Inspection on 12/01/09 for Westleas

This inspection was carried out on 12th January 2009.

CSCI found this care home to be providing an Adequate 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

Westleas 03/03/08

Westleas 18/07/06

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Westleas 47 Earls Avenue Folkestone Kent CT20 2HB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Grafton     Date: 1 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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 30 Information about the care home Name of care home: Address: Westleas 47 Earls Avenue Folkestone Kent CT20 2HB 01303242784 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sita Bhadye Type of registration: Number of places registered: Kestrel Care Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Westleas is a large premises offering accommodation over three floors for up to 20 residents over the age of 65, requiring residential care. The home is situated in an avenue, close to the Leas area of Folkestone. There is a mainline railway station and local bus routes nearby. There are 16 single and 2 shared bedrooms available. 4 of the bedrooms have en-suite facilities and all have a wash hand basin and a call bell system. Residents are encouraged to bring personal possessions to furnish their bedroom. There is a stair lift and a shaft lift to provide access to all upper floors. Care Homes for Older People Page 4 of 30 Over 65 20 0 Brief description of the care home Communal areas comprise of a main lounge, and dining room. The home has a statement of purpose and service users guide that gives information about the service. A copy of the service users guide is kept in each of the bedrooms. A copy of the most recent CSCI report is displayed in the entrance hall and available on request. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of the service, which means that we reviewed all the information we have received since the last inspection of 3rd March 2008, including a visit to the home. An unannounced visit took place on 12th January 2009 between 10.05 hours and 17.10 hours. The visit included talking to people living in the home, the providers, acting manager, staff and observing the home routines and staff practices. We looked at some records and looked round the home. The providers sent us some information prior to the visit, in the form of the homes annual quality assurance assessment (AQAA), which has been used in the planning of Care Homes for Older People Page 6 of 30 the visit and the overall assessment of the service. Information from the last inspection and that received since then has also been considered, such as, information sent to us about concerns and complaints and how these have been managed. This has included one safeguarding adults alert raised in November 2008. The local authority social services care management and contracting teams have investigated this and at the time of writing this report it has not yet been closed. At the time of the visit there were 13 people living at the home and their weekly fees were in the range of 318.12 to 500.00 pounds per week. Kestral Care Ltd is the registered provider of Westleas. The Responsible Individual for the company is Mr Bhadye and Mrs Bhadye is the registered manager. In the past year, there has been a change in the management of the home, in that since the 12th March 2008, Mrs Bhadye has taken a break from her role as manager, during which time the deputy manager has been acting up as manager. An application has been made to register the acting manager. For the purposes of this report, she will be referred to as manager, Mr Bhadye as provider and Mrs Bhadye as registered manager. What the care home does well: What has improved since the last inspection? They have acted to meet the five requirements set at the last inspection. These related to care planning, healthcare, medications, staffing levels and recruitment. They have continued to develop the care plans, which contain detailed assessments showing peoples preferences and choices. The plans look at people as individuals and are personal to them. They show how both health and social care needs are to be met and the daily records have improved, showing a picture of each persons day. Such records are important to make sure that all of peoples needs are met. They have improved their medication procedures and practices to make sure that people receive their medication safely. They have continued to make a lot of environmental improvements. They have bought a new wide screen television for the lounge, which provides a better picture for peoples enjoyment. They have refurbished one of the bathrooms with new sanitary ware, flooring and tiling, making it attractive and safe for people to use. They have created a new laundry area with more space and new equipment. This makes it easier for staff and helps to make sure that clothing and linen is properly laundered in a safe way. Several bedrooms have had new carpet fitted, making them look more homely. They have had mixer valves installed to all bedroom washbasins to reduce the risk of scalds. They have increased the cleaners hours providing more time to keep the home clean Care Homes for Older People Page 8 of 30 and hygienic. They have also increased the number of catering staff hours, which has freed up some of the care staff time, so that they have more time to spend with the people living in the home. There are now two waking staff members on duty at night. They have started to recruit more care staff and increase the numbers of care staff available to look after people living in the home. They have made some improvements in their recruitment practices to protect people since the last inspection. However, they must be vigilant in making sure that thorough checks are completed in all cases before a person starts working with people living in the home. What they could do better: The weakened management structure over the past eight months has, at times, impacted on outcomes for people living in the home. It has affected healthcare, care monitoring, hygiene, staffing numbers and recruitment, which have not always been as good as they should be. The management have acted to improve these things and are making good progress at this time. They now need to continue with the improvements started. They need to make sure that care plans are regularly monitored and reviewed so that changing needs are picked up and the right action taken. Medication storage space is limited and there might be some benefit in looking at this within the homes development plan to see if any improvement to the location and size could be achieved. In the meantime, the manager has introduced practices to make sure the cupboard is kept clean and hygienic. Infection control measures need to be continually reviewed to make sure that all possible steps are taken to prevent the spread of infection in the home. Things discussed for consideration, are to provide a separate hand wash basin and a foot operated clinical waste bin to reduce the risk of infection. Some staff have attended training on the protection of vulnerable adults. The manager indicated that arrangements have been made to send more staff on such courses. This is important to make sure that all staff know what to do if abuse is suspected. There have been times when the numbers of care staff on duty during the day have not been enough to meet peoples needs. The management have recognised this and are actively recruiting more staff to increase the number of care staff on duty in the mornings. Care staffing levels then need to be regularly reviewed and adjusted according to peoples needs, bearing in mind the layout of the building over three floors and deployment of staff. Recruitment checks are being done, but some people have started work at the home before the full police check has been received. This is allowed in exceptional circumstances and when this happens, stringent checks must have been completed and the new person must be supervised at all times when working with people living in the home. They also need to make sure that references received are from people where they have worked for an adequate length of time, so that they have some validity. If Care Homes for Older People Page 9 of 30 not they should carry out further checks to protect people. The manager and provider indicated their intention to address these matters fully. Therefore the requirement from the last inspection has been assessed as met. We will expect them to continue to carry out full checks at all times. The providers have shown that they have development plans for the home and have met targets they have set themselves. They have identified areas where they could do better and set new goals. They now need to continue their self monitoring and development, reviewing their action plans as they go along, in order to continue to improve the service that they provide. 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 10 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into the home are given all the information they need to decide if it is right for them. They have an assessment that tells staff about them and the support they need. This makes sure that their needs can be met upon moving in. It is not the general policy of the home to admit people for specialist intermediate care, so standard 6 was judged as not applicable at this inspection visit. Evidence: People can read about the home in the service users guide, which is contained within an attractive brochure folder. Copies are kept available in the entrance hall for people to look at and take away if they choose. The folder contains all the information that people need, to make a decision about the suitability of the home, before moving in. There is also the homes statement of purpose, which contains additional information and this is kept in the office. People can ask to read this as well if they want. Our last Care Homes for Older People Page 12 of 30 Evidence: inspection report is also displayed. All of this helps to make sure that people have access to everything they need to decide if the home is right for them. The manager assesses peoples needs to make sure that the home is suitable for them and that they have the capability to meet the persons needs. This is done by obtaining written information from care managers and going out to visit the person to do an assessment to find out what support they need. The visit is also used to tell the person about the home and what they should expect upon moving in. At this point, if any equipment is needed, the manager makes sure it is obtained ready for them when they move in. This pre-admission procedure also sometimes results in the manager making the decision that the persons needs cannot be met at the home and they are not then admitted. We looked at four care plan files and saw that detailed assessments had been carried out covering all aspects of each persons life, including their care needs, health, any risks to their safety, details about their past life, their likes and dislikes, pastimes, religious and cultural preferences. This is then used to devise a care plan. We spoke to several people living in the home who each said that they have the care that they need. One person recounted how they had improved since moving in to the point where they are now able to do things independently that they previously needed help with. They said that they could not praise the staff enough for their support and encouragement. The manager stated that the home no longer has an intermediate care contract with the local social services, but does sometimes take people for respite care. Care Homes for Older People Page 13 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having a plan of care that provides staff with the information they need to make sure that their health and personal care needs are met. The home now needs to make sure that regular reviews are clearly recorded to reflect changing needs, so that the current situation can be easily identified. Recent improvements in medication storage and practices provide people with better protection. Medicines are dispensed in the correct manner. People can be confident that staff will respect their privacy and dignity. Evidence: Each person living in the home has their own individual plan of care that shows staff what assistance they need and how this should be given. At the last inspection these were in need of improvement and a requirement was made which has now been met. The manager told us that all of the care plans had recently been reviewed and rewritten, so they were all up to date. This is good because at our last visit this was Care Homes for Older People Page 14 of 30 Evidence: not the case, and information we have from another relevant organisation in November 2008 indicates that at that time, care plans had not been reviewed as needed. We looked at four care plans that had all recently been clearly rewritten. We saw that they provide a good overall picture of the person and their care needs. They each contain comprehensive details on all aspects of care. Examples include how to help with such things as, personal care. Instructions are recorded on how to assist with washing and dressing, what the person can do for themselves and what they need help with, emphasising choice, privacy and dignity. Any help needed with moving around is clearly stated, specifying if one or two carers are needed and if moving equipment is to be used, there are step by step instructions. We looked at the care provided for four people who have a range of differing needs. We saw that attention is paid to maintaining health, with involvement from professionals such as doctors, community nurses and chiropodists. The care plans we saw contained all the right information to help staff meet the needs of people suffering from such conditions as diabetes, Parkinsons Disease, nutritional problems and continence problems. We spoke to the people about their care and also to staff. Everything we saw in the care plans and what we were told by the people themselves, as well as staff, indicates that the home is monitoring peoples needs and taking action to address any changes. Daily records have improved and provide a good picture of how people spend their day. They are now starting to relate to things identified in the care plans, for example where a nutritional problem has been identified, the daily records indicate amounts eaten each day, such as, ate seventy five per cent of meal and other comments about fluid intake and elimination. However, information from the November 2008 visit by local authority contracts officers showed that a persons care needs were not being properly met and changing needs were not easily identified in the records. Also, it had been difficult to cross reference the different components of the care plans to see where changes had taken place. Another issue identified at the November visit and was still apparent at this visit was that in some cases, weight records were not being consistently recorded in the care plans each month. This is an important indicator of change in health and had been well recorded in two care plans seen. The manager recognises this and indicated that it is something the home strives to do better in future. People say that carers offer them the assistance they need. They say that the staff are very helpful and courteous. One person commented that the caring side is so good here. We saw that staff are discreet when assisting residents, for example, with eating, movement, or assisting to the toilet. Care Homes for Older People Page 15 of 30 Evidence: Medication procedures were identified at the last inspection of needing improvement. The requirement made has now been met. We saw that things are much better in this respect now. We observed the lunch time medication round and saw that medications were dispensed competently in a way that makes sure that the right medicine is given to the right people at the right time. We looked at a sample of records completed each time a medicine is dispensed and saw that they were correctly completed with no gaps. We were told that any medication allergies are recorded in the care plans. It is good practice to record these on the medication administration sheets as well, so that there is a clear reminder for people when giving out the drugs. Since the last inspection, guidelines have been written for medicines prescribed to be given when required, the effects of pain relief are being monitored within the care plans and risk assessments have been carried out and recorded for people who have chosen to look after their own medication. We saw that they have been provided with lockable storage within their bedrooms to keep medicines safe and their key worker regularly monitors their medications to make sure they are taking them as prescribed. Medication storage is satisfactory, but might benefit from being added to a future development plan for the home, as a goal to see if any improvement in location and size could be achieved, as it is small and the location is not ideal. The providers have obtained a new controlled drugs cabinet, which they will be having fitted inside the cupboard soon and a medication fridge is available but kept in another location. From observation and talking with people living in the home we can confirm that privacy and dignity is respected. We saw staff interacting with people in a friendly respectful manner. The atmosphere was calm and relaxed. People were nicely dressed in clean clothing, appropriate for the season. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from having opportunities to take part in various activities to suit their individual needs. They are encouraged to lead their lives the way that they want and to keep in contact with families and friends. People benefit from the relaxed mealtimes and enjoy their food and the choices available to them. Evidence: People were experiencing good outcomes in respect of their daily lives and social activities at the last inspection. Since then they have continued to make sure that people have the sort of lifestyles that they choose. They have changed the written information they keep in the care plans so that peoples preferences and choices of daily activities are clearly recorded. We saw lots of examples of this in the records we looked at, which were confirmed in discussion with people. One care plan showed that the person likes to play bingo and joins in other activities such as, aerobics and games, plus enjoys having manicures and visits from the hairdresser. Records also showed that people have visits from their relatives and friends and people spoke to us about these things with enthusiasm. Care Homes for Older People Page 17 of 30 Evidence: The manager stated in the AQAA that an area of improvement in the past twelve months is the introduction of a more varied range of activities and we saw that a two week activities programme is displayed. They have freed up care staff time in the afternoons by increasing the cooks hours so that staff do not have to prepare the afternoon meal. This means that staff can spend more time with people doing activities. On the day of our visit they were doing board games. The manager spoke about the Christmas activities that took place, including taking a group of people out for a meal at a local hotel, an outing to see a school play and the homes Christmas party. Some people spoke about going out to the local community, either on their own, or accompanied. People keep in touch with what is going on outside the home by having their own newspapers delivered, or group discussion sessions to reminisce and discuss current affairs. Peoples daily records show that their choices are met about times of getting up, having breakfast, where they eat their meals and bed times. Some of the people we spoke to prefer to spend their time in their bedrooms and they told us that staff make sure they do not feel isolated by regularly coming to see they are alright and talking to them. One lady commented that staff always respond to her call bell, when she uses it. Peoples religious and spiritual preferences are recorded. A monthly service is held at the home and one persons care plan record showed that they regularly take communion. People say they enjoy their food and have enough to eat. We saw that meal times are relaxed, social occasions. There is a choice of dish at each meal and the menu provides a varied diet with special diets catered for, such as vegetarian or sugar free diets. We saw that if a person needs assistance with eating, staff do this in a sensitive, unhurried way. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that any complaints will be listened to and acted upon. They will know that the home has procedures and practices to safeguard them from abuse. However, some practices need to be strengthened to fully safeguard their welfare. Evidence: People say that if they have a worry or concern, they talk to either the staff or manager, who usually sort it out. The manager says she talks to people on a daily basis and deals with any minor issues before they escalate to become a complaint. The complaints procedure is displayed and each person has their own copy in their bedroom. The manager told us there have been no formal complaints received since the last inspection, but she does keep a complaints record. There has been one safeguarding adults alert raised since the last inspection, in November 2008. The local social services adult protection team have investigated this and at the time of writing this report the alert has not yet been closed. Issues raised have been looked at during the visit and referred to within this report where they fall within the national minimum standards. One of the things raised as a result of the alert was that stringent recruitment checks were not being fully adhered to. A new staff member had been working at the home without all the required checks having been completed and was not being properly supervised. This does not safeguard the people living in the home. Care Homes for Older People Page 19 of 30 Evidence: The staff training matrix indicates that less than half of the staff have attended training on the protection of vulnerable adults. This training is important so that all staff employed at the home know what to do if abuse is suspected. The manager indicated that courses have been booked for more staff to do this training in coming months. The manager and one senior carer have attended a Mental Capacity Act Awareness course. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are benefiting from the ongoing investment to improve the environment, which is comfortable and homely. Practices to maintain hygiene and prevent the spread of infection within the home provide people with adequate protection. Evidence: Since taking over the home in February 2006, the providers have embarked upon an improvement programme, which has included the replacement of the shaft lift and stair lift, the creation of a new laundry area with new equipment, a number of new bedroom carpets and furniture items. In the past twelve months, the ground floor bathroom has been refurbished, with a new bath, toilet, washbasin and non-slip flooring. The existing bath hoist has been refitted so that people with mobility problems are able to have a bath. The refurbishment of the first and second floor bathrooms has been identified as a longer term plan. The manager spoke of future plans to change one into a wet room with shower that will be more easily accessible for people with disabilities. A new wide screen television has been provided in the lounge and attractive tablecloths added in the dining room. Bedrooms are individually decorated, with wallpaper and people have personalised them, making them each very individual. Care Homes for Older People Page 21 of 30 Evidence: People say they like their rooms and that the furniture is comfortable. Several people commented upon their enjoyment since having the new television. The home has one electric bed, one electric recliner chair and some people have brought their own electric recliners in with them. This adds to peoples comfort. The majority of bedrooms have laminate flooring, which is not particularly homely. The providers recognise that they still have more improvements to make and have indicated in their AQAA that they plan to redecorate throughout the home and carpet bedrooms in the next twelve to eighteen months. Since the last inspection, the cleaning hours have been increased. There is a cleaner on duty six days a week and we saw that the home was clean throughout with no unpleasant odours. However, at the November 2008 visit by local authority contracts officers, this was not the case and one bedroom had a strong odour of urine with unclean bed linen. The home has responded well following this and has introduced a new procedure so that the cleaner knows where to start first. The new laundry area is well equipped and the washing machine has a sluicing cycle. There is a system for the transporting of soiled items in water soluble bags that are placed directly into the washing machine to prevent the spread of infection. We saw that commode pans are left in the laundry sink and on the draining board after washing and there is no separate washbasin for staff to wash their hands. Therefore they use the same sink where the commode pans are cleaned. This is a potential risk that needs to be addressed and was discussed with both the manager and providers. We also discussed that clinical waste bins should be foot operated to prevent the spread of infection. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being cared for by staff that have a good understanding of their needs. However, due to the layout of the building and changing needs of some of the people being cared for, the numbers of care staff on duty during the day need to be regularly reviewed, so that arrangements can be made to provide additional staff on shift as people become more dependent. Recruitment policies and procedures need to be adhered to ensure that the people living in the home are fully protected. Evidence: At the last inspection, weaknesses were identified in the numbers of staff on duty to meet the needs of people being cared for. Also, the home was not adhering to its stated recruitment procedures to protect the people living in the home. Action has been taken to meet the two requirements made, but there have been some recent remissions that were apparent at the social services contracts visit in November. At that time there were not enough care staff on duty to meet the needs of all the people living in the home. Care Homes for Older People Page 23 of 30 Evidence: Changes in the management of the home since March 2008 have meant that the registered manager has been absent from the day to day running of the home, with the deputy manager taking over the role as manager. The deputy role was not replaced and care staffing levels had been running at two carers during the day, plus an extra carer on some days between 08.00 and 11.00 hours, and the manager on weekdays. This meant that if peoples needs changed, or the numbers of people living in the home increased, staffing levels were not reviewed and changed to accommodate this. Also, the home is spread over three floors, with several people choosing to stay in their bedrooms during the day. Therefore if they needed assistance in their bedrooms on upper floors, there might not have been any care staff available on the ground floor for people in communal areas. The manager and providers have acted to address this and have increased night staffing levels from one person on waking duty and one sleeping in, to two waking night staff. They have also increased ancillary hours to free up care staff time and are currently recruiting more care staff to provide three carers on duty each morning, plus the manager and they aim to provide an extra person during the afternoons on some days as well. Once they have achieved this, it should make a real difference and offer more flexibility in meeting peoples needs. Staff say they have been on lots of training courses since working at the home. They gave examples, including, fire safety, moving and handling, skin care, medication and National Vocational Qualification (NVQ) in care level 2. The manager has developed a staff training matrix so that as gaps are identified, update courses can be booked. Staff spoken to confirmed they had received induction training when they first started and that the manager is very supportive. An induction record was seen for a new staff member. It covers things like the organisation and role of the person, care principles, safe working practices, peoples needs and protection. The manager signs off each completed section of the induction with the employee. The manager sent an improvement plan following the last inspection confirming that the recruitment requirement was met. The November visit by social services contracts officers highlighted poor practice with regard to staff recruitment in one case that placed people living in the home at risk. We looked at two staff files and saw evidence of full employment histories, two written references are requested, plus telephone references are recorded and the criminal records bureau (CRB) checks are applied for. Two new staff were on duty during the course of the visit for their first day induction. Both had protection of vulnerable adults (POVA) register first checks completed and the CRB checks applied for. We questioned the validity of two of the references, due to the very short time frame that they had Care Homes for Older People Page 24 of 30 Evidence: been employed by the referees. These should have been followed up prior to the people starting work at the home. The new staff were being supervised by a senior carer. We spoke to the providers about waiting until all the pre employment checks have been completed before the new person commences and that staff should only start with the POVA check only, as an exception rather than the rule. We emphasised that until the full CRB is received, new staff must be supervised at all times that they are with people living in the home and not left alone to provide care. Therefore, as such, they must be extra on the rota. Although the requirement from the last inspection had been met, there has been some slippage that needs to be rectified. The providers made a commitment to be more vigilant in future. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in a way that promotes the best interests of the people living there. However, changes in the management structure during the past year have resulted in some staffing deficits that are now being addressed. The management have introduced practices to protect the health, safety and welfare of the people living in the home. Evidence: As already stated, the registered manager has taken time out in the past eight months, during which time the deputy manager has taken on the role of manager, with support from Mr Bhadye (registered provider). The registered manager (Mrs Bhadye) and provider attended for part of the visit. They are both qualified nurses with many years experience. They discussed their plans for the future running of the home. The manager has made a registration application and will continue in full time day to day control, but Mrs Bhadye will be returning to work at the home part time, in a Care Homes for Older People Page 26 of 30 Evidence: management role. Mr Bhadye also plans to take a more active role from April. This will provide a stronger management structure that should benefit the people living in the home. However, the vulnerable adults alert raised in November 2008 and the subsequent visit by the local authority social services contracts officers identified weaknesses in healthcare, care monitoring, hygiene, staffing and recruitment. Whilst this visit indicates improvements have been made, all of these things show that the weakened management structure has had an impact upon the outcomes for the people living in the home. The home has some quality monitoring systems in place that involve seeking the views of people living in the home, their relatives and staff about the home and standard of care offered. They do this by using surveys, having meetings and regular discussions. The manager confirmed that the provider visits the home every week and does a formal monthly visit report to monitor quality. They now need to build upon the recent improvements and strengthen their quality monitoring processes to make sure that any slippages in meeting the national minimum standards are picked up promptly and dealt with. They have shown that they have made a number of changes to improve safety and outcomes for people living in the home. They have installed mixer valves to all washbasins and sinks and hot water temperatures are checked regularly to reduce the risk of scalds. The manager told us that she carries out weekly and monthly fire safety checks. The AQAA indicates that the homes equipment has been serviced at appropriate intervals. The staff training matrix and discussion with the manager and providers indicates that most of the mandatory staff training courses have been completed and arrangements are in place to address gaps. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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