Inspection on 26/02/09 for Wick House

This inspection was carried out on 26th February 2009.

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

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

Other inspections for this house

Wick House 26/02/07

Wick House 09/02/06

Wick House 28/09/05

Wick House 30/03/05

Wick House 26/01/05

Wick House 09/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

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Didsbury Court Rest Home

Belma

Hunters Care Centre

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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: Wick House Buttermere Liden Swindon Wiltshire SN3 6LF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elaine Barber     Date: 0 5 0 3 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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: Wick House Buttermere Liden Swindon Wiltshire SN3 6LF 01793641189 01793525199 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Swindon Borough Council care home 48 Number of places (if applicable): Under 65 Over 65 48 old age, not falling within any other category Additional conditions: 0 Any person outside the category of `Older People` who was receiving care and accommodation at the home as at 30th October 2003 may remain living in the home, subject to an assessment or review of their needs at least every 6 months that the home is able to satisfactorily meet their needs. For the purposes of this registration the definition of short term, or respite care, or intermediate care, is care and accommodation that does not exceed 8 weeks in any one care episode. That Intermediate care may only be provided for up to 9 people in the area known as the `rehabilitation unit`. That the home may provide care and accommodation for people aged over 55 years and under 65 years so long as they are receiving intermediate care or short term care and that not more than 2 people aged between 55 years and 65 years are accommodated in the home at any one time. Date of last inspection Care Homes for Older People Page 4 of 30 Brief description of the care home Wick House is a single storey purpose built care home that provides care and accommodation for up to 48 older people over 65 years. The home includes a mixture of respite beds, crisis care beds and long term beds. The home is situated in the Liden area of Swindon and is owned and managed by Swindon Borough Council. People who live in the home have their own single bedrooms and there is a large well maintained secure garden. Car parking is available. Typically the home is staffed by 8 care staff in the morning and six in the evening with three night staff. Additionally there are cleaners, housekeepers, an administrator and gardener. The fees are four hundred and five pounds per week. Information about the service is available in a statement of purpose and a service user guide. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We sent out surveys so that these could be completed by the people who lived in the home. We had surveys back from fifteen people who lived in the home, three health care professionals and three staff members. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during our visits to the home which took place on 26th February and 5th March 2009. We talked to four people who lived in the home and three Care Homes for Older People Page 6 of 30 members of staff. We looked at some of the homes records. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. The last inspection of the home was on 26th February 2007. What the care home does well: There was a statement of purpose and service user guide which contained detailed information about the service provided including the terms and conditions. This meant that most people had the information they needed to decide whether the home was the right place for them. Peoples needs were assessed so that their needs could be met. Most people had a contract so that they knew what to expect from the service. Each person had a care plan so that all their personal, social and diverse needs would be met. Peoples health care needs were being met. Peoples privacy and dignity were respected. Medication was securely stored and records were well recorded so that people were protected by the policy and procedures for medication. People took part in a variety of activities. There was a regular prgoramme of activities and something took place every day for example newspaper reading on a Sunday and cinema on a Saturday. People were supported to make choices including a choice of meals and choosing where and how to spend their time. Staff supported people to keep in contact with their family and friends. There was a varied menu with a choice at each meal. Special diets were catered for. People were offered nutritious meals and enjoyed the food. Complaints and concerns were taken seriously and acted upon. There was a complaints procedure and people had information about this so that they knew how to make a complaint. Any complaints were investigated. There was a procedure about safeguarding adults and staff had received training about prevention of abuse so that people were protected from abuse. The home was freshly decorated throughout and had new carpets. The accommodation had a light airy atmosphere. A large amount of shared space was available for different uses. There was a large dining room with a seating area and a private dining space so people could have a meal with visitors. There was a large conservatory and people used this to receive visitors in private. There were three other lounges and a visitors kitchen so that they could make drinks. The laundry arrangements were suitable and the home was clean throughout. People were cared for by consistent staff in sufficient numbers. People were supported by well trained and qualified staff. All new staff had an induction based on the common induction standards. All staff had the basic required training such as health and safety and moving and handling. There was a range of other training to meet more specific needs such as dementia and Parkinsons. Thirty out of thirty eight care staff had a National Vocational Qualification at level 2 or above. The manager was suitably qualified and experienced but had not yet been approved as a fit person to run the home. The quality of the service was monitored to make sure it was run in peoples best interests. Staff had supervision meetings with their manager so that people were cared for by staff who had some support. Staff kept small amounts of money for people. Records were kept of all money coming in and going out so that peoples financial interests were safeguarded. Peoples health, safety and welfare were promoted and protected. There were health and safety checks and staff had received Care Homes for Older People Page 8 of 30 the necessary training. What has improved since the last inspection? What they could do better: Evidence must be kept in the home of all staff recruitment checks to show that staff who have been employed are suitable to support people. Staff should receive one to one supervision with a manager at least six times a year so that people benefit from being cared for by staff who are supported. All staff that are interviewed for a post at Wick House should be asked to account for any gaps in their employment. When staff are being recruited any reference provided by a recent employer should be Care Homes for Older People Page 9 of 30 validated by a company stamp or letter head and confirm the persons name and job title to ensure its authenticity. 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. Most people had the information they needed to decide whether the home was the right place for them. Peoples needs were assessed so that their needs could be met. Most people had a contract so that they knew what to expect from the service. Evidence: We read the statement of purpose and the service user guide. These contained detailed information about the service provided. We made a requirement at the last inspection that the service user guide must be updated to include a standard form of contract and recent changes to the service. We saw that the service user guide was updated in September 2008. The statement of purpose was updated in January 2009 and reflected changes that had been made to the accommodation. Both the statement of purpose and the service user guide contained a copy of the terms and conditions. The manager told us in the AQAA that they were introducing more person centred Care Homes for Older People Page 12 of 30 Evidence: assessments. We read four personal files. We saw that each person had had an assessment of their needs before they moved into the home. They also had an admission sheet which contained information about their contact with their family, their GP and care manager, and their religious needs. Information about any dietary needs was recorded. The assessment and admission sheet contained information about what was important to each person. Each person also had a manual handling assessment. Fifteen people who used the service completed survey forms. Thirteen said that they had a contract and two said that they did not. Thirteen said that they had received enough information about the home to decide that it was the right place for them and two said that they had not. One of these said that they moved in very quickly so there was not time to provide information. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person had a care plan so that all their diverse needs would be met. Peoples health care needs were being met. Peoples privacy and dignity were respected. People were protected by the policy and procedures for medication. Evidence: The manager told us in the AQAA that the home was developing more person centred care planning. We looked a four peoples care plans. Two people had very detailed care plans. Information included their interests, activities, spiritual, religious and cultural needs, nutrition, medication, personal care, healthcare, dental, optical care and audio care, podiatry, laundry and buying clothes. These plans also included the risks to the person if particular actions were not carried out. The plans showed what was important to the person including their routines and preferences. Two people had much shorter care plans. These two people were receiving crisis or respite care. The team leader told us that people who had crisis care were usually only in the home for a few days as the aim was for their stay to be a maximum of ten days. Care Homes for Older People Page 14 of 30 Evidence: They also said that respite stays varied in length. They told us that if people were only staying in the home for a few days they would have a short care plan. Those people who had planned respite and who lived in the home permanently had full care plans. Twelve people said in their surveys that they always received the care and support that they needed and three people said that they usually did. At the last inspection we recommended that the service reviewed if the arrangements for providing people with a bath or shower met the needs of each person. This was being addressed. We saw that each person had a record in their care plan of whether they preferred a bath or a shower and how often they would like one. One person told us that they had a bath once a week, which was what they wanted. We saw that the arrangements for each persons health care were recorded in their care plan. This included appointments with the GP, optician, audiologist, podiatrist and district nurse. We saw that district nurses visited to give injections and apply dressings. We met one district nurse who said they came into the home twice a day. One person told us that they saw the GP when they requested a visit, the district nurse called, they had checks for their hearing aid, and saw the optician and podiatrist. They said that they would like to see the dentist and with their agreement we told the manager about this. Thirteen people said in their surveys that they always received the medical support that they needed, one said they usually did and one said that they sometimes did. Three health care professionals said in their surveys that peoples health care needs were usually met by the service. One commented that they only saw three people and their needs were always met. Another commented that sometimes people needing nursing care stayed at Wick House longer than they should because staff worked above and beyond the call of duty. We spoke to three people who said that the staff respected their privacy. We saw that each person had their own room and staff knocked on doors and waited for a reply before entering. The bedroom doors could be locked if people chose. We saw that each person was dressed individually and their clothes were well cared for and presented. Care was provided in the privacy of the bedrooms and bathrooms. We observed staff speak to people respectfully over lunch. Three healthcare professionals told us in their surveys that the service respected peoples privacy and dignity. There was a medication policy. We observed a medication round at lunch time. Two staff were giving out medication. Each was wearing a tabard stating that they were giving medication and must not be disturbed. A member of staff told us that they had introduced the tabards after some medication errors occurred when visitors interrupted the staff giving medication to ask them something. We saw the staff give the medicines to each person individually. They put their tablets into a medicine pot, Care Homes for Older People Page 15 of 30 Evidence: handed the pot to the person, watched them take it then signed the medication administration record. The medication was stored in two locked trolleys in a locked room. Controlled drugs were stored in a controlled drugs cupboard. During our first visit we suggested to the manager that they made sure that the controlled drugs cupboard complied with the new regulations for the storage of controlled drugs. By the day of our second visit the manager had arranged for the fixing bolts for the cupboard to be changed to comply with the new regulations. Any controlled drugs that were administered were recorded in a controlled drugs register. A monitored dosage system was used and printed medication administration record (MAR) sheets came with the system. These were appropriately recorded when medication was administered. People who were having crisis and respite care had hand written MAR sheets. Two staff completed these when the person came into the home and their medication was handed over for safe keeping. Two staff members had completed each sheet and signed and dated them. There were records of medicines returned to the pharmacy. Some people looked after their own medication but the home ordered it for them. They had signed a form to say that they would keep their own medicines. A record S/A (self-administer) was made on their MAR sheet. However the person had not signed the MAR sheet to confirm when they received their medicines. The manager told us that the staff had received training and we saw certificates to confirm this. 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 had a variety of activities to take part in. People were supported to make choices and to keep in contact with their family and friends. People were offered nutritious meals and enjoyed the food. Evidence: One person told us that there were activities every day that they could take part in. On the day of our first visit it was beauty therapy. Another person told us that there were activities but they only chose to go to bingo. The manager showed us a room where they kept resources for activities such as craft materials. They said that there were activities every day and these were often linked to festivals. They showed us photographs and cards that people had written on Valentines day. We saw a schedule of activities, which showed that something was planned everyday, for example newspaper reading on Sunday and cinema on a Saturday. Two staff were in charge of activities every day to make sure that they happened. Eleven people said in their surveys that there were always activities that they could take part in. Three said that there usually were and one of these said Most afternoons- music, quizzes, exercise classes etc. One person said that there were sometimes activities they could take part in and they liked parties. Care Homes for Older People Page 17 of 30 Evidence: We saw that the arrangements for people keeping in contact with their family and friends were recorded in their care plans. On the day of our visits we saw several visitors. One person had a relative share lunch with them because it was their birthday. They had lunch in a small dining area off the dining room to give them some privacy. The manager told us that they arranged trips out in the summer for example to Weston Super Mare or the garden centre. There were records in peoples care plans of how they liked to go shopping for clothes. The manager said that sometimes family members took them out shopping and sometimes care staff took people shopping. One person told us that their daughter and son in law visited once a week. One person said in their survey, I can still go out with my family and go to church when I want. We found several examples of when people made choices. We saw that people all wore individual clothing. On the second day of our visit a sales company visited and people chose new clothes to buy. We saw that people chose to spend time in their rooms or in the communal rooms. People chose whether or not to join in with the activities. The times when people liked to go to bed, get up and have a bath or a shower were recorded. Some people had chosen the decor of their rooms and brought items of furniture into their rooms. The cook showed us a four weekly menu. She said that she planned the menu after talking to people to ask them what they would like. We saw that the menu was varied. There was a choice of a variety of foods for breakfast and a choice of two different meals at both lunch and tea. She said that if someone wanted something different she could make that. One person had a diabetic diet. They told us that this was well catered for and they had special puddings. There was one vegetarian and the cook said that she asked them every day what they would like to eat. Four people we spoke to said the food was good. Four people said in their surveys that they usually liked the meals and one said that they sometimes did but they were fussy about what they ate. Ten people said that they always liked the meals. Comments included Very much lovely meals, Very, very nice, Always a choice of main course and either hot pudding or a choice from cold sweet trolley, and Good choices and well cooked. 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. Complaints and concerns were taken seriously and acted upon. People were protected from abuse. Evidence: There was a complaints procedure and this was included in the service user guide so that it was available to people. Thirteen of the fifteen people who completed surveys knew how to make a complaint. One person whom we spoke to told us that they had made a complaint and it was dealt with to their satisfaction. The manager showed us the complaints and comments file. This had a record of complaints received, the investigation into the complaints and letters to complainants informing them of the outcome. We saw that there was information about the procedure for safeguarding vulnerable adults in Swindon and how to make a referral. There were copies of the information in the office and on a notice board. The manager told us that there had been no safeguarding referrals in the last twelve months. When we looked at the training records we saw that staff received training about protection of vulnerable adults. Care Homes for Older People Page 19 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 lived a comfortable, clean environment suitable to their needs. Evidence: Since the last inspection the home had been refurbished. All the communal areas had bee redecorated and re-carpeted and the manager said that people had chosen the decor and carpets. Some of the bedrooms had been redecorated. There were colour co-ordinated walls and carpets in the corridors. There was new furniture in the dining room and the curtains and table cloths co-ordinated. The manager and a member of staff told us that they had linked areas throughout the house with themed colours to give a coherent appearance. There was a large dining room with a seating area and a private dining space so people could have a meal with visitors. There was a large conservatory and the manager told us that people used this to receive visitors in private. There were three other lounges and a visitors kitchen so that they could make drinks. There were new toilets with sensor taps and hand driers. On the day of our first visit the heating was not working and an engineer had been called. Extra heating had been brought in. On the day of our second visit the heating was working but would not turn off. An engineer had been called again. Care Homes for Older People Page 20 of 30 Evidence: We made a requirement at the last inspection that hot water must be stored at a temperature to prevent Legionnella and delivered to the taps at a safe temperature to prevent scalding. This had been addressed as part of the refurbishment and was being stored at the right temperature. There were thermostatic valves on taps to prevent scalding. There was a laundry area. Each person had a separate named basket for clean clothes to make sure that their clothes were returned to them. The manager told us that nearly all the clothes were named. She said that there were occasional problems when a person came into a crisis room and their clothes had not been named. During our visits we saw that the home was clean throughout. Thirteen people said in their surveys that the home was always fresh and clean and two said that it usually was. We made a recommendation at the last inspection that the cleaning schedule of the toilets should be reviewed to make sure they were kept clean. The manager told us that there were now morning and afternoon cleaners to ensure that the home was kept clean. She said that the toilets were cleaned three times a day so that they were clean and pleasant to use at all times. Care Homes for Older People Page 21 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 were cared for by consistent staff in sufficient numbers. People were supported by well trained and qualified staff. The system for recruiting staff was not thorough enough to make sure that people were being cared for by staff who were suitable. Evidence: The manager told us that they were relying less on agency staff to work in the home. She said that the Borough Council had set up a system of bank staff. She said that they had recruited some permanent bank staff and staff who worked part time in all the Borough Council homes worked extra hours for the bank. This provided better continuity for people who lived in the home. She said that there was only occasional use of agency at weekends. We made a requirement at the last inspection that the induction process for agency staff and checks of their competency must be improved to ensure that people are not put at risk. This had been addressed. There was little use of agency staff and a checklist had been introduced to ensure all aspects of their induction had been covered. The manager told us that the home was nearly fully staffed and she was recruiting to a few part time posts. She said that there were eight care staff on duty in the morning, Care Homes for Older People Page 22 of 30 Evidence: six in the afternoon and three at night. The rota confirmed this. The rota showed that there were five housekeeping staff in the morning and one from 3pm to 8pm. There were also cooks, a handy man, a laundry assistant and an administrator. The rota also showed that bank staff covered vacant hours, sickness and holidays. Nine people said in their surveys that the staff were always available when they needed them. Five said that they usually were available. One of these said Sometimes I have to wait, if there is an emergency, but they tell me, and come as soon as they are free. Another said But sometimes they are very busy but they come a.s.a.p. One person said that staff are sometimes available when they needed them but did not comment further. The manager told us in the AQAA that there were thirty eight permanent care staff and thirty of them had a National Vocational Qualification (NVQ) at level 2. We saw a staffing list that confirmed this. Well over 50 of the staff had an NVQ. Three staff who completed surveys said that their employer completed checks such as Criminal Records Bureau (CRB) and references before they started work. We looked at the recruitment checks for staff. We saw that one member of staff, who had been in post since 2007, had completed an application form. This did not contain a declaration about convictions and there was no separate declaration. There were three written references and a fax confirming that an enhanced CRB check had been received. Another member of staff had completed an application form but no other checks were available in the home. A third member of staff had two written references and a memo to say that a CRB check had been received. It was not possible to tell from these records whether all the required checks had been obtained before each member of staff started to work with people. The manager said that all the recruitment checks were kept in the Human Resources office at the Borough Council. We made two recommendations about recruitment at the last inspection. We recommended that staff who are interviewed should be asked to explain any gaps in employment. We saw no record to show this was happening. We also recommended that any reference provided by a recent employer is validated by a company stamp or letter head and confirms the persons name and job title to ensure authenticity. We saw that some references for staff had a letter head but we did not see references for some staff. We looked at the training records of three staff. Two staff members had completed the common induction standards and had training about infection control, safe food handling, emergency life support, moving and handling, health and safety, fire safety, principles of care and protection of vulnerable adults. One of them also had training about medication and health care. A third member of staff had training about health and safety and emergency first aid and they already had an NVQ level 2. A fourth Care Homes for Older People Page 23 of 30 Evidence: member of staff had recently started work and had an induction and had training about moving and handling and emergency aid. We looked at the staff training records and saw that all staff have the basic training including moving and handling, emergency aid, food hygiene, fire awareness, infection control, protection of vulnerable adults and medication and this training was updated. There were also courses about palliative care, stoma and catheter care, the Mental Capacity Act, equalities, epilepsy, death, dying and bereavement, falls awareness and Parkinsons awareness. Some staff had attended a comprehensive course about dementia care. Staff who supervised other staff had received training about supervision skills. The team leader told us that staff were accessing more courses from Swindon College and were doing more distance learning courses. Three staff who completed surveys said that they received training that was relevant to their role, helped them to understand peoples diverse needs and kept them up to date with new ways of working. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager was suitably qualified and experienced but had not yet been approved as a fit person to run the home. The quality of the service was monitord to make sure it was run in peoples best interests. People were cared for by staff who had some support from their managers. Peoples financial interests were safeguarded. Peoples health, safety and welfare were promoted and protected. Evidence: The manager had the Registered Managers Award and an NVQ Level 4 in care. She had started a diploma in management and leadership. She had applied to become the registered manager. The manager was supported by a line management structure within the local authority. The home also had access to specialist departments such as customer care, finance and human resources. The manager showed us a quality monitoring report from the Swindon Borough Council contracts team. This checked the quality of the service that they were purchasing for Care Homes for Older People Page 25 of 30 Evidence: people and identified any service improvements. The manager also said that they sent quarterly surveys to people who lived in the home, their relatives and professionals. The manager had collated the findings and used these to identify service improvements. For example they had changed the door bell so staff could hear it better and did not keep visitors waiting. The manager had completed the AQAA and sent it to us before the inspection. It provided information about what the service does well, what had improved in the last year and what they planned to improve. We made a recommendation at the last inspection that one to one supervision meetings with staff do not occur less frequently than every two months. We looked at the supervision records for four staff. We saw that three staff had had an annual appraisal and the fourth had not yet worked for a year. We saw that one to one meetings with a supervisor were recorded but these were not occurring every two months. For example one new member of staff had had two supervision meetings five months apart and another member of staff had supervision in 2008 approximately every three months. The team leader told us that they aimed to give supervision every six to eight weeks. They showed us a supervision audit checklist which showed that supervision meetings with staff were occurring every two to five months. Staff were keeping small amounts of money on behalf of some people who lived in the home. We saw a member of staff giving money to some people. We saw that they kept a record of money given out. The records were well kept. When a member of staff gave money to a person both the member of staff and the person signed the record. If the person was not able to sign then two staff members signed the record. Each person had a wallet to keep their money in. We checked two wallets and found that the amounts corresponded with the records. There was a health and safety policy. Staff received training about manual handling, health and safety and food hygiene. There was a monthly health and safety inspection checklist. The hot water temperatures were checked weekly. We saw that there was fire risk assessment which was reviewed annually. There were checks of the fire prevention measures and staff received fire instruction. We saw certificates to confirm that equipment such as hoists was serviced. Portable appliances were checked annually. Radiators were covered to reduce the risk of burns. 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 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 28 19 The registered person shall 16/05/2009 not employ a person to work at the care home unless they have obtained two written references, a Criminal records Bureau check, a Protection of Vulnerable Adults check, proof of identity, details of any criminal offences and a declaration that the person is physically and mentally fit. So that people are supported by staff who are suitable. 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 10 When staff give a person their medication to look after themself the person should sign the medication record and staff should record the date to confirm that they have been given the medication. This will help to acccount for the Page 28 of 30 Care Homes for Older People medicinces and show that the person has been given the right medicines. 2 29 All staff that are interviewed for a post at Wick House should be asked to account for any gaps in their employment. When staff are being recruited any reference provided by a recent employer should be validated by a company stamp or letter head and confirm the persons name and job title to ensure its authenticity. When staff recruitment records are kept in a central office a record of all the checks undertaken for each member of staff should be kept in the home. A proforma for doing this is available on the Commissions professional website. Staff should receive one to one supervision with a manager at least six times a year so that people benefit from being cared for by staff who are supported. 3 29 4 29 5 36 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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