Inspection on 13/01/09 for White Windows Cheshire Home

This inspection was carried out on 13th 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

White Windows Cheshire Home 14/12/09

White Windows Cheshire Home 04/01/07

White Windows Cheshire Home 07/02/06

White Windows Cheshire Home 25/08/05

White Windows Cheshire Home 17/02/05

White Windows Cheshire Home 30/09/04

Similar services:

Snydale Care Home

Staveley Birk Leas Nursing Home

Fairmount Nursing Home

Currergate Nursing Home

Brookfield

Castlethorpe Care Home

Elmleigh Convent

Woodlands Respite Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: White Windows Cheshire Home Fore Lane Sowerby Bridge West Yorkshire HX6 1BH     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: Tony Brindle-Wills     Date: 1 3 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: White Windows Cheshire Home Fore Lane Sowerby Bridge West Yorkshire HX6 1BH 01422831981 01422836645 carole.davies@LCDisability.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Leonard Cheshire Disability care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Date of last inspection Brief description of the care home White windows is owned and managed by the Leonard Cheshire organisation which is a registered charity. The establishment is registered to provide accommodation and and both personal and nursing care for up to 25 adults with a physical disability. The home is situated in Sowerby Bridge with easy access to the town centre of Halifax. The property, a stone built period residence is well maintained both internally and externally. The home is fully equipped with aids and adaptations to promote the residents independence and all areas are fully accessible. All bedrooms are for single occupancy and highly personalised to reflect the residents interests and tastes. Communal areas are spacious and comfortable and furnished and fitted to a good standard. Externally there are spacious and well maintained gardens and grounds which are fully accessible for wheel chair users. 25 Over 65 25 Care Homes for Older People Page 4 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 site visit was unannounced. It started on 12/1/09, and concluded in the afternoon of 13/1/09. The inspection was prompted following receipt of information from the local authority regarding poor practice at the home, and our attendance at a Local Authority strategy meeting concerning this service, during which a number of issues were raised by various stakeholders relating to service provision at White Windows. The issues raised at the strategy meeting related to: poor assessment and care planning processes; inadequate provision to meet peoples health care and medication needs; inadequate provision in relation to meeting peoples dietary requirements; a reluctance of people to complain; poor leadership from management. As part of this visit we looked at written documentation held at the home; we spoke to people living at the home; we spoke to staff working in the home; we spoke to the registered manager; we Care Homes for Older People Page 5 of 30 checked the medication held at the home and observed practice. As result of this visit, the quality rating for the service has changed. A number of issues were identified as needing attention in order to ensure the outcomes for people living at the home are positive. These are detailed within this report. What the care home does well: What has improved since the last inspection? What they could do better: Greater attention should be paid to collecting information about peoples desires and life goals. In order to ensure that people receive a person centred service, which is based on their needs, wishes, desires and personal goals, the systems for assessing risks and developing care plans should be revised with a view of using a person centred tool or process. Medicine management must be improved so as to not put peoples health and wellbeing at risk. Improvements to the care planning system, and the information contained within peoples care plan files, should be made to ensure that the lifestyle experienced by people at the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Adult Safeguarding training could be further enhanced if staff received training from the local authority. The development of an accessible lifestyle kitchen would enhance the independent living skills and opportunities of people living at the home. The high use of volunteers in relation to providing social and leisure activities needs to be monitored so that over reliance on unpaid staff is not developed, as on occasion restrictions have been placed on the opportunities for people in engage in meaningful activities outside of the home. Care Homes for Older People Page 7 of 30 The monitoring and audit systems relating to medication, and the care planning system should be more robust so as to promote peoples best interests, health and welfare. 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 8 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 9 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. The information given to us by the registered manager, both verbally and in record form, demonstrates that there are satisfactory systems and procedures in place to ensure that peoples healthcare and personal needs are properly assessed prior to moving into the home, and that they are given to the opportunity to visit it before moving in, however, greater attention should be paid to collecting information about peoples desires and life goals. The home does not provide intermediate care. Evidence: A discussion took place with the registered manager about what would happen if people wanted to move into the home. She explained that if someone wanted to move into the home, then she or a member of staff with experience of assessments, would visit the person, and their family or representative, and undertake an assessment of their needs. The acting manager showed us the pre-admission records of 2 people who had moved into the home. These records were found to contain assessments about Care Homes for Older People Page 10 of 30 Evidence: peoples healthcare and personal care needs, but did not contain alot of information about peoples desires or short, medium or long term goals. There were written details of how peoples health and personal care needs needs should be met, and the registered manager explained that this information had been gathered through meeting the person, talking to them, their family and the health and social care professionals involved in their life. Care Homes for Older People Page 11 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. In order to ensure that people receive a person centred service, which is based on their needs, wishes, desires and personal goals, the systems for assessing risks and developing care plans should be revised with a view of using a person centred tool or process. Medicine management must be improved so as to not put peoples health and well-being at risk. Evidence: The registered manager showed us the care plan files of 4 people living at the home. She was able to explain the care planning process in detail, which she said includes making sure that the staff learn what is important to the person in everyday life so that they can be supported to live a fulfilling life. She added that the staff involved in the care planning process, find out what the health and safety risks are to each person by talking to them and their families, and by undertaking risk assessments. Information contained within the care plan files confirmed in part, what the registered manager had spoken about. One set of risk assessments and care plans were very detailed; written in a person centred manner and easy to follow. However, the other 3 Care Homes for Older People Page 12 of 30 Evidence: did not contain satisfactory risk assessments; the care plans were lacking in detail; and there was a distinct lack of information about how the service has determined peoples short. medium or long term goals. It was explained to the registered manager that as this was lacking, then there was very little information about what peoples short, medium and long term goals actually were. Examples of the this lack of risk assessment and care planning included; no risk assessment for a person with epilepsy. The records showed that this person had not had a seizure for sometime, and was taking medication to control their epilepsy, however, there was no risk assessment to show that the risk of this person having a seizure was low. One persons file contained information about a goal to make a cup of tea. It was explained to the registered manager that this was seen to very limited in its scope, and that the plan could have been expanded to include goals to improve this persons independent living skills instead of just making a cup of tea. It was explained to the registered manager that as many of the care plans contained information about just meeting peoples health care and personal care needs, they were not seen to be holistic, and person centred in their approach. She added that wherever possible, the person themselves, and or their family members (if appropriate) are involved in the care planning process. Again this was not supported by way of information contained within the care plans as many signatures of either the person themselves, or their representative were missing. People living at the home did not speak about the care planning process, but did say that the staff ask them about what they like to do, about what their interests are and about how they like to be supported to undertake certain activities such as washing, dressing, shopping and socialising. We looked at the daily records which were found to contain some information about what people had been doing during the day and night. However, it was explained to the registered manager that they did not tell a full story of what people had done during the day, and how decisions had been made either by that person or on that persons behalf. The information that was contained within the daily records was seen to be to be factual and non-judge-mental. The registered manager explained that for some people, decision making can be difficult due to their level of cognitive ability, and agreed that it was important to ensure that when decisions are made on a persons behalf, to engage in a social activity for example, then the staff should always ensure that good records are kept so that the reasons why and when decisions are made by others, can be clearly demonstrated. The registered manager explained that personal supported is always provided to people in private, and that routines such as the times for going to bed, having baths, meals and other activities are flexible. She added that people are encouraged to choose their own clothes and hairstyle, and where possible Care Homes for Older People Page 13 of 30 Evidence: peoples appearance reflects their personality. Discussions with people living at the home confirmed this. Observations made on the day of the visit confirmed that staff work with people in a sensitive manner, providing flexible personal support in ways that promote peoples privacy and dignity and where possible their independence. Information contained within peoples care files indicated that peoples health is monitored and any potential complications and problems that are identified are dealt with at an early stage, including referral to the appropriate health-care professional. The registered manager explained that people with specific health-care needs are supported to visit a specialist or that specialist comes to the home. This was supported by way of information contained peoples care plans showing when appointment had been made, the outcome, and any action that needs to be taken by the person, or the staff at the home to promote peoples health and wellbeing. The nurse on duty manager was able to explain in detail the medication policies and procedures, and these were found to be satisfactory. This person explained that records are kept of all medications that are received, administered and disposed of within the home. A sample of the medications held at the home were looked at and unfortunately, a number of error were identified. These included; incorrect quantities held in the medication cabinet when compared with the Medicine Administration Record (MAR); hand written entries on the MAR that had not been countersigned; the quantities of medication received into the home had not been recorded on the MAR; when people had taken medication home, a clear record of what had been taken home, and what had been received back into the home had not been made; some administration signatures were missing. The nurse on duty explained that when the medication had arrived at the home on Christmas Eve, the task of booking it in had been passed onto the nurse on duty during the night. However, when the nurse came back on duty during the day, the medication had not been booked in and its details put on the MAR. This person went on to say that this was done, but the correct checks had not taken place. The registered manager explained that she was unaware that this had happened. She added that as a matter of urgency a full audit of the medications would take place, and any errors would be rectified as soon as possible, and the nursing staff with responsibilities for medication would be briefed, and told to ensure that the correct procedures are followed. Since the site visit, the registered manager has connected the Commission and explained that actions she has taken to ensure that the medication systems are not up to date and accurate. This is to be commended. However, as the issues that came to light were seen to be substantial, the quality rating for this area of the report has been affected. This was explained to the registered manager at the time of the site visit. The staff training records show that staff have had training in the use and medication. Care Homes for Older People Page 14 of 30 Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do keep in contact with their friends and relatives; access local facilities and recieve a varied diet, however, due to a weak care planning system, and as a result, a lack of information contained within peoples care plan files, it is difficult to determine to what extent the lifestyle experienced by people at the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Evidence: The registered manager explained that the people who live at White Windows have differing interests and preferences as to how they spend their day. The records show that a lot of people attend day placements, and these include day centres, employment services, college and services that offer people day time activities. The records show that the people who do not attend a placement are supported to engage in activities both inside and outside of the home. Some people take part in craft activities, others watch TV, and others use personal computers to access the internet or email. One staff member said that from time to time, people get the opportunity to visit the local shops, pubs and other leisure facilities in the area, and they added that some people had recently attended the theatre. The records show that every Thursday Care Homes for Older People Page 16 of 30 Evidence: an outing is organised. The registered manager explained that the trip involves people going out on the homes minibus to visit local attractions and leisure facilities. She added that recently one of the homes minibuses had been out of commission, so the opportunities for people to get out had slightly reduced. The registered manager explained that a found rising programme had recently been followed and that a large quantity of money had been raised which would be used to purchase a new minibus. Observations on the day of the visit found that the home uses alot of volunteers who involved in providing social activities for people living at the home. The registered manager explained that volunteers do get involved in supporting people on the weekly Thursday trip, and are seen to be a valuable resource. We agreed with the registered manager. She added that some staff are reluctant to get involved in supporting people on the Thursday trip as they have personal responsibilities outside of work that mean they need to finish work at specific times in the afternoon. The registered manager went on to say that this can sometimes restrict the types of activities on offer to people on a Thursday trip. A discussion took place about the nature of a weekly outing day for people living at the home, and the fact that it could be considered to be an institutionalised practice. The registered manager agreed that this could be seen that way, but didnt think that was the case. As previously mentioned, the care plans of people living at the home did not contain sufficient information about their wishes and desires, and it was explained to the registered manager that it was difficult to determine to what extent the service was supporting people to fulfil their social, cultural, religious and recreational interests and needs. Evidence within peoples care plans indicated that people go keep in touch with their family members. The daily records show that people go on home visits and family members visit the home. One family member who was spoken with on the day of our visit said that they are always made welcome when they visit, and added that they did not have any concerns about how their relative was being cared for, saying that the food was always good, their relative always looked clean and tidy, and they thought their relative was comfortable. The menus were looked at, and were found to offer people a varied diet. One person said that there was always plenty to choose from, and that if they didnt like what was on the menu, then the staff would make them something different. One staff member explained that people need to be supported in different ways when eating their meals, and went on to say that some people need a lot of support to be fed, others need a lot of time. The registered manager supported this, saying that if people need time to finish their meal then they will be supported to do this. One person living at the home confirmed that they need along time to eat their meal, saying that the staff give them time. Observations made on the day found that people with differing needs were being supported in different ways, however, it was noted that during lunch, four people who require support to be fed, were being supported by 2 members of staff. The staff were sitting with the four people, and were seen to feed one person, then turn to the next person and feed them. This was raised with the manager as it was seen to be poor Care Homes for Older People Page 17 of 30 Evidence: practice and not in line with the principles of person centred care. The registered manager said that this practice would not usually take place, as she would be available to support people at lunch time, and not usually engaged in an inspection. The cook was spoken with about ways in which the service support people with different dietary requirements. She was able to demonstrate through information contained within written records and various food products how she supports people. One person living at the home said that they are given food that meets their dietary needs, and added that they were very happy with the way they were supported. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are satisfactory systems in place for dealing with complaints appropriately. The systems and procedures in place to protect people from abuse and neglect are satisfactory, with staff receiving training in this area, however, this could be further enhanced if staff received training from the local authority. The procedures that are in place are in line with those produced by the Local Authority. Evidence: The registered manager explained that the home has a complaints procedure, which is available for all to see as it is posted in the entrance hall of the home. The procedure was seen to be satisfactory. The records show that the service has has some minor complaints within the last year which have been dealt with appropriately and to the satisfaction of the complainants. The records held by CSCI show that we have received various pieces of information from the local authority about problems within the home. This issues were also voiced by various stakeholders at a strategy meeting convened by the local authority. As previously mentioned, these issues included a reluctance of people to complain. In relation to this issue two people living at the home who were spoken with said that they would speak to a staff member if they were worried about anything, and that they felt sure the staff would support them and deal with their worries properly. The records show that there are advocacy services involved in the service, and that they have raised issues with the registered manager on behalf of people. The registered manager explained that she had had discussions with both Care Homes for Older People Page 19 of 30 Evidence: advocates and people using the service, and believed that the issues they had raised had been dealt with to the satisfaction of people. She added that regular residents meetings take place, and that she regularly gets feedback from relatives about life in the home, which was positive. She explained that relatives meetings dont take place at the present time, but she would be happy to reinstate them so that if people wanted a forum to raise issues, then there would be opportunities for people to do so. Following a discussion about Adult Safeguarding training and the systems relating to this, the registered manager explained that staff have had in house adult safeguarding training, and added that the service has a adult safeguarding policy and procedure, which is displayed within the home, given to staff, and used as a basis for staff training. Staff who were spoken with confirmed that they had had training in this area, and one staff member was able to talk about in detail, what they would do if an adult safeguarding issue came about. The procedures relating to the area of care provision were seen to be satisfactory. The registered manager explained that staff from the service had not accessed Adult Protection training from the local authority as the in house training was seen be very good, however, she agreed that accessing this type of training would be useful, saying that she would make enquiries. The records show that they there have been no adult protection referrals made by the service in the time since the last inspection. The records show that the organisation has a whistle blowing procedure. These policies and procedures were looked at the found to be in good order and in line with the local authority safeguarding procedures. 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 live in a comfortable home with plenty of space. All parts of the home are kept clean and tidy. The development of an accessible lifestyle kitchen would enhance the independent living skills and opportunities of people living at the home. Evidence: The registered manager explained that the comments she regularly gets back from people living at the home, their relatives and visitors state that people see the home as being comfortable, roomy, bright, cheerful and clean. On the day of the visit, the home was found to clean and tidy, with the furnishings and fittings being seen to be of a good quality and in good working order. Some areas of the home have been redecorated and furniture replaced. People living at the home said that think it is kept clean and tidy. This was confirmed on having a look around the building. Hand washing facilities were found to be located appropriately throughout the building, and the acting manager explained that laundry facilities are sited so that soiled articles and clothing are not carried through areas where food is stored and prepared. This was confirmed on having a look around the building. The registered manager explained that there are plans to introduce a lifestyle kitchen. She said that alot of work had been undertaken with the people living at the home and the local occupational therapy team to devise plans for the kitchen. The plans were seen and indicated that work surfaces, cupboards and facilities within the kitchen would be accessible so as to cater Care Homes for Older People Page 21 of 30 Evidence: for the needs of people with varying disabilities. The registered manager explained that at the present time, the funding is not in place to go ahead with this project, however, it is something the registered manager is very much interested in developing so as to promote the independent living skills and opportunities of people living at the home. 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. Trained staff support the people living at White Windows, and the recruitment practices are good, with good procedures in place that offer people protection. A high use of volunteers in relation to providing social and leisure activities gives the impression that there is an over reliance on unpaid staff, which on occasion can restrict the opportunities for people in engage in meaningful activities outside of the home. Evidence: The registered manager explained that the comments she regularly gets back from people living at the home, their relatives and visitors state that people believe the staff team to be approachable, reliable, honest and motivated to make sure people are cared for properly. Observations made on the day supported this, with staff being seen to work sensitively with people, communicating with people effectively and showing an interest in individuals. However, as previously mentioned, some poor practice was seen during meal times. Feedback from a relative who was spoken with on the day of the visited indicated that they believed the staff to be good at what they do, friendly and enthusiastic about the work they undertake. Observations on the day of the visit, indicated that there is a high use of volunteers in the home. It was explained to the registered manager that is seen to be a good thing, however we did comment that an over reliance on the use of volunteers for social and leisure activities could decease the Care Homes for Older People Page 23 of 30 Evidence: opportunities created for people living in the home. This was clearly demonstrated when relating this issue to the weekly Thursday outings. The registered manager explained that sometimes, depending on the number of volunteers available to the service, the numbers of people who get to go out can be limited. The rotas show that the number of paid staff is dependent on the numbers of people living at the home. The numbers were seen to be appropriate. The personnel and employment records that were looked at contained good levels of information. Information contained within the records show that new starters are only confirmed into post once a satisfactory Criminal records Bureau check has been undertaken, and a check against the Protection of Vulnerable Adults register and Nursing register is made. The staff training records show that staff received good levels of training in all aspects of work within a care setting. Feedback from a visiting relative indicated that they believed the staff to be well trained. Staff working at the home spoke about the training they had received, giving details of scenarios that come up from time to time, and details of what they would do, how they would deal with issues, and how they could do things differently if needs be. The numbers of staff with an NVQ II qualification is above the 50 per cent level. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The monitoring and audit systems relating to medication, and the care planning system have not been as robust as was anticipated, and as a result peoples best interests, health and welfare have not been promoted effectively. Evidence: The records held by CSCI show that the manager is registered with us. She explained that she obtains feedback from people using the service, their relatives, and other relevant parties about the services provided by way of user satisfaction questionnaires. The records of these were seen, and the feedback supplied by people was seen to be positive. She added that she has in place audit and monitoring systems for various practices within the home such as medication, money, accidents and incidents. Again, the records of these were seen, and most were found to be satisfactory. However, it is clear that the monitoring and audits systems relating to care plan audits and medication have been overlooked in recent weeks as problems with the medication were identified at this site visit, along with gaps in the risk assessments and care Care Homes for Older People Page 25 of 30 Evidence: planning systems. The records relating to the health and safety of systems in the home were seen, and were found to be satisfactory. These included records relating to weekly alarm system tests, food hygiene control measures, infection control systems, the regulation of water temperatures and the maintenance of equipment. Care Homes for Older People Page 26 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 27 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 1 9 13 There must be a safe medication system operated within the home. This is to as to protect and promote the health and wellbeing of people living within the home. 30/01/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 To ensure that the service has all the information it needs about people, the assessment systems should be reviewed to ensure details about peoples longer term needs, outcomes and goals are collected before they move into the home. A person centred system for assessing risks and developing appropriate plans of care should be introduced so as to ensure that risks are correctly documented, and care plans not only cover peoples health and personal care needs, but their short, medium and long term desires, wishes, aspirations and goals. Consideration should be given to making sure there are stronger systems in place to ensure that information is collected, and opportunities created to ensure the experience of people living in the home matches their expectations and preferences, and satisfies their social, Page 28 of 30 2 7 3 12 Care Homes for Older People cultural, religious and recreational interests and needs. 4 14 Consideration should be given to making sure there are stronger systems in place to ensure that information is collected, and opportunities created to ensure the experience of people living in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. The systems and procedures in place to protect people from abuse and neglect are satisfactory, with staff receiveing training in this area, however, this could be further enhanced if staff recieved training from the local authority. The development of an accessible lifestyle kitchen would enhance the independent living skills and opportunities of people living at the home. The high use of volunteers in relation to providing social and leisure activities should not have a detrimental impact on the opportunities provided for people to engage in meaningful activities outside of the home. Staff training could be further enhanced if staff received training from the local authority in the area of Adult Safeguarding. The monitoring and audit systems relating to medication, and the care planning system should be robust in nature so as to protect the best interests, health and welfare of the people living in the home. 5 18 6 19 7 27 8 30 9 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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