Inspection on 25/11/08 for Whitchurch House

This inspection was carried out on 25th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whitchurch House 22/07/09

Whitchurch House 27/05/09

Whitchurch House 27/11/06

Whitchurch House 14/12/05

Whitchurch House 19/05/05

Whitchurch House 25/10/04

Whitchurch House 14/04/04

Similar services:

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 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Whitchurch House Whitchurch House Whitchurch Ross-on-Wye Herefordshire HR9 6BZ     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: Philippa Jarvis     Date: 2 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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: Whitchurch House Whitchurch House Whitchurch Ross-on-Wye Herefordshire HR9 6BZ 01600890655 F/P01600890655 whitchurchhouse@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Keith Arnold Brown Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 1. The home may admit one named service user who has a learning disability. 2. Staff must be trained in the needs of people with a learning disability. . Date of last inspection Brief description of the care home The Provider is registered in respect of Whitchurch House to offer residential services to older people who may be too frail to continue to live in their own homes. Some may have developed some level of physical disability and some may experience confusion associated with memory loss. Whitchurch House is a period property which has been extended and is registered to provide accommodation for up to 29 people. There are bedrooms on both the ground floor and first floor level. The first floor is in two separate areas, one served by a staircase and lift, the other by another staircase and chair lift. The home is situated in attractive gardens in a rural situation within walking distance of a church and nearby park attractions. It is within the flood plain of the Care Homes for Older People Page 4 of 32 Over 65 29 0 Brief description of the care home River Wye and in 2000 a floodwall protection system was installed around the home. There are folders of information about the service that are available in each bedroom. A supply of brochures describing the service is also displayed in the front entrance. Each resident is charged individually according to their needs and the service should be approached for guidance regarding this. Additional charges are made for hairdressing, chiropody, magazines and newspapers. 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: 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 full inspection of Whitchurch House to look at how the home is performing in respect of the core national minimum standards and the quality of the service that the people who live there experience. This type of inspection is called a key inspection. We, the Commission, spent two days at the home, the first of which happened without the home expecting us. We arranged the second day with the home to continue looking at the service. We spent time talking with some people who live there, their visitors and some staff. We also spent time talking with the management team and looking at records which must be kept by the home to show that it is being run properly. We also received completed survey forms from people who use the service and from Care Homes for Older People Page 6 of 32 staff who work within the home. The information we received in these helped us in planning our inspection and we have also used this information in our report. What the care home does well: What has improved since the last inspection? What they could do better: The home has a management team. However, there is no registered manager to be in control of the home on a day to day basis. There are two acting managers who work on a job share basis but they have not submitted an application to us for registration in this capacity. Assessments of peoples needs should be completed in full and risk assessments used to identify where people who use the service may be at risk of harm or injury. This includes areas such as moving and handling, falls and nutritional risk assessments. Written information about the care that people need should be improved to provide clearer and more detailed guidance to staff. When people have behaviour that challenges the service, the home should prepare Care Homes for Older People Page 8 of 32 guidance for staff about how to manage this so that they all work consistently and in the way that the home has assessed as being correct. The home should review the care of each person living in the home on a monthly basis, not every two to three months as is current practice, so that they can be confident about whether there have been any changes to their care needs. We found that there were some aspects of the management of medication where the home was not following expected practice. It needs to review the medication policy and make sure that all staff follow this guidance. The home does provide some training for care staff, however, there are some areas where further training is needed such as safeguarding people from harm. There are also some aspects of training where we think the home needs to review the standard of the training provided to make sure that it is compliant with expected standards. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is written information available to help people decide if they wish to move to Whitchurch House. The information gathered about a persons care needs before admission is not sufficient for the home to be confident that they can meet all their care needs. Evidence: We received eight completed survey forms from people who live in the home and all but one person told us that they had been given enough information to help them decide whether or not they wanted to move into Whitchurch House. The home has a brochure and a Service User Guide that provide information about the facilities at the home. People who had been newly admitted to the home and their families told us that they had been encouraged to come and look round the home before making a decision about whether to live there. Care Homes for Older People Page 11 of 32 Evidence: In their AQAA the home told us that We complete rigorous pre-admission assessments and gather all available information. We looked at the files of two people who had recently been admitted. We could not find the pre admission assessment for one person and the information in the other was very limited in content. Furthermore the forms did not cover all the topics suggested in the national minimum standards. The information in the assessment has not been used to develop plans that describe appropriately what staff need to do to make sure that people have their care needs met. For these two people this included areas that staff need clear guidance about such as moving and handling, falls, pressure areas, diabetes and dementia. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Whitchurch House do not have their needs fully assessed. Therefore they cannot be confident that their needs will always be met because there is a lack of clear written guidance for staff about each persons care needs and how to meet these safely. Evidence: People who sent surveys to us told us that the staff always listen to what they have to say. Five said that they always get the care they need and four said they usually did. We also spoke to residents and their visitors during our inspection and they confirmed that they were satisfied with the care they received. One visitor said that It was as good as it could possibly get. In their AQAA the home told us that they are in the process of setting up new care plans. We looked at the files of three people in some detail. We saw that their plans of care were not well developed. There was a document called a care plan that provided some nice guidance about peoples daily routine. These documents did not, however, Care Homes for Older People Page 13 of 32 Evidence: describe the care that needed to be given as a result of the identified needs for each person. This could result in aspects of their care not being dealt correctly with or overlooked. We read the file for one person who had come to Whitchurch House from hospital where they had been admitted following a fall. The pre admission assessment said they were not at risk of falls and they had fallen twice since admission to the home. There were no records to show what the home could do to help prevent further falls. This person had also developed a pressure area and there was no care plan in place to manage the exisiting pressure area or to reduce the risk of further pressure areas developing. A member of the management team told us that they had contacted the district nurse to inform them of the situation. We found that the home is not now carrying out any assessments of the risks associated with the provision of peoples care. This means that they are not informing staff of how to work safely with each person and reduce the risks associated with the provision of their care. This includes moving and handling assessments. We observed one person where the staff were carrying out manual handling procedures. Staff have received training in moving and handling procedures, so they understand the general principles of correct manual handling. The home needs to assess each persons needs individually and provide the staff with guidance that is specific to their needs. We found that the home is not regularly and reliably making a record of the weight of people living there nor are they undertaking a nutritional risk assessment. We examined two files where there was no record of weight recorded but the senior on duty subsequently told us that some weights are taken and showed us written evidence of this. Weight and diet provide one indicator of their wellness. One person whose file we read chooses to have a restricted diet but there is no evidence that the home has consulted with health care professionals over this. A visiting friend confirmed that the home actually work hard to encourage her to eat well within the limitations that she chooses. The home keeps a record of contacts that each resident has with health care professionals and this showed that they have regular contact with them. The home also has visiting outside professionals who provide optical, auditory and chiropody care. We watched staff treating people with kindness and respect during the time we were in the home. Visitors confirmed that they thought the staff were very kind and understanding with the residents. One person visiting the home commented on how patient the staff were with her friend who she acknowledged could challenge the service. There was no written guidance available for staff about how to manage these challenging behaviours. Care Homes for Older People Page 14 of 32 Evidence: The home are carrying out reviews of peoples care about every two to three months not monthly as is recommended good practice in the national minimum standards. We watched part of a round of the administration of residents medication. At one point the carer left the medication trolley open and unattended. There is separate cupboard where controlled drugs are stored. The home does not have a register for controlled drugs which records their coming into the home and their administration. We were told that the home has not had any controlled drugs in the home during the last year and that the medication stored in there was there on a good practice basis. We looked at the medication policy and found that the policy indicated that they should have a register and that two people should sign for each administration of a controlled drug. The home needs to be careful to ensure that it follows its own policy and procedures. We looked at the topics covered in staff training in medication and the management of controlled drugs was not on this list. The medication policy has not been reviewed since 2005. There were other aspects of the management of medication that caused us concern examples being lack of guidance for staff about when to administer as required medication and a member of staff signing the record of administration when the medication had been given by another member of staff. Care Homes for Older People Page 15 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 home is developing a range of activites for people to take part in. A varied menu of nutritious food is available although peoples dietary needs are not assessed. Evidence: The home has recently appointed an activites organiser who works two half days in the home. In this time she provides varied activities, or one to one sessions for those who prefer this. She keeps a record of the activities joined in by the residents. For two of those we case tracked, who were relatively new admissions to the home, there was no record and for the remaining person we looked at in detail there was one entry in each of September and October. We noted that there were some residents where there were significantly more entries. The activities organiser told us that there were some residents who prefer not to take part in organised activities in which case she tries to spend some time with them on a one to one basis. In their survey a resident said Over the last few months activities have improved as they have appointed a coordinator. In addition to the activities with the organiser, the home also has weekly music and movement sessions, weekly hairdressing visits and fortnightly visits from an organist. Care Homes for Older People Page 16 of 32 Evidence: They ensure that they celebrate peoples birthdays and one visitor commented on how much effort was made to decorate her relatives room and to make the day special for her. The residents files contained some information about their past interests but this was not developed into a plan of care for the things people might like to do based on their own interests and preferences. We asked how the home lets people know about organised activities and were informed that a poster is put up to advertise these. There was one on display for the Christmas raffle that is currently taking place. The local vicar has recently left the area and the home are in the process of trying to arrange with the new incumbent for church services to recommence in the home. The activities organiser takes some residents to the local church on alternate Sundays. The home also arranges for a catholic priest to visit one resident at her request. Visitors told us they were made welcome at all times and that they appreciated being offered a drink and refreshments with their relative. They also liked the availability of small lounges where they could carry out their conversation in private. The menus showed a varied selection of meals, which are rotated on a four week basis. The home does not use a formal system for monitoring the nutritional content of the food, but the menus appeared to be well balanced and included fresh fruit and vegetables. For breakfast and tea the residents are offered a choice. There is no routine choice for the main meal of the day but the cook told us, and residents confirmed, that a choice is made availble if they have specialist dietary needs or do not like the main meal being provided. The meals we saw offered looked appetising and people seemed to be enjoying them. In their survey one person told us that I love the food. During the day we saw that drinks were offered at regular intervals. The home does not use a tool for the assessment and monitoring of residents nutrition and dietary needs. Nor does it keep a regular and reliable record of their weights. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know they can speak to if they have a concern about the home. However they cannot be confident that serious concerns about abuse or neglect will be dealt with correctly because staff do not have the training they need or information in an up to date policy. Evidence: In their surveys most people indicated that they knew who to speak to if they had a concern or complaint. They have each been provided with information about how to make a complaint but this is in need of further detail. In their AQAA the home indicates that, in the next twelve months, it would like to improve their ways of presenting this information by using user friendly formats. The home keeps a complaints log and records in this details of all complaints it receives and, in all but one instance, how it has dealt with them. No complaints have been made directly to us. We asked to look at the safeguarding policy for the home. The management team were unsure about this term. When we saw the policy it had last been reviewed in September 2005. It did not make a statement about what the senior team should do if a safeguarding referral was made to them. The two acting managers have not trained in this area of practice and the deputy manager who had trained some time ago was uncertain about certain key elements within the procedures such as the lead authority Care Homes for Older People Page 18 of 32 Evidence: in the local multi agency procedures. We looked at three staff files and none of these staff had received training in this area of practice. Staff we spoke with confirmed their lack of training and knowledge in this area. In their AQAA the home indicated that they intended to access further training for all staff to raise awareness. We advised the management team that they and the staff needed to do this training and provided guidance about where to access this locally. One person who we case tracked sometimes had difficult behaviours. There was no guidance in the care plan to inform staff how they should manage any incidents of aggression. This would help to ensure that staff worked with this resident consistently and appropriately. Evidence in the staff files we examined showed that the home carries out appropriate recruitment procedures such as POVAfirst and CRB checks to confirm that staff are suitable to work with vulnerable people. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and comfortable environment for the people who live there. It is well maintained, clean and tidy and provides a homely and welcoming atmosphere. Evidence: Whitchurch House is a detached house in a small rural hamlet situated between Ross on Wye and Monmouth. It has been adapted to meet the needs of the people who use the service and is maintained to a good standard. All areas that we saw were clean and well decorated and furnished. The home has a full time maintenace man and the service provider is also involved in the maintenance and upkeep of the building. In the AQAA the service provider told us that they Have continued with and maintained our ongoing programme of internal and external redecoration and refurbishment. Several bedrooms have been redecorated and recarpeted. External areas of our home have been repaired and/or repainted. An additional stairlift has been installed giving better access to two bedrooms. Our showerroom and two communal bathrooms have been completely refurbished, retiled and/or redecorated giving clean, welcoming and comfortable areas for individuals and staff. When we visited they had also nearly completed creating a new garden at the front of the home that would be accessible to residents. Care Homes for Older People Page 20 of 32 Evidence: There are four lounges and a dining room giving residents and their visitors a good choice of communal areas to sit in. They are all comfortable and equipped with suitable furniture. Residents are encouraged to bring personal belongings into their rooms and those that we visited were well personalised. We found the home clean and hygenic throughout. The laundry is suitably sited and equipped for the management of the washing in the home. There was safe storage for cleaning materials. We found that there were appropriate handwashing facilities throughout the home and these were equipped with paper towels and liquid handwash. We only found one thermometer in the bathrooms and whilst we were told that staff are expected to take the temperature of the bathwater each time they assist a resident with a bath there was no record kept of this. We were told that the maintenance man tests the water temperatures on a regular basis to ensure that they are within safe limits and should not pose a risk to residents. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff to meet the needs of the people who live in Whitchurch House. They are kind and caring. Training arrangements are inadequate to provide staff with the knowledge and skills in important aspects of health, safety and care. Evidence: There was a staff rota available for the week of the inspection. This showed that on the day of the inspection there was one senior member of care staff and two carers on duty all day with a member of the management team. In their surveys two staff said they always had sufficient staff on duty, six staff said usually and one said sometimes: and five residents said that there were always staff available and three said usually. The staffing levels therefore appear appropriate. The deputy manager said that they have been able to put additional staff on shift in the event of need such as resident illness or increased resident numbers. There are bank staff available to cover gaps in the rotas caused through illness or holidays. In addition to the care staff there are also ancillary staff who work as domestics, cooks and in the laundry. We talked to members of the staff team and they told us that they enjoy working at Whitchurch House. They said they found the staff and management team supportive. People told us that the staff were very kind and caring. One said Everyone is lovely. We observed examples of caring and considerate interactions between the staff and Care Homes for Older People Page 22 of 32 Evidence: the residents. We examined two staff files. We found that the homes recruitment procedures were generally satisfactory although in one instance a reference had not been taken from the last employer. There was no exploration of this expected shortfall in standards was documented in the file. Following recruitment there was evidence in the files that staff complete a one day induction. This is not in line with the common induction standards set down by Skills for Care, the sector training organisation. We were told that new care staff work with an established member of staff to gain experience but we did not see written evidence of this happening. Staff move on to an NVQ programme and the home has ten staff who have qualified or enrolled in NVQ. The home is careful to ensure that all staff complete training in moving and handling. However there are some areas of training where staff have not received the expected level of training, for example first aid, medication, food hygiene, health and safety and infection control. We have advised the home to obtain advice about expected standards of training for all staff so that they can be confident their staff have received the training they need to have the right knowledge and skills. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a supportive and aproachable management team although there is no registered manager in post. The home needs to make sure that staff training in relation to health and safety is carried out to a standard that ensures the health and well being of residents is promoted at all times. Evidence: There is a mangement team comprising the two acting managers, who work on a job share basis and the deputy manager. The service provider is also actively involved in the running of the home. The service provider was not aware of that people who are managing the home on a day to day basis are acting illegally if they are not registered in this capacity and it was agreed that their applications for registration would be dealt with as a matter of urgency. They are in the process of taking relevant training for this role. Staff told us in their surveys, and during the inspection, that they feel well supported by the management team and that they find them very approachable. We found the acting managers and the deputy manager to be receptive to recognising the Care Homes for Older People Page 24 of 32 Evidence: areas where the home needs to improve and they stated their intention of addressing matters identified for action. The deputy manager completed the Annual Quality Assurance Assessment and provided us with some detailed information about the service. There were some elements within the document that would have benefitted from further development. There is a policy regarding quality assurance in the home. The content of this would benefit from expansion as there are aspects of quality management that they are carrying out but that are not acknowledged in the policy, for example the twice daily checks on the condition of the room of each resident. They send each resident and their family a questionnaire once a year. This was last done in August: the replies were read and suggestions for action taken into account, for example mention was made about tidying up the front of the house and a new garden is in process of being created. They do not carry out a formal analysis of the information received. They reported that they keep good informal contact with the families of residents by ensuring that they speak with them regularly when they visit. This forms an additional element of qulaity monitoring. We met three relatives or friends during our inspection and they all commented that they speak often with the management team. The approach of the home to the management of peoples money helps to promote their financial interests. The home does not encourage residents to keep money on the premises. If money is spent on their behalf they invoice their representative on a regular basis. The home does have a safe and if someone wishes to place money or valuables there for safekeeping appropriate records are kept and signed. There was also a record of monies deposited and withdrawn from a residents fund. There are some aspects of the management of health and safety in the home that are well managed. We looked at the fire log and this recorded that checks and tests have been carried out at regular intervals. There was also a recently reviewed fire risk assessment. The cook told us that she takes the temperature of the fridge and freezers on a daily basis. The home achieved an excellent rating for food safety following the recent inspection from the Environmental Health Department. In the AQAA the deputy manager reported that servicing and checks had been carried out on equipment in the home. We were not able to confirm this because the most recent certificates were not filed in the home. There is a maintenance man who works in the home daily and who carries out minor repairs promptly. Staff have not had sufficient or recent training in some health and safety related topics for the home to have confidence that they have the knowledge to work safely. Examples of this that we identified included one member of staff employed in May who Care Homes for Older People Page 25 of 32 Evidence: did fire training in her day 1 induction but where there was no evidence of further fire safety training, a member of staff who is involved in the preparation of evening meals and who has not done food hygiene training and lack of health and safety training for the staff group. Care Homes for Older People Page 26 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 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 A detailed pre-admission assessment must be carried out by a suitably trained person. This is to help ensure that you are able to provide people moving in to the home with the care they need and so a written plan of care can be provided to give staff clear information about the persons care needs when they arrive. A requirement relating to pre admission assessment was made after the last inspection. 31/01/2009 2 7 15 You must prepare a written plan for each persons care. Thsi must be kept under review. This must be sufficiently detailed to guide staff in meeting the personal, helath and social care needs of each person living in the 31/01/2009 Care Homes for Older People Page 28 of 32 home. A requirement about care planning and keeping them under regular review was made following the last inspection. 3 9 13 You must review the medication policy. This will make sure that the home has up to date information about the practices and procedures that it expects to have in place for the management of medication within the home. 4 9 13 You must carry out a moving 31/01/2009 and handling risk assessment for each person living in the home. This will make sure that staff are provided with written guidance about a safe system for the moving and handling of people. 5 9 13 You must review the arrangements for the management of controlled drugs in the home. This will help to ensure that safeguards are in place for the managment of controlled drugs. 6 18 18 All staff working in the home 30/01/2009 should receive training in safeguarding vulnerable people from abuse. This will help to ensure that they understand and 31/01/2009 23/01/2009 Care Homes for Older People Page 29 of 32 recognise abuse and neglect and willknow what to do if they suspect this is happening. 7 30 19 All satff who are involved in the preparation of food should complete training in food hygiene. This will help to ensure the health and safety of the people living in the home. 8 38 23 All people who work in the 29/01/2009 home should receive training in fire safety at regular intervals. This will help to ensure that they are aware of the procedure to be followed in the event of fire. 9 38 13 There must be at least one first aid trained person in the home at all times. This is to make sure that people living there receive apropriate attention in the event of an accident. 30/01/2009 28/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 You should ensure that staff are appropriately trained in the handling of medication and that this training covers all the areas appropriate to the work in the home. The training should be provided by staff who have a body of up to date knnowledge in the subject of medicines. The home should ensure that all residents have nutritional screening as part of their needs assessment when moving into the home. This will help the home to assess whether they are meeting peoples nutritional needs and monitor Page 30 of 32 2 15 Care Homes for Older People their progress in this area. 3 26 The home is recommended to provide a thermometer in each bathroom and to keep a record of the water temperature each time a resident is provided with a bath. This will help to ensure that people are protected from contact with water that is an unsuitable temperature. The training programme for staff needs to be reviewed to ensure that each member of staff is competent, that they understand their role, and are able to deliver appropriate care in a manner that is safe and accountable. An application for the registration of the acting care managers should be submitted to the Commision without delay. 4 30 5 31 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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