellent home. You have a warm feeling about being here. Residents whose fees are subsidised by the local authority have regular review meetings with a care manager and staff to discuss their care and any concerns or suggestions they may have. The Commission for Social Care Inspection had not been made aware of any concerns, complaints or allegations about the home. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is modern and provides clean, comfortable and attractive rooms and facilities for residents. Evidence: The home is purpose built on three floors, with residents accommodation on the ground and first floors. The home is divided into two units, with those people living with dementia on the ground floor and those people who have more physical nursing care needs upstairs. The home is light and spacious, with different colour schemes in communal areas. The organisations newsletter states that the design of the building has incorporated picture clues and colour coding to assist residents who suffer from dementia. On the ground floor, peoples room doors have their names on, but other than this there are few visual cues to orientate residents to their surroundings and how to get to toilets or the dining room. This was discussed with the deputy manager who said that so far this did not appear to cause a problem for current residents. We recommend that the home should consider whether additional symbols or different coloured doors for example, would help residents find their way around more easily. All rooms are single and have en suite toilets and showers. Residents are encouraged Care Homes for Older People Page 20 of 30 Evidence: to personalise their rooms and those rooms visited were comfortable and homely, with people own photos, pictures, ornaments and small pieces of furniture. The standard of infection control in the home is good, with recommended hand hygiene facilities throughout and disposable protective clothing available for staff. The home has a designated laundry worker and the laundry is spacious tidy and wellmanaged. All areas of the home were clean and tidy on the day of this unannounced visit. However, the deputy manager said that the housekeeper and a domestic had recently left which meant that there were no cleaning staff available for the afternoon and over the week-ends. The home is actively recruiting staff for the domestic team. Meanwhile, care staff and the deputy manager are doing some of the routine cleaning work (cleaning and personal care roles are not undertaken in the same shift) to ensure that the home remains clean and hygienic for residents. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient skilled staff, who have received relevant training, to meet residents care needs. The recruitment procedures are thorough and should protect residents from potentially unsuitable carers. Evidence: A staff rota is kept and this showed that there are 2 registered nurses (RNs)and 3 care staff on the ground floor and 1 RN and 3 care assistants for the first floor. Overnight there are 2 RNs and 3 carers on duty. On the day of the inspection there was a total of 32 residents. The majority of staff have worked at the home since it opened in April this year and so the staff team know the residents well. Staff spoken with felt that there are usually enough staff and that residents care needs are well met. Care and nursing staff are currently doing some cleaning tasks because the housekeeper and a domestic have recently left so that afternoon and week-end shifts are not covered (please see Environment also). The provider acknowledges that there must be sufficient domestic staff always on duty and are actively recruiting to improve staffing levels. The deputy manager said that prospective new staff are being interviewed for the vacant domestic posts in the near future. Care Homes for Older People Page 22 of 30 Evidence: The recruitment procedures were discussed with the deputy manager and the system described follows good practice. All prospective staff submit an application form that shows their work history. Criminal Records Bureau (CRB) checks are undertaken and references are sought before new staff start work in the home. Checks of the potential staff members identity and suitability to work with vulnerable people (PoVA) are also undertaken as required. The deputy manager said that there are considerable delays sometimes in getting CRB and PoVA clearance for prospective staff and this in turn can delay the start date for new workers. Staff spoken with confirmed that they had had induction training before the home opened and have had updates in mandatory safe working practices since. Induction training includes Diversity and Respect for All and Customer Service - right first time that emphasise the need to support the dignity, privacy and independence of residents. Three staff surveys were received; two of the three staff were very satisfied with the induction and ongoing training and support they have to do their work. The third respondent was more critical, and considered the induction training was too rushed and that communication between staff about residents care needs is inadequate. This staff member, and one of the health care professionals feel that there are sometimes language difficulties where staff do not speak English as their first language and this sometimes hinders communication between residents and staff and visiting health professionals. Fifty percent of care staff hold the National Vocational Qualification (NVQ) in Care at Level 2. This meets the required percentage of care staff who have a nationally recognised qualification. Sanctuary Care uses a national training organisation to deliver mandatory training for staff. This home has a training room facility on the third floor. The staff training matrix shows that there is a regular programme of training in place for all staff. Additional training and updates for registered nurses in clinical care topics are provided. Training sessions are often shared with nurses from the adjacent community hospital so that staff benefit from sharing learning resources. Most members of staff have had dementia care training. Observations made on the day of the inspection visit and comments from relatives and residents confirmed that residents and their families are very satisfied with the care and attention given by staff. Several visitors commented on the friendly and welcoming atmosphere in the home. Care Homes for Older People Page 23 of 30 Care Homes for Older People Page 24 of 30 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 well managed and there are quality assurance systems in place to ensure that the care and facilities meet the needs of the people living here and that action is taken when any deficits in standards are found. The views of residents, their families and advocates, and other professionals are taken into account in the running of the home. Evidence: The registered manager left the home in August 2008 and the home is currently being managed by the deputy manager who has been in post since the home opened. Sanctuary Care did not inform us about this and will need to appoint a new manager to apply to be registered with Commission for Social Care Inspection. The deputy manager has considerable experience in working with older people in an NHS hospital setting before joining Sanctuary Care. Residents and staff spoken with say that the management team are approachable and readily available to discuss any ideas for changes and improvement about how the home runs. Care Homes for Older People Page 25 of 30 Evidence: The home has a quality assurance system in place: the results of the monthly surveys (August) were looked at during the inspection and showed very positive responses from people the organisation had asked about the care and facilities. Sanctuary Care has a central quality assurance team who undertake regular audits of the results of surveys and highlight any areas that need improvement. The organisation also monitors the quality of care by means of regular visits (as required under Regulation 26 of the Care Standards Act 2000). Reports of these provider visits, with action points, are kept in the home. The most recent report for August 2008 was seen. Regular resident, family and staff meetings are also held. The home does not manage any residents finances but does hold some peoples personal allowances securely on their behalf if they or their family wish (if the individual is no longer able to manage their own money safely). Peoples individual cash balances are kept in separate folders in the safe and only the administrator or deputy manager have access to the keys. The administrator described safe systems of checking and auditing monies held on residents behalf. Records of transactions are kept and available to residents or their representatives at any time. There are health and safety policies and procedures in place with copies of these available to staff in the home in their offices and training room. All staff are given a Sanctuary Care staff handbook that outline the their responsibilities in relation to safe professional work practice. Staff training records and discussion with individual staff showed that they have received mandatory training in moving and handling, health and safety, food hygiene, infection control and fire safety training. The deputy manager confirmed that the maintenance person undertakes the routine fire alarm and fire equipment safety checks. It was noted that 2 residents room doors were propped open. Residents room doors have automatic self-closing devices fitted as a fire safety measure: the doors are either held fully open or kept shut. Any doors held open by the devices will release and close automatically when the fire alarm sounds. Room doors should not be propped or wedged open as this impedes the automatic mechanism and would not protect the resident from flame and smoke spread in the event of a fire. This was discussed with the deputy manager. One door closer was faulty and was repaired during the visit. The other door is wedged open because the resident is unwell and needs regular attention and checks. The home should consult with the fire safety authority to review the fire precaution measures so that for those residents who prefer, or whose care needs require it, can have their room doors held partially opened. Care Homes for Older People Page 26 of 30 Evidence: As a new-build, the homes equipment and fittings are new and under warranty, so that any repairs and replacements are promptly dealt with by the manufacturers, builders and suppliers. Records are kept of safety checks of hot water temperatures, particularly baths and showers, to minimise the risk of scalds to residents. Care Homes for Older People Page 27 of 30 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 30 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 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 Ensure that all residents (or their representative, if they are acting on the residents behalf) are provided with a written contract and statement of terms and conditions with the home. The home should include regular written evaluation of the care given and ensure that individuals care plans contain sufficient up to date information to guide carers as to how best to meet residents care needs and wishes. Consideration should be given to improving the signage and layout in the ground floor unit to help people with dementia remain independent and confident in finding their way around the unit safely. The home should consult with the Fire Protection authority about the automatic door release mechanisms and whether, following appropriate risk assessment, alternative door closers may be fitted to room doors where residents wish to have the option of having their door partially opened. 2 7 3 19 4 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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!