Inspection on 26/09/08 for Watlington and District Care Home

This inspection was carried out on 26th 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

Watlington and District Care Home 17/10/07

Watlington and District Care Home 24/01/07

Watlington and District Care Home 24/11/05

Watlington and District Care Home 13/07/05

Watlington and District Care Home 31/01/05

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: Watlington and District Care Home Hill Road Watlington Oxfordshire OX49 5AE     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: 2 6 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 31 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 31 Information about the care home Name of care home: Address: Watlington and District Care Home Hill Road Watlington Oxfordshire OX49 5AE 01491613400 01491615115 julie.cooper@sanctuary-housing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sanctuary Care Ltd Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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: Old age, not falling within any other category (OP) Dementia - (DE). The total number of service users to be accommodated is 60. Date of last inspection Brief description of the care home The Watlington & District Care Home is a purpose-built 60-bed care facility, providing nursing care to older people who are physically or mentally frail. The ground floor has 30 single rooms, a dining room and a sitting room overlooking the front of the home, and a quiet sitting room and a sun lounge to the rear of the home with access to an enclosed courtyard garden with a large raised centre flower/herb bed and paved pathways to a further large garden area. The first floor, with a further 30 single rooms, Care Homes for Older People Page 4 of 31 Over 65 0 60 60 0 Brief description of the care home includes a designated area for the care of a maximum of ten service users requiring intensive short-term rehabilitative intermediate care. The local primary care trust works in partnership with the home to provide physiotherapy and occupational therapy for service users receiving intermediate care. Service users admitted for intermediate care may be in a younger age range (from age 18 years and over). There is a large sitting room/activities lounge and dining room. A third floor is used for staff accommodation. There are passenger lifts and stairs accessing residents accommodation. The home has a range of assisted bath and shower facilities and two treatment rooms. All residents rooms have an en-suite toilet and washbasin. The homes kitchen and laundry facilities are in refurbished and refitted former outbuildings across the approach drive to the homes main front entrance. The home has its own minibus for taking residents on outings. Care Homes for Older People Page 5 of 31 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 last key inspection of this care home was on October 17 2007. This 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 deputy manager completed an annual quality assurance self-assessment (AQAA) about th home and the service it provides. CSCI questionnaires (surveys) were distributed to residents, relatives, visiting health and social care professionals and staff on the day of the visit. Completed surveys were returned - 10 from residents, 10 from relatives, carers and advocates, 4 from staff, and 6 from health and social care professionals - and their views are reflected in this report. Residents and family visitors were also spoken with during the visit. Discussions took Care Homes for Older People Page 6 of 31 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 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 this home are from 624.00 to 1065.00 pounds per week. People admitted for short stay intermediate care (rehabilitation) are paid for by the NHS. What the care home does well: What has improved since the last inspection? The home has taken action to meet the requirements made at the last inspection, namely, in relation to improving staff awareness and promotion of privacy and dignity for people living here; improving the records and procedures for recruiting and checking prospective new staff; ensuring that all staff have training and updates in safeguarding of vulnerable adults; and in caring for people living with dementia. Improvements are ongoing in the ways in which the homes staff support and prepare people for discharge home following their stay in the intermediate care unit, in particular their ability to manage their own medication safely. The home has continued a planned programme of redecoration and improvements in the building for the benefit of people living here, especially those with dementia. In the grounds, removal of an inner fence around the garden allows better access for residents, especially those with dementia. A greenhouse has been constructed with access for people using wheelchairs, so that residents can take part in gardening Care Homes for Older People Page 8 of 31 hobbies. Additional outdoor seating has been provided so that residents and their families can enjoy the tranquility and views from the grounds. An Art Therapy programme for people with dementia has been piloted and there are plans to re-commence the programme in the home. 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 31 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 31 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 about the home and its facilities, and peoples diverse health and support needs are identified with them before they move to the home so that they confident their care needs will be met. Evidence: The homes Statement of Purpose, Residents Service User Guide and colour brochure provide clearly written information about the homes services, facilities and fees (and any additional charges that will be made for services such as hairdressing, chiropody, newspapers and any personal shopping). Since our last visit and recommendation to include more information about how the home intends to promote and protect peoples privacy and dignity, the Statement of Purpose has been amended (March 2008). It includes Sanctuary Care (the home owners) philosophy of care in relation to maintaining the dignity and privacy of the individual...we employ caring staff of the highest possible standard. People who are sensitive to each service users spiritual and Care Homes for Older People Page 11 of 31 Evidence: ethnic needs, and who appreciate that mutual respect is essential to achieving our aims. Additional information had just been added to advise people who are self-funding about what to do if their financial reserves are falling and nearing the threshold limit and how to get financial information about care home fees from the local authority. A sample of pre-admission information for 5 residents was looked at. The assessment information was detailed and informative and would have given sufficient information for staff to start to draw up peoples initial plans of care and to prepare for their admission. In the case of people referred for intermediate care there was appropriate assessment information provided from the local NHS multidisciplinary team (for example, occupational therapists, care managers and physiotherapists and doctors) who had arranged peoples transfer from local NHS hospitals for intensive rehabilitation and preparation for going home. Responses from our questionnaires (surveys) from relatives indicated that people felt that residents and their friends and relatives had enough information about the care home to help them make decisions about whether the home was likely to meet their expectations and care needs before they moved in. Care Homes for Older People Page 12 of 31 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. Further attention should be given to updating and evaluating residents written plans of care. Evidence: A sample of 5 residents care plans were examined. Most were detailed and included a lot of assessment information including the Malnutrition Universal Screening Tool (MUST) - a means of assessing peoples risk of malnutrition; their risk of falls; and psychological well-being and whether they may be depressed. There were no specific plans of care to show how staff will meet peoples emotional and social care needs. In many of the care records seen there was no record of peoples participation in any planned activity or social event since July 2008. The planning and evaluation of peoples social and emotional care should be improved as this an important part of person-centred care. Care Homes for Older People Page 13 of 31 Evidence: Several care plans had not been updated to show that a residents care needs had changed and the actions that staff should take to meet those changed needs - for example, the effects of changes in someones medication and how this affected their behaviour and ability to take part in excursions out of the home. Similarly, for someone assessed at risk of falls, there was no evaluation by staff of the effectiveness of the planned intervention of regular exercise, or care of a wound sustained as a result of a fall. In practice, staff spoken with, and observed during the visit, were seen to be skilled and patient in their interventions with residents. Residents, relatives and health care professionals comments in the CSCI surveys they completed tell us that the care home meets the needs of the people living here and that the support and care given by staff is that which was expected and agreed when individuals came to live here. Residents family members feel that they are kept up to date with important issues affecting their loved ones (such as hospital admission or following an accident or fall). Comments from health care professionals included: Care plans are always up to date and residents needs and choices identified correctly ...carers are always able to discuss care plans and actions in a knowledgable way. In answer to the question What does the home do well? one health care professional wrote: Person-centred care. Understanding dementia and the effect it can have on behaviour. Knowledgeable in finding ways to manage the different stages of dementia and trying to understand the underlying message that the behaviour is conveying. Another professional wrote: The service does a good job under difficult circumstances on the EMI [dementia care] unit where problems with dealing with frail, but aggressive patients are the norm. Relatives comments were also very positive, for example, They give excellent care to all patients Staff are great at what they do. Theyre kind and caring I cannot fault the care and attention my [spouse] gets. A service user from the intermediate care unit wrote: I feel that the care and support that has been provided for me has been of an excellent standard. Checks of a sample of the medication administration records (MAR) showed that the medication is well managed. There are safe systems and procedures in place to ensure that residents receive their prescribed medicines correctly from registered nurses. On the intermediate care unit, some people manage their own medicines. There are safeguards in place to make sure that people understand the purpose of their medicines, instructions about when to take them and can do so safely, in preparation for when they go home. Care Homes for Older People Page 14 of 31 Evidence: The records seen, and conversation with residents and visitors confirmed that arrangements are made for people to have eye and hearing tests, physiotherapy (at additional cost, unless the person is receiving intermediate care and rehabilitation) and chiropody. Health care appointments and visits from GPs, specialist mental health professionals and care managers were recorded, showing that people have access to medical and social care services as required. At our last inspection we had some concerns that some staff were communicating with and about residents in a way that appeared to be patronising or inappropriate and a requirement was made that the home must improve the ways in which it promotes and protects the privacy and dignity of people living here. During this visit, we observed no instances of poor practice in relation to making sure peoples privacy and dignity was protected. Staff were polite, friendly and discrete when talking to residents and their visitors. However, we did note that some residents in the ground floor unit were wearing clothes with food and drink stains down their fronts indicating that they had not had clothes protectors when needed during the morning. The deputy manager had also noted this and took action to remind staff to assist people and offer a change of clothing or discreet protection so that they could maintain their appearance as they would wish. Several surveys commented specifically about the care and support provided: [Residents] are treated with love and respect [The home]respects peoples individual needs [Staff] are continually prepared to try and meet the needs of residents as individuals and listen to the relatives and residents. Care Homes for Older People Page 15 of 31 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 generally meets peoples needs and expectations. Evidence: The homes AQAA (completed in June 2008) tells us that there are two activity workers who job share and this has improved the availibility of organised activities on both floors of the home. An art therapy project, piloted for 6 months in the dementia care unit, has proved very successful and the home was looking forward to the return of the Art Therapist following a period of sick leave, to continue this work. There were displays of residents art work in the ground floor residents lounge and the first floor dining room. Two residents spoken to on the first floor were pleased to point out their work. On the day of our inspection, several residents in the ground floor lounge were busy with colouring, listening to music and chatting with a carer. The homes AQAA tells us that they have improved the activities programme since our Care Homes for Older People Page 16 of 31 Evidence: last inspection with more variety of things to do, information boards to tell people what is available, and use of the homes minibus for trips out. In answer to our survey question about whether people felt there were activities organised by the home that they can take part in, 7 out of the 10 residents surveys we received stated this was always the case and 3 stated usually. The home has recently bought and constructed a large greenhouse in the garden that has wheelchair access, so that people with an interest in gardening can be involved in growing seeds and plants for the garden and in more outdoor activity. Local church clergy conduct regular services in the home and the times and dates of services are displayed in the reception area. Residents also have regular visits from their own church communities and denominational ministers as they wish. The removal of an internal perimeter fence around the grounds at the rear of the home has improved the access to the gardens and additional seating means that residents and their visitors can enjoy walks and the beautiful views. The grounds and gardens are very well maintained and attractive. Families and friends are actively encouraged to participate in the daily life of the home and there are no restrictions placed on visiting times (during day light hours). Our own observations and relatives surveys and comments made during our visit, showed that visitors are made to feel welcome in the home. Comments made included: The general atmosphere of the care home is happy and welcoming on all levels The overall contact with my [parent] is excellent and with me - its always great. The home has an active Board of Trustees (the Watlington Hospital Charitable Trust) members of which visit the home regularly and who represent and help maintain links with the local community. The Trust supports relatives and friends of the care home in fund raising for additional equipment or facilities for residents (such as the purchase of the greenhouse). Families. friends and local school groups are invited into the home for social events and to participate in special occasions such as bonfire night firework celebrations. The inspector joined residents for lunch (the main meal of the day) in the first floor dining room. Dining tables were nicely set with linen table clothes and napkins and each table had a laminated menu showing the choices for lunch. There are always two main meal choices, including a vegetarian option, and always alternatives if people change their mind or do not like either of the menu choices on the day. The atmosphere in the dining room was relaxed and sociable. Staff were attentive and Care Homes for Older People Page 17 of 31 Evidence: helped people discreetly if they needed assistance. Two residents spoken to during lunch said they enjoyed their meal and that the food is always good in their experience. There was a choice of chilled fruit drinks or water to drink and some residents had an alcoholic drink with their meal. Tea or coffee was available after the meal. Residents survey responses to the question about whether people like the meals at the home ranged from always (6 people), usually (3), but one person answered almost never. Care Homes for Older People Page 18 of 31 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 and their families and advocates are confident that people feel safe and are listened to, so that any concerns are followed up and acted upon. Staff training in safeguarding of vulnerable adults has improved since our last inspection. The homes policies and procedures are available, understood and consistently followed so that residents are protected from abuse. Evidence: The home has a complaints procedure leaflet and information about how to make a complaint. Copies of the leaflet are in the reception area. The information is clearly set out and easy to understand. All 10 if the relatives who responded to the survey we gave out, stated that they know how to make a complaint about the home if they need to. Seven out of 10 people said that the home has responded appropriately if they or their relative have raised concerns about their care and the remaining 3 felt this had usually been the case. Out of the 10 residents surveys received, 8 people stated they knew how to make a complaint; one person did not answer this question, and one answered no. The homes AQAA (June) tells us they received 4 complaints in the 12 month period between June 2007 and June 2008. None of the complaints were upheld. One referral was made to the local authority safeguarding of adults team and investigation carried Care Homes for Older People Page 19 of 31 Evidence: out by them. The local authority were satisfied with the homes procedures and practice, and their responses to the investigation. Since our last inspection, the home has acted on our recommendations about improving the way in which complaints and concerns (even if informal or verbal) are logged in their complaints record. The complaints log was seen and contained copies of the complaints and related correspondence. The AQAA information confirms that the home has updated its policy about Safeguarding adults and prevention of abuse as recommended in our last report, so that staff are aware that they must report any allegation, suspicion or actual occurrence of abuse to the Commission for Social Care, as required, within 24 hours. The Commission has not been contacted directly by any residents or their representatives regarding complaints or adult safeguarding matters. The records of staff training seen during this inspection showed that staff are required to attend training in safeguarding adults and to attend regular updates, so that they are clear about what they must do if they suspect or witness abuse of residents. The deputy manager said that the training consists of watching a video, followed by a question and answer session. Further information about safeguarding is available from the local authority website - www.oxonsafeguardingadults.org.uk - Safer from Harm. We recommend that managers and staff have access to this site and the homes policy document includes reference to the website and training available through the local authority. All new care staff receive information about safeguarding in their induction training as part of the Skills for Care programme. New staff also receive a copy of the General Social Care Council (GSCC) Codes of Conduct booklet for all employers and employees working in social care, that sets out the responsibilities of all staff in protecting vulnerable people. Care Homes for Older People Page 20 of 31 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. The home is well maintained and provides a clean, comfortable, safe and attractive environment for people living here. Evidence: The home is located close to National Trust open countryside and a short drive from the shops and facilities of Watlington. The building was purpose- designed to accommodate people with disabilities and has wide corridors and doorways. Residents accommodation is in single rooms each with an en suite hand washbasin and toilet. Accommodation is on two floors. The first floor has 10 rooms for people needing short stay rehabilitative care (intermediate care) and 20 rooms for older people with general nursing and palliative care needs. The 30 ground floor rooms are for people living with dementia. The standard of decor and furnishing throughout the home is of a very good standard. All areas of the home were commendably clean, attractive and comfortable and with one exception in the ground floor area near the main lounge, all areas were free of unpleasant odours. Since our last inspection, a programme of redecoration and re-carpeting has Care Homes for Older People Page 21 of 31 Evidence: continued. People are encouraged to personalise their rooms with pictures, ornaments, small bits of furniture and treasured possessions. The homes AQAA tells us that they are working to improve the signage around the home to make it more user-friendly, especially for those residents with dementia, so that they can find their way around the home more easily. The main kitchen and laundry are located in a separate building. The laundry is well equipped with machinery designed to meet the work load and standards to ensure infection control. Care Homes for Older People Page 22 of 31 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 numbers of staff who have received relevant training to meet the care needs of the people living here. Since our last inspection the records of staff recruitment and training have improved and show that the recruitment procedures are thorough and should protect residents from potentially unsuitable carers. Staff have a good understanding of residents care needs and personal support is offered by a skilled and caring team. Evidence: On the day of our visit the home had sufficient numbers of staff on duty, with a mix of qualified nurses and carers, the deputy manager, administrator, receptionist, maintenance person, catering, laundry and domestic staff working the shifts that were as listed on the home duty rosters. The 6 health care professionals who completed our surveys all answered that care staff usually have the skills and knowledge to meet the needs of residents. One person wrote that because of their limited English language skills and accents, some foreign staff were difficult to understand, especially for the elderly; and that understandably, some overseas staff are not always familiar with the UK system of health care and the NHS. This individual also pointed out that overseas staff sometimes have to deal with racist behaviour from residents with dementia and this is a delicate situation as, of Care Homes for Older People Page 23 of 31 Evidence: course, a demented person cannot learn not to discriminate [and] they sometimes prefer the white staff. Three of 6 health care professionals surveys indicated that, in their opinion, the numbers of staff are not always sufficient. One person wrote It is a universal feature of care homes that they require greater staffing levels; another suggested Maybe need more staff for busy times, and the third felt that the home could improve by ensuring staffing levels are sufficient to deliver top quality care. Three out of the 4 staff who completed surveys stated that they consider there are usually enough staff on duty - but one person stated this is sometimes the case. Overall, staff were usually satisfied with the information exchange about residents and their care needs and felt they had the support experience and knowledge to meet residents different needs. There was evidence that since our last inspection the records of staff training are better maintained and show that staff have attended or are planning to attend mandatory training and updates. Four staff have completed a Diploma in Dementia Awareness course to improve their knowledge and practice in caring for residents living with dementia. Staff surveys showed that people had had induction training when they started working at the home. Their 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 (and colleagues). The deputy manager confirmed that 11 out of a total of 38 staff have achieved National Vocational Qualification at Level 2 or above, with a further 10 working towards this. This means that the recommended 50 per cent target for care staff with a nationally recognised qualification in care should soon be achieved. Information provided in the homes AQAA tells us that 5 full time and 10 part time staff had left in the 12 month period between July 2007 and 2008. Examination of a sample of staff files showed that the home has improved its records and practices in relation to recruitment as required following our last inspection. The files looked at showed that application forms had been completed by prospective staff that showed their previous work history. Criminal Records Bureau (CRB) checks had been undertaken. There was evidence that one person had been allowed to start work in the home on receipt of a satisfactory PoVAFirst check (an initial check to show that someone has not been listed as unsuitable to work with vulnerable people) but only under direct supervision of other experienced staff until the home had received the full and satisfactory CRB Care Homes for Older People Page 24 of 31 Evidence: clearance. From our observations, surveys and conversations with residents, relatives and staff we consider that the home has taken action to improve and promote staff practice in relation to how staff interact with residents, so that the outcomes for this part of our assessment are now rated as good. Care Homes for Older People Page 25 of 31 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. The homes policies and procedures in place ensure the safety and wellbeing of residents, visitors and staff. Evidence: The home has been without a registered manager since July 2008 and the home is currently being managed by the deputy manager. For this reason the standard 31 relating to the management cannot be scored as fully met. Senior nurses in each unit undertake the clinical nursing care assessments and lead on nursing care matters. We understand that the organisation as actively recruiting for a new manager who will need to apply to be registered with the Commission. Three out of the four staff who had completed our survey added comments in appreciation of the deputy manager, for Care Homes for Older People Page 26 of 31 Evidence: example, At the moment we dont have a Home Manager but our deputy manager carries out the role very well and is very supportive to all the staff and I feel our Deputy Manager has done a great job while we have no manager. It was evident that there is an open door approach to management and residents; visitors and staff find that the deputy manager and visiting regional managers from the company are readily available to discuss any ideas for changes and improvement about how the home is run. The homes AQAA states that one way it is felt it can improve is by encouraging peoples interest in, and attendance at, the residents and relatives forum. Sanctuary Care has an established quality assurance process and residents are invited to complete an annual survey to get their views about the home and service it provides. The results of the surveys are discussed with residents, relatives and staff at their meetings. The organisation also monitors the quality of care by means of regular visits (as required under Regulation 26 of the Care Homes Regulations 2001). Reports of the Regulation 26 provider visits with action points for staff to carry out, are kept in the home. At our last inspection we found that a number of the policies and procedures for the home were dated 2004 and needed reviewing and updating, to reflect current best practice in the conduct, safety and management aspects of the home to ensure the health and well being of residents and staff . The AQAA completed in July 2008 states that a review of almost all the policies and documents were undertaken in September 2007 or February 2008. Copies of the current health and polices and procedures are available to all staff in the nurses stations and managers office. 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 (where an individual is no longer able to manage their own money safely). Peoples individual cash balances are kept in individual wallets with a record of any transactions. A sample of the balances and records seen at the inspection showed that residents money is kept secure and with limited authorised staff access. Health and safety aspects of running the home are well managed with a range of checks in place to ensure the environment is safe for residents, visitors and staff. The flre log showed that risk assessments had been updated with actions to be taken for November 2008. Care Homes for Older People Page 27 of 31 Evidence: The staff training matrix and discussion with individual staff showed that they have received mandatory training in a range of health and safety topics. Care Homes for Older People Page 28 of 31 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 29 of 31 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 7 The home should continue to develop and improve care plans to ensure that they contain sufficient up to date information to guide carers as to residents needs and wishes, especially in relation to their emotional and recreational care. Care records should include evaluation information to show to what extent the planned care has met peoples needs and, if not, what agreed changes have been made to the plans of care. Ensure that staff are aware of the local authority information and training about safeguarding and that the website and local contact numbers are included in the homes policy and procedures. 2 18 Care Homes for Older People Page 30 of 31 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 31 of 31 - 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!