Inspection on 16/12/08 for Weir Nursing Home The

This inspection was carried out on 16th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Weir Nursing Home The 13/03/07

Weir Nursing Home The 16/05/06

Weir Nursing Home The 31/10/05

Weir Nursing Home The 18/07/05

Weir Nursing Home The 12/10/04

Weir Nursing Home The 06/05/04

Weir Nursing Home The 09/02/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Weir Nursing Home The Weir Nursing Home The Swainshill Hereford Herefordshire HR4 7QF     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: Denise Reynolds     Date: 1 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Weir Nursing Home The Weir Nursing Home The Swainshill Hereford Herefordshire HR4 7QF 01981590229 01981590445 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Weir Nursing Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 35 Number of places (if applicable): Under 65 Over 65 35 35 35 dementia old age, not falling within any other category physical disability Additional conditions: 35 0 35 The home may continue to admit service users with the categories DE and DE(E) provided that dementia is not of such severity as to render such service users either, as a danger to themselves or others. This Home provides care for residents aged 60 years and over. This Home provides specialist care for Parkinsons Disease sufferers. Date of last inspection Brief description of the care home The Weir Nursing Home is situated near the village of Swainshill 4 miles from Hereford. The Georgian property is leased from the National Trust and operated by The Weir Nursing Home Ltd. It is set in attractive gardens adjacent to the Weir National Trust Care Homes for Older People Page 4 of 32 Brief description of the care home gardens with extensive views over the River Wye and surrounding countryside. The Weir is a large country house with large rooms and high ceilings; recent improvements to the building have been done to a high standard. The home is currently registered for up to 35 people. It provides a service for people who need personal or nursing care including people with dementia related care needs and Parkinsons Disease. People at the home are able to choose whether they mix with other people or spend their time mainly in their own rooms. Some of the rooms are much larger than the minimum required and many have enuite facilities. The rural setting means that people visiting need their own transport or to use bus services that pass on the Hereford to Brecon road. Information about what is covered by the weekly fee and what services are charged for seperately should be obtained from the home. A copy of the most recent inspection report is made available at 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: This was a full inspection of The Weir to look at how the home is performing in respect of the core national minimum standards (the report says which these standards are) and the quality of the service that the people who live there experience. We call this type of inspection a key inspection. We, the Commission, made two visits to the home for this inspection; these were carried out by one inspector who, on the first day, arrived unannounced. We returned for a second day to complete some aspects of the inspection. The Home completed an Annual Quality Assurance Assessment (AQAA) earlier in the year and we used information provided in this to help us plan our inspection. We also Care Homes for Older People Page 6 of 32 took into account information in surveys that were returned to when we did our Annual Service Review in the summer. During the inspection we spoke privately to four people who live in the home and visited three others who are cared for in bed. This helped us get an impression of the level of care and comfort being provided to them. We also had a conversation with the relatives of one person who had recently moved in. During both days we were able to observe life in the home and the way that the staff team treats people who live there. We met a number of staff and spoke with four of them in private. We also spoke with the owner, acting manager, training manager, cook and activity organiser. We looked at parts of the premises and at various records such as care records, staff files and records to do with the premises. Our last key inspection was in March 2007 and we did an Annual Service Review in June 2008. What the care home does well: What has improved since the last inspection? What they could do better: Some of the improvements found when we did our last inspection and described in the AQAA had not all progressed to the extent we had expected. For example, adoption of the principles of the Mental Capacity Act was not strongly evident. We also found some things that needed to be done better. Some things were dealt with as soon as we mentioned them at the inspection and the critisisms we made were responded to in a constructive way. Areas for improvement include care documentation that helps ensure staff are well informed about each persons care and some aspects of the way medication is managed. We have also asked the owner and management team to review their staffing levels at the busiest times of day and develop their systems for monitoring the quality of the service. The ability and willingness of the owner and management team to address the things that need to improve gives us confidence that they will be acted on. Care Homes for Older People Page 8 of 32 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 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 10 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 who might be thinking of The Weir as their home (or their relatives if they are not well enough) are able to visit the home before making this decision. The staff do as much as they can to check that they are able to provide the right care for each person they offer a place to. Evidence: We looked at information about two people who had moved to the home recently. This showed that staff had gathered information to help them be sure they would be able to cater correctly for their needs. We spoke to the acting manager about the process they follow when new people to come to the home. He confirmed that they get copies of information from social services and meet and speak with the person concerned and their relatives. One person had been at the home for two weeks and there was clear information available about their care needs; in addition the person was able to express her needs to staff well. However, the written information about the care and Care Homes for Older People Page 11 of 32 Evidence: support they need had not been developed further since they arrived. When we discussed this with the acting manager he showed us a new form he has designed to give people and their families more idea of the care they can expect when they arrive. This was just being introduced and will help make sure that staff have the information they need as soon as a person arrives. We spoke to two people who had not been at the home long. They confirmed that they had been able to visit the home before they moved in and that they and their relatives had been dealt with in a friendly and helpful way by the owner, manager and staff. The Home does not provide an intermediate care service so Standard 6 does not apply to The Weir. Care Homes for Older People Page 12 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. People living at the home generally receive the care and attention they need. There are some areas where improvements are needed and the management team are committed to dealing with these to make sure people get the care they need. Evidence: To help us understand the standards of care the owner and management team expect we looked at the content of the staff handbook. This showed us that staff are expected to work in a caring and respectful way and to treat everyone who lives at the home as an individual. A large proportion of the staff who work at The Weir do not speak English as their first language; we saw in the handbook that the management expect staff to speak only English in the home. During our inspection we found that staff were speaking English and that in most cases did so well. Some comments were made by people living in the home that the staff are very good but that a few can be hard to understand at times. One person was very good humoured about this and joked that they often have a Care Homes for Older People Page 13 of 32 Evidence: laugh with the staff about it. The owner and acting manager accepted that it would be beneficial to explore more avenues for staff to improve their English language skills. The staff handbook also has section about how peoples personal care should be dealt with in respect of things like privacy and warmth when helping people with washing, bathing, dressing etc. It also stesses the importance of people having their call bell, phone, paper, TV remote and a drink within reach and that their glasses and hearing aids are there for them. During our inspection we saw this happening in practice and noted that staff were very caring in their approach to people. This positive view was supported by numerous cards and letters we saw from the last 2 years thanking staff for the care provided. For example, one person wrote Sincere thanks for the very kind care that you and your excellent staff showed mother during the past months. We feel she had 5 star treatment. We are sure that the lovely room made mother feel special together with the kindness of your staff. We would not hesitate in recommending your nursing home. Another relative wrote The staff werent just carers they became her friends. X in particular was exceptional. The stress you took off us as family was immense. We cannot praise you and all at The Weir highly enough. Although we observed examples of good practice we also became aware of some areas that need to be improved. In particular we found a lack of written information about some aspects of peoples care. In some cases the information needed to be more detailed and in others information was out of date or had not been reviewed. We found some duplication caused by there being different forms in use for the same topics and felt that this could be confusing for staff. We saw records of pressure area and wound care management where there was unclear information to show what care was being provided and what the correct treatment plan was. This was caused partly by the use of a washable board for some recording; when the board was cleaned the information was lost. It is essential that pressure area and wound care records are comprehensive so that nurses and carers at the home know the correct care to give and so that improvement or deterioration can be carefully monitored. Our discussions with the acting manager and two other nurses established that all were aware of the condition of each person and gave consistent accounts of the wound Care Homes for Older People Page 14 of 32 Evidence: care being given. Care assistants we spoke to also gave clear accounts of how they work alongside the nurses to provide pressure area care, for example by reporting concerns to the nurses. The use of the wipe clean board was immediately dispensed with by the management team with the support of the owner. When we returned for the second day of the inspection the acting manager had reviewed each persons pressure area or wound care plan himself and set up a well organised and clear system to make sure the records were kept correctly in future. When we received the AQAA from the home we were pleased to see that work had been done to implement the requirements of the Mental Capacity Act, (legislation aimed at upholding the rights of people with reduced capacity to make their own decisions). When we looked at the care records we found limited evidence that this was being followed through to the extent we expected; for example, there was limited information that showed people are being actively involved in making decisions about the content of their care plan. We also noted that while there are consent forms in each persons file for a photograph and who has access to their records, these had not been filled in. The quality of the records about food and fluids taken by the most unwell people needed to be improved and the home should record the ratio of fluid thickening powder to the amount of liquid. These are important things because when people are unwell their nutrition and how much they drink become even more important than usual. Similarly, thickening powders help people with swallowing problems to eat and drink more safely but the consistency depends on the persons needs and must not be guessed at. We consider that the care assistants should be more involved in the overall planning of care and the content of the written care plans because at the moment they do not routinely see the main care file for each person. We think this matters because it excludes them from information that could be very important. For example, on one occasion we saw a person who had been left with food in her mouth although her care plan included details of her being at risk of choking if left unattended while eating. This information was not readily available to the care assistants. On one occasion during the inspection we became aware of a delay of about 10 minutes before someone had their call bell answered. We spoke to this person who was distressed by the wait as they were afraid they might not get to the toilet in time. Generally staff were quick to answer bells and in fact the previous day this person told us so herself and commeneted that such a long dealy was unusual. While this may Care Homes for Older People Page 15 of 32 Evidence: have been an isolated incident we asked the owner to review staffing levels at the busiest times of day to ensure that people wait for as little time as possible for attention. On the first day we were at the home we saw wheelchairs being used without footrests. This is unsafe and we made an immediate requirement for it to be addressed. When we returned on the second day we were given written confirmation that all wheelchairs had been checked to make sure footrests were in place and observed that they were being used. We also observed staff discussing the importance of people spending as little time as possible in wheelchairs for their comfort and to reduce the added risk of pressure area problems. We inspected the medication at the home by doing a check of part of the medication storage and a simple audit of some items of medication. We found that most of the items we checked were correct but did identify some errors. Most significantly we found some examples of administration charts bing signed for medication that had not been given. The audit indicated that this had happened on one day, for one dose (ie there was a discrepancy of only one tablet). Whilst this was therefore not an indicator of widespread poor practice it was of concern. The owner and the acting manager planned to raise the matter with the nurses on duty during the period in question and accepted the importance of improving their internal audit systems. We identified that external items such as prescribed creams were not being signed for; this was in spite of this being in a report by the PCT pharmacist in September 2008. Packages are not being signed and dated when opened; this was also identified by the PCT pharmacist. We noted that the medication round took well over an hour which is unsurprising given the size and layout of the home and the number of people staying in their rooms. This should also be taken into account when reviewing the staffing arrangements. During the inspection the General Practitioner who provides primary health care support to the home visited. We noted that the acting manager updated the GP on the specific health related issues of the people he wanted the doctor to see with detailed information about each of them. This arrangement appeared to be providing regular and thorough medical attention for people who have health problems and the acting manager and the GP appeared to share a committment to leave no stone unturned. The acting manager is planning to improve the quality of the care the home provides by implementing the nationally recognised Gold Standard Framework into the home. This is a tool to help staff make sure each person gets the specific individualised care Care Homes for Older People Page 16 of 32 Evidence: they need, particularly when they have significant care needs. This initiative, together with the improvements that were begun before we completed the inspection reassured us that the home has the ability and commitment to address the faults we found. We also saw some examples of very kind and gentle care being given which led us to think that staff will work with the management team to achieve this. 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. The importance of nutritious enjoyable food is recognised and people who live at The Weir can choose from a varied menu at each mealtime. Improvements to the current range of activities are planned so that people have more choice of ways to spend their time. Families and other visitors are made welcome and there is a friendly atmosphere in the home. Evidence: People are able to choose whether they spend their time in their own room, in the communal rooms or to move between these at different times of day. A number of people at the home are cared for in bed and we observed staff popping in to see them when time allowed. The staff handbook says how staff are expected to help make day to day life pleasant for people for example, by describing the sort of help people should be given at mealtimes. In a thank you letter, a family spoke of the welcome at the home - Care Homes for Older People Page 18 of 32 Evidence: The Weir was so relaxing and your staff treated visitors with the same kindness as they showed to residents. Many friends that we brought to see Mum were so impressed with all aspects of your home. We experienced a friendly welcome when we arrived on the first day of our inspection; we were let in and greeted very promptly when we arrived and given a warm welcome by the acting manager who did not know our inspector. When we explained the reason for our visit the response was one of interest and helpfulness which was then demonstrated by all staff throughout both days. Relatives we met when we were there described the same experience whenever they have visited. One or two people told us they felt the food could be improved; something that was raised in surveys when we did our ASR in June. The management team agreed that this was the case and have taken steps towards this already. We saw the menus which showed a reasonable variety of meals and a choice of food at every mealtime. We spoke to a new cook who had just come to the home and she told us that she is developing the variety in the diet by changing the 2 week menu to a 4 week menu so that repeats are less frequent. She showed her knowledge and experience of catering over a long career and an awareness of the nutritional needs of older people. There was limited information available in the kitchen about the specific dietary needs of individual people. This is an area that should be developed so that the cooks can work in partnership with the nurses and carers to tailor meals to peoples nutritional needs. People who need a lot of help with eating their meals are assisted in a small dining room near to the kitchen, not in the main dining room at the front of the house. This smaller dining room is not a very attractive room and is used for staff breaks and as a staff signing in station. Whilst helping people to eat in a private setting helps maintain their dignity, the surroundings for this need to be pleasant and we recommend that thought is given to improving this room or using a different one. We met two people who told us that they knew each other before coming to The Weir and enjoy spending time together chatting. There were numerous Christmas related activities booked throughout December. During the inspection a talented harpist came to play and this was really enjoyed by the people who attended. A new activity organiser had recently started work and she was planning to increase the number and variety of things for people to do. She had already spoken with the mobile library to request more variety in their regular delivery of large print books so people would be more likely to find a book to suit their tastes. There was a notice in the entrance hall inviting families to come for dinner on Christmas day if they wished; a number of people had already put their names down for this. We felt that this was a very positive thing to offer and a way of helping people Care Homes for Older People Page 19 of 32 Evidence: spend a relaxed Christmas with their family. Care Homes for Older People Page 20 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. People told us they would tell the senior staff if they were unhappy about something. Staff are trained to give them the knowledge and understanding they need to deal with any concern about abuse or neglect correctly. Evidence: Awareness of abuse is covered in the staff handbook in a section that describes different forms of abuse. The handbook tells staff to report any incidents of abuse and tells them they can get more detailed information in the full abuse policy. The home has a clear safeguarding policy which is consistent with the overall Herefordshire multi agency policy and procedure. The training records and plans for 2008 and 2009 show safeguarding training is regularly scheduled in. The handbook makes it clear to staff that they should report concerns to the most senior person available. When we spoke to them about this subject they showed that they understood this and told us if they felt their concerns werent listened to they would tell us or social services. One of the nurses told us that the nurses and carers work hand in hand and depend on each other. She said the carers are brilliant at noticing if something is wrong and that no one will let go of a situation they are concerned about. She was confident that abuse would be reported and that the owner and management team are always Care Homes for Older People Page 21 of 32 Evidence: contactable if they need to be told about a concern. We have had one concern raised with us about the home since the last inspection. This was earlier this winter and was about the heating. We asked the owner to investigate. He informed us verbally and in writing of a recent major service of the heating system and that following the complaint he had also had the heating checked again throughout the building. When we did our inspection the building was warm at all times and staff we spoke to told us they thought it often gets too warm. The person who contacted us was anxious about complaining to the home. The owner, Mr Kingham told us that he would like people to feel that they can approach him or the management team and that they will endeavor to make people feel at their ease about this. When we spoke to people living at the home and to the relatives who were visiting they told us they would tell staff if they had concerns but that they currently did not have any. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Weir have comfortable and clean accommodation which is safe, well maintained and spacious. The rural setting and surrounding views provide people with a beautiful setting that is much appreciated. Evidence: The Weir is set in large grounds adjoining a local National Trust beauty spot. Many of the rooms have extensive views over the River Wye, surrounding countryside and the well maintained gardens. People told us this was one of the attractions of moving to the home. A large proportion of bedrooms have ensuite facilities and all either meet or exceed the national minimum standard. People are encouraged to make their rooms personal by having their own belongings around them. Ongoing improvements to the building are being made such as the rolling programme of refurbishment of the window frames to National Trust/Listed Building specification. The owner also hopes to start work on a new conservatory following lengthy negotiations with the National Trust and planning authorities. During the visit we found the building to be clean and warm and rooms like the kitchen, bathrooms and toilets to be tidy and hygienic. The laundry was also well organised and clean. The building smelled clean and fresh. Care Homes for Older People Page 23 of 32 Evidence: The most recent thank you cards at the home included the following comment The laundry was always beautifully done and her room kept warm and clean. All this and such a beautiful room, the setting, the incredible views, the space, everything, just perfect. Maintainance records were available at the home as indicated in the AQAA and those we sampled (fire safety, legionella, passenger lift and hoists) were up to date. Care Homes for Older People Page 24 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. People living at The Weir are protected by recruitment procedures which reduce the chances of unsuitable people being employed. Training is provided so that staff can develop their knowledge and skills in important aspects of nursing, care and safety. Evidence: People living at the home told us that they like the staff and feel that they do a good job. We observed examples of staff being very caring and attentive and heard them speaking to people who live at the home politely. Some staff at the home may need some support to improve their English. This would enhance their ability to communicate with people living at the home, particularly those with impaired communication due to their health needs. Our experiences during the two days (which we have already mentioned) lead us to conclude that at times there may not be enough staff on duty to be able to respond to people promptly and we discussed this with the owner and management team. Staff are given clear guidance on how they are expected to work, for example the staff handbook sets out information about standards of conduct and appearance whlie on duty. The staff we saw while we were at the home were smart and wearing sensible Care Homes for Older People Page 25 of 32 Evidence: shoes but one person had finger nails which were too long. We told the acting manager about this. The training plans for 2008 and 2009 and the staff training records show that improvements to training have continued. There is a wide range of training planned for the coming year. New staff receive induction before starting work. This is based on an in- house checklist. This list is comprehensive but not linked clearly enough to the Skills for Care occupational standards and we recommend this as a further development to ensure the induction covers all expected topics. We looked at the staff recruitment records for four people which showed that in three cases the procedures followed met the legal requirement. A nurse had begun work at the home without all the required checks being done. This had happened because the person was known to have recently been a registered manager of a service and a freelance trainer with a very recent CRB certificate. The person was also working under one to one supervision from the acting manager. Nevertheless, the law requires that all new employees have standard checks done before they start work. The member of the management team responsible for recruitment apologised and decided that they would not have the person on duty again until these checks had all been done. Staff supervision and appraisal is being done but not yet at the frequency that the training manager is aiming for. The records we saw of supervision that had taken place indicated a well thought out process with meaningful discussion about how people do their jobs and what their individual development needs are. Care Homes for Older People Page 26 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 being managed in a cooperative way by the owner and management team but will benefit from the clear leadership of a designated Care Home Manager. Planned improvements to the quality assurance and staff supervision systems should enhance all aspects of the service. Evidence: There is currently no registered manager at the home although there is a management team lead by the owner which has been working effectively. This was discussed with the owner who told us he anticipates that an application for registration will shortly be sent to us by the acting manager. There is a quality assurance system in place at the home but this has not been operating to its full potential in the last year. This has been identified by the acting manager and training manager as an area for improvement and work on this was already in hand when we inspected. A new survey form has been drawn up for people Care Homes for Older People Page 27 of 32 Evidence: to express their views about the home. We emphasised the importance of collating the results of surveys to to form the basis of an action plan. The home rarely looks after peoples personal money. We were told that most relatives deal with finances and provide anything people need. If the home makes a purchase for someone they invoice the person responsible for their finances. Whilst this does limit individual freedom and independence we recognise that many people at the home are too unwell to manage their money themselves. On occasions that the home deals with a persons money they keep records of this. Health and safety is taken seriously at the home and other than the issue of wheel chair footrests we did not identify any other safety concerns about the building or equipment. The staff training programme covers safety related topics and equipment such as disposable gloves and aprons is provided. Equipment used for moving people with restricted mobility is regularly serviced by a specialist company to the required standard. We sampled some maintenance records linked to health and safety and found that these were up to date. Care Homes for Older People Page 28 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 29 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 1 38 13 Regulation 13(4) (b) and (c) 29/01/2009 Wheelchairs must have footrests in place when residents are being moved in them. To reduce the risk of entrapment and injury to the person in the chair. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Regulation 13 (2) 15/02/2009 You must ensure that the arrangements for the management of medication are robust and that staff administering medication are not expected to do other tasks (such as dealing with phone calls) whilst doing so. This is so that people living at the home always receive their medication correctly. 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. Care Homes for Older People Page 30 of 32 No. Refer to Standard Good Practice Recommendations 1 7 It would be good practice for care staff to be more actively involved in the content of the written care records, and have more access to them. You need to ensure that the planned initiative in respect of the Gold Standard framework is used as an opportunity to address any shortcomings in the systems in place to manage and monitor the care provided at the home. Staffing numbers and deployment need to be reviewed to make sure that staff can respond to requests for assistance as promptly as possible. More work needs to be done to identify and support the pastimes that individual people might enjoy in addition to the communal activities. Dining facilities for people who need help with eating their meals should be made more comfortable and attractive to help make meal times more enjoyable for them. Catering staff need to work in partnership with nurses and carers to make sure that all opportunities are taken to improve individual peoples nutrition. 2 7 3 8 4 12 5 15 6 15 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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