Inspection on 23/01/09 for Wilbraham House Residential Home

This inspection was carried out on 23rd January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wilbraham House Residential Home 25/01/08

Wilbraham House Residential Home 15/05/07

Wilbraham House Residential Home 22/02/07

Wilbraham House Residential Home 23/03/06

Wilbraham House Residential Home 29/06/05

Wilbraham House Residential Home 11/02/05

Wilbraham House Residential Home 05/05/04

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 20/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wilbraham House Residential Home The Old Vicarage Church Street Audley Stoke On Trent Staffordshire ST7 8HL     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: Peter Dawson     Date: 2 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. 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 31 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 31 Information about the care home Name of care home: Address: Wilbraham House Residential Home Church Street The Old Vicarage Audley Stoke On Trent Staffordshire ST7 8HL 01782720729 01782720729 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wilbraham Limited Name of registered manager (if applicable) Mrs Susan Elizabeth Cameron Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 33. The registered person may provide personal care and accommodation (without nursing) for service users of both sexes whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 33 Physical Disability over 65 (PD)(E) 6 Physical Disability over 55 (PD) 2 Dementia over 65 (DE) (E) 6 Date of last inspection Brief description of the care home Wilbraham House is a privately owned residential care home, registered to care for up to 33 elderly residents with a variety of dependency needs. The home has been under Care Homes for Older People Page 4 of 31 0 0 0 Over 65 6 33 6 care home 33 Brief description of the care home the present ownership since October 2001. Sue Cameron has been the Registered Manager since October 2006. She has clearly made improvements to the home and quality of care during that time. The extension to the home was finally completed in 2006 - providing 6 additional bedrooms, each equipped with an en suite, as well as a separate adapted bathroom and shower. Many improvements to the environment were needed. A programme of improvement over the past two years has taken place and is almost complete. Other areas such as staff training and care practice have also improved. Wilbraham House is well located in the village of Audley, opposite the Church and convenient for a wide range of local amenities including shops, pubs, post office, community centre and health centre. There are plans to further develop the external space to provide more user friendly and safe areas for residents to enjoy during the better weather. Weekly charges at Wilbraham House state in the Statement of Purpose are 335- 390 pounds per week. The Manager states that current maximum fees are 400 pounds per week. Care Homes for Older People Page 5 of 31 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: The last Key Inspection on this service was carried out on 25th January 2008, when, because of the progress made in many areas, the service was upgraded from a poor to adequate service. This Key inspection was carried out on one day by one inspector from 08:30 - 18:00 The service completed an AQAA (Annual Quality Assurance Assessment). It is a legal requirement to provide the AQAA which is a self-assessment tool outlining the level of service provided. This was returned to us prior to the inspection and forms part of the information included in this report. Five written responses from people using the service or their relatives were also Care Homes for Older People Page 6 of 31 received prior to the inspection and many positive comments made about the care provided at Wilbraham House and the improvements made to the service over the past two years. During the inspection most people were seen and many spoken with separately and together, the gave positive feedback about life at Wilbraham House and their comments are also reflected in this report. The inspection was carried out with the Manager and Deputy, involving other members of staff on duty, who all made a positive contribution to the inspection process. A provider was also seen and spoken with. There was an inspection of the environment including all the communal areas and a sample of bedrooms. An improvement plan for the environment was required and agreed prior to the last inspection when most improvements had been made. There were two outstanding matters relating to provision of a shower area and upgrading of the kitchen. The shower has been completed and the kitchen will be upgraded by May this year. Records seen included care plans, risk assessments, health care records, medication, complaints and staffing records. All were readily available in the home and assisted in the progress of the inspection. The Registered Manager has been in post for 2 years and presided over improvements in areas of care practice, care planning, staff training, medication and food provision. Additionally the providers have made improvements to the environment in line with the the required and agreed actions and timescales of the improvement plan. What the care home does well: What has improved since the last inspection? Food Hygiene training has been provided for all catering staff - this was subject to a requirement of the last report. All staff have had moving and handling training, also in line with a requirement of the last report, in fact the homes training matrix indicates that staff have all had the required statutory training. There has been further training to NVQ standards and the required minimum of 50 of staff trained to this level is exceeded. People are now weighed upon admission and regularly thereafter. Those assessed as nutritionally at risk are monitored and weighed weekly. All staff administering medication have received accredited training. Creams were not seen in communal areas during this inspection, but kept in peoples bedrooms. Those not prescribed must be labelled to avoid any confusion. The first floor bathroom has been completely upgraded/redesigned to provide a walk in shower (wet room). The bath has been removed but there is another bathroom on the same floor level. The new shower provides an excellent facility to meet peoples bathing choices and assist greatly in meeting the needs of people with physical disabilities with an alternative to an assisted bath. Care Homes for Older People Page 8 of 31 What they could do better: 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 31 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 31 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. Pre admission assessments and procedures ensure peoples needs are assessed well and can be met by the service. Evidence: There is a statement of purpose and service users guide. All people using the service have a copy of this and there is a copy in the home available for visitors. The Service Users Guide is in pictorial form to assist easy reading. There is also a short wellpresnted home brochure provided as a supplement. People are assessed prior to admission both by the homes manager and by means of a multi-agency assessment compiled by the social worker. This ensures that all needs are known and a decision made that they can be met. People are always informed in writing as required that following the assessments their needs can be met. In the sample of 3 care plans inspected all had pre-admission assessments included one Care Homes for Older People Page 11 of 31 Evidence: admitted on an emergency basis, assessments being carried out on the day of referral and admission to the service. Where possible it is the homes preferred option that people considering admission should spend time in the home to assess the quality, facilities and suitability of the service. This also allows a more in-depth assessment and is beneficial to the person and the home. Wilbraham House does not provide intermediate care. Care Homes for Older People Page 12 of 31 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. Further improvements in aspects of healthcare and medication will ensure peoples needs are met safely. Evidence: Three requirements made in the last report relating to these outcomes were: All people must be weighed upon admission and regularly thereafter. Accredited medication training must be provided for all staff administering medication and All creams must be prescribed with clear labels for use and removed from communal areas. - All three requirements re-assessed during this inspection were found to have been met. A sample of 3 care plans were inspected, one person admitted recently and two who have been at the home for sometime. It was clear that pre-admission assessments had been carried out with good assessment of the persons needs. This informed the care plans that were then established. There was evidence of regular monthly reviews of care plans. Care Homes for Older People Page 13 of 31 Evidence: One of the care plans related to a person being cared for in bed for 2 months, who is supported in end of life care by the District Nursing Service. Pressure relieiving equipment is in place and a specialist bed. Relatives are not local but kept informed of the persons ongoing condition and care, their wish is for the peson to remain at Wilbraham House. Pressure damage is being managed by the Nursing Service together with pain control. Although the person is unable to verbalise, staff are sensitive to her changing condition and pain relief in the form of controlled drugs recently put into place. A fluid balance chart is in place with diligent recording of inputs. Two hourly turning is also consistently recorded. There is a very high standard of care for this person. This was confirmed in discussions with the visiting District Nurse, seen during the inspection, who said that staff worked closely with them and other healthcare professionals from the local health centre accross the road from the home. She said that staff followed instructions in relation to medical needs and instructions given and had a pro-active approach in reporting/informing healthcare professionals of any concerns. There is clearly a good working relationship between the homes staff and healthcare workers. A recently admitted person had good assessments with details including Life History, likes and dislikes, preferred mode of care - there was a copy of her food choices in the kitchen area. A medication check with the pharmacy after admission resulted in new medication in blister packs for administration. There was no moving and handling risk assessment for this person. This should be completed. It was also noted in relation to other people who had had falls resulting in injury, that the moving and handling risk assessments had not been reviewed. The Manger will address these issues with suitable moving and handling risk assessments - stating the risk involved and actions that can be taken to reduce or eliminate those risks. Two people who are diabetic have daily insulin, administered in Novapen form by care staff. In relation to one person records stated staff trained by the District Nurse can administer insulin - see list of staff approved. Those staff trained by the District Nurse did not have written confirmation of training and competence and additionally care staff had trained other carers to administer insulin with the approval of a District Nurse. This is not acceptable and was brought to the attention of the District Nurse spoken with during the inspection who said that she would report the matter to her Nurse Manager. Those staff trained internally by care staff will cease administering insulin immediately and certification of training and competence obtained for other staff from the nursing service. The AQAA (Annual Quality Assurance Assessment) submitted by the service prior to the inspection stated Staff have received training in chiropody to eliminate waiting Care Homes for Older People Page 14 of 31 Evidence: times and cost. We have been able to support the Chiropodist by reducing treatement time by our trained staff. The Chiropodist just carries out tretement on service users who are diabetic or have special requirements - Because of this training the Chiropodist now provides a service for about 6 people only, who are in a priority category due to their medical condition. This NHS (National Health Service) Chiropodist does not provide a service individually to people in their bedrooms - currently the office area is used. This is not an appropriate place to provide personal healthcare and certainly not conducive with maintaing privacy and dignity as defined in the National Minimum Standards (10.1). The GP, District Nurses and other healthcare professionals see people in the privacy of their own bedrooms. The Chiropodist should follow this example particularly in the light of his reduced workload at the home. There were many detailed and positive records relating to the personal and healthcare needs of people. All are now weighed upon admission and regularly thereafter, where there are concerns about weight loss these are reported to the GP and monitored closely by the homes staff. There has been training by Nursing staff and the Community Matron in areas of stoma care training, continence care and epilepsy. Inspection of the medication system indicated that one person self-administers his own medication, kept in a locked cupboard in his bedroom. It was suggested that the home may wish to review the medication risk assessment. A months suppply of his medication is kept in his room, this would include for instance 56 Co-codamol tablets and other medication. It may be that the revised risk assessment would indicate there is no risk in having such large amounts of medication available to him. It was noted that Morphine prescribed 2 days prior to the inspection had been entered on the MAR (Medication Administration Record) and not in the homes controlled drugs book as required. Only one staff signature had been provided on the MAR sheet, not two as required. It was noted on MAR sheets seen that there were 4 missing signatures, where medication had been given but not recorded. A person is prescribed haloperidol PRN (as required) but there was no protocol for its administration. Protocols must be obtained from the prescriber defining the circumstances in which the medication can be given and the timing of subsequent doses. It is important for staff to record the outcomes when this medication is given. Protocols and recording justify the medication being given. Improvements have been made to the medication in this home over the past 2 years. Care Homes for Older People Page 15 of 31 Evidence: Some attention to the shortfalls mentioned above will ensure that people have the correct medication safely administered. Care Homes for Older People Page 16 of 31 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. A range of activties are provided to meet the social and recreational needs of people and food choice and type has improved greatly. Evidence: The AQAA received prior to the inspection stated We pomote activities, encouraging group discussions, we have a quiet lounge where service users can sit and read peacefully. Visitors are welcomed to the home, there are no time restrictions. The vicar comes once a month and holds a service, also every other week we have a keep-fit instructor with music to movement. Service users on a regular basis go into the village, with support of staff, there are also trips to the local cafe or supermarket. This was evidenced during the inspection from discussions with people seen and from records. A new staff member with responsiblity for leading activities has just been allocated hours to come into the home twice weekly to promote stimulation and social interactions with people. Staff do taken people out where possible into the village and local area, they have car insurance to cover this activity. There was evidence of chosen lifestyles being known and met, this was confirmed by Care Homes for Older People Page 17 of 31 Evidence: people spoken with. A person with a learning diability enjoys being in his room writing, playing music and rarely visits the lounge. He is taken out each week for 2 half-days by someone from the social work resource team to access community faciliteis, additionally he goes to church weekly and has weekly family contact. This was an example of the home providing activity to meet the individual needs of people and chosen lifestyle. Food choices have improved, previously there was no choice of main meal. People spoken with said There are marvellous choices now, we have pate, chilli and other things we like, there is always a choice for everyone People have an input into the daily menu one person said I suggested tongue would be nice - the next day it was there! Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that their complaints would be taken seriously and acted upon. Increased Safeguarding training ensures all staff are aware of the procedures for protecting people in the service. Evidence: There is a clear and concise complaints procedure in place. All people have a copy in their rooms with the Service Users Guide and there is a copy in the reception area of the home for visitors. The home have received one complaint since the last inspecton in relation to a medication error, the incorrect dose was provided by the pharmacy and the Pharmacist took responsiblity for the error. This was handled well by the home who have also revised their procedures for checking medication received into the home from the pharmacy. Copies of prescriptions are now made to check against medication received from the pharmacy. There is a suggestion box located in the reception area of the home, but apparently little used. People spoken with said that if they had any concerns about the care they were receiving they would feel able to speak to the Manager or one of the care staff one Care Homes for Older People Page 19 of 31 Evidence: said they are always around and they will listen to us. The majority of staff have now received training in the Protection of Vulnerable Adults (Safeguarding). The Manager has also attended the trainers course for this. Care Homes for Older People Page 20 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing improvements to the environment mean that people live in a safe, comfortable home with good facilities. Evidence: The environment has previously been poor. Many improvements have been made and recorded in recent inspecton reports. The providers have agreed an improvement plan for the home. At the time of the last inspection upgrading of many communal areas and bedrooms had taken place vastly improving presentation. Two areas for improvement were outstanding: One related to the upgrading of a first floor bathroom the other related to the upgrading of the kitchen area - a compliance date of 30th April 2008 was agreed for both. At the time of this inspection the fourth bathroom has been completely upgraded, the bath removed and a walk-in shower (wet-room) created with toilet and wash hand basin. This provides an excellent facility for people prefering the use of a shower rather than a bath and also for people unable to use an assisted bath. The planned work on the kitchen has not taken place - the providers stating that other pressures for finance had overtaken their plans - a replacement stair lift had to be installed at Care Homes for Older People Page 21 of 31 Evidence: considerable cost. The provider present during the inspection undertook to upgrade the kitchen by 30th May 2009. The service will inform us when the work is completed. The home now has 2 shower and 2 assisted bathing facilities located strategically throughout the home ensuring they are easily accessible from all bedrooms and communal areas. These facilities are good. Redecoration of many communal areas and bedrooms has taken place since the last inspection. The reception and corridor areas adjoining look particularly bright and inviting. The re-carpeting was completed on the first floor landing area near the lift as identified in the last report. The rear part of the main large lounge area was seen to be lacking in natural and articifial light at the time of the last inspecton with a recommendation to address this. This has been done with additional free-standing lamps, increased bulb wattage and now presents a bright, homely area where people can enjoy sitting and reading if they wish. Overall the presentation of the home has vastly improved over the past 2 years. The Manager has a redecoration programme for 2009 which has commenced. It was noted that the exterior woodwork is in poor condition due to lack of painting, some wooden windows are bare and rotting. In the dining area the wooden frame of the metal windows had cavities and evidence of rot. It is important to preserve and maintain the external part of the building. It was noticed during the inspection two door thresholds where the ceramic tiles meet the carpet were a potential trip hazard and require cover strips to ensure the safety of people using those areas. Testing of the hot water outlet in a sink located on the first floor showed that the temperature exceeded the safe limit. It is important to pursue the cause and ensure a safe temperature to avoid scalding. There are weekly tests of hot water outlets, the one seen had clearly been missed. A sample of bedrooms seen were well furnished and decor was to a good standard. All rooms seen were very well personalised refleting the history and interests of the people in them. The standards of hygiene throughout the home were to a high standard and there were no mal-odours. Care Homes for Older People Page 22 of 31 Care Homes for Older People Page 23 of 31 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. Staffing levels and training are satisfactory but it is important to carry out robust checks when recruiting staff to ensure the safety of people using the service Evidence: The staffing levels in the home remain 4 Care staff on the early shift and 3 on the afternoon shift - Plus the Manger. There are 2 waking night carers. An additional carer works on the early shift from 6.30 a.m. prior to night staff completing their shift at 8 a.m. There are no pressures to get people up early to comply with shift changes. Additional staff for catering, domestic and laundry support the care staff. There is no laundry assistant on duty on Mondays or Fridays, this puts additional pressure upon care staff at weekends particularly and the providers may wish to review this. There were shortfalls in areas of staff training at the time of the last inspection, two requirements were made in relation to training in Moving & Handling and Food Hygiene. These requirements have now been met, the staff training matrix evidenced that all staff have had moving and handling training and all staff preparing food have had Food Hygiene training. Other areas of statutory training have all been met at this time. Care Homes for Older People Page 24 of 31 Evidence: Two staff files were inspected. There was no interview record in either and it was found that a reference had not been obtained from the previous employer of a person with previous convictions. Although these had been discussed with the person there was no record of the circumstances surrounding them and the person had not completed and signed a declaration of any convictions prior to a CRB (Criminal Records Bureau) record being obtained. The person was working as a carer for 4 months after a POVA (Protection of Vulnerable Adults) record check before a CRB was obtained. References must always be obtained from the last employer and details of any convictions recorded. Care Homes for Older People Page 25 of 31 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. A well managed home, run in the interests of the people who live there. Evidence: The Registered Manager has been managing the home for the past 2 years. Her management style is open and positive, she takes a positive lead in the home. She has several years experience in care and obtained the Registered Managers award in 2007. She has made many necessary improvements in that time in areas such as staff training, improvement of the environment, care planning and reviewing and changing care practices in the home. This home was originally rated poor, but progress was made and at the time of the last inspection became a 1 Star Service - Adequate. Many improvements have been further developed and sustained but some shortfalls in Health and Person Care and Staffing in this report have hindered the progression to a 2 Star - Good service at this inspection. The service has potential to acheive this level. There was an extremely open, relaxed and homely atmosphere during this inspection. Care Homes for Older People Page 26 of 31 Evidence: Manager, staff and people in the service were positive about the standards of care provided. Staff spoken with were very committed to the care of people and keen to build further upon the improvements already made in the standards of care. People said that they were involved in decisions about the running of the home and their choices and preferences were known and met. Comments in written feedback to us from people prior to the inspection included Professional care and excellent standards and communication - inspires confidence and All staff work as a team with Sue, to provide actvities and events, often in their own time and initiative. Further comments included The improvements seen under Sues management are quite marked, the rooms are undergoing a programme of refurbishment and the home always looks homely and inviting. I visit almost every day at different times. A requirement of the last report to ensure all staff have regular fire drills has been met. Four people smoke, have been risk assessed and are supervised in the designated smoking area. Staff supervision records showed regular supervision of all staff undertaken by the Manager and Senior staff. The providers Responsible Individual visits the home weekly, although there were no records of those visits left in the home. The Manager has immediate access to the providers by telephone and there is a meeting with the providers approximately 6 weekly. Staff training has improved safety for people. Further shortfalls identified in relation to safety of people are in medication and staff recruitment. These need to be addressed. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 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 9 13 Medication records must accurately record the medication prescribed and given to people This will demonstrate that people have the medication they need. 21/02/2009 2 29 19 The homes recruitment policies must ensure a robust procedure This will ensure that people using the service are protected 20/02/2009 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 8 Administration of insulin must only be given by staff trained and certified in writing to be competent by the District Nursing Service. This will ensure safety for people needing daily insulin. All healthcare professionals should see people in their own bedrooms and not in communal areas. This will ensure that Page 29 of 31 2 10 Care Homes for Older People their privacy and dignity is maintained. 3 4 5 19 19 25 Some remedial work is needed to the external part of the building to maintain its viability for those living there. Complete the upgrading of the kitchen area as planned to improve presenation and infection control. Ensure that all hot water outlets do not exceed the safe limit to reduce the risk of scalding people. Care Homes for Older People Page 30 of 31 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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