Inspection on 09/09/08 for Winchester House

This inspection was carried out on 9th September 2008.

CSCI found this care home to be providing an Excellent 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

Winchester House 18/04/07

Winchester House 22/08/06

Winchester House 07/02/06

Winchester House 28/09/05

Winchester House 10/03/05

Winchester House 12/07/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Winchester House 180 Wouldham Road Rochester Kent ME1 3TR     The quality rating for this care home is:   three star excellent 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: Elizabeth Baker     Date: 1 0 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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: Winchester House 180 Wouldham Road Rochester Kent ME1 3TR 01634685001 01634661030 winchester@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Anthony Clifford Beorby Type of registration: Number of places registered: Barchester Healthcare Homes Ltd care home 123 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 123. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Winchester House is a care home for older people with nursing needs and includes a Dementia Care Unit. The home also provides services to those under the age of 65 who have a Physical Disability. Accommodation is provided on two floors with access by shaft lift to the first floor, many of the rooms have en-suite facilities. All areas are accessible to both residents and visitors. The home is situated in a rural area of Care Homes for Older People Page 4 of 31 123 0 123 Over 65 0 123 0 Brief description of the care home Wouldham some distance from local shops and approximately 2 miles from the City of Rochester. The home provides some transport and a local taxis are available. There is ample car parking around the home. Fees currently range from £518.99 to £1500.00 per week. Additional charges are payable for chiropody, newspapers, hairdressing and physiotherapy. 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: three star excellent 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: Link inspector Elizabeth Baker carried out the key unannounced visit to the service on the 9 and 10 September 2008. In total the visit lasted 15 hours. As well as briefly touring the home, the visit consisted of talking with some residents and staff. Six residents, five visitors and seven members of staff were interviewed in private. Verbal feedback of the visit was provided to the registered manager and clinical lead manager during and at the end of the visit. At the time of compiling the report, in support of the visit, we (the Commission) received survey forms about the service from five members of staff, three care managers, one healthcare professional, three allied healthcare professionals and seven residents. At our request the home completed and returned the Annual Quality Care Homes for Older People Page 6 of 31 Assurance Assessment (AQAA). Some of the information gathered from these sources has been incorporated into the report. Since the last visit there have been three safeguarding referrals. There have been no referrals to the Protection of Vulnerable Adults list. What the care home does well: The new registered manager and clinical lead manager were receptive to advice given and demonstrated a commitment to put right any matters needing addressing to improve the service further. Staff are enthusiastic about their roles and enjoy working at the home. There is a relaxed and happy atmosphere around the home with communication between staff, residents and management open and engaging. Indeed visitors and service users commented on the friendliness and laughter exhibited by staff. Compliments and comments received during the visit and from survey respondents included The managers and staff have the right skills, this is an all round good home. I am very pleased with the care this home afforded my client. The manager is very proactive in his management style with the needs of the residents being met being paramount. His approach is very professional leading to motivation with the staff who he supports and guides as necessary. The nursing care has been very good since [residents] return from hospital. It is very rare for [resident] not to enjoy both the quality and quantity of the food. As a resident [relative] is pleased with the standard of cleanliness and as a regular visitor, I too think the home is well maintained. The standards of cleanliness are very high throughout the part of the home where my [relative] lives. I visit my [relative] twice a week and no matter what time I go the standards are always high and the rooms - personal and communal - are kept to a high standard. The standard of cleanliness is excellent and very well managed. Residents always look clean and well presented. Welcoming and pleasant approach to residents, relatives and other visitors. Efficient and friendly service. Clean and comfortable environment. Detailed and accurate care plans and client information maintained and updated to a high standard in my experience with my client. I was particularly impressed with the senior nurse on the EMI unit. The care service liaised with the GP and myself when there were any queries or difficulties. In my experience the care plans and assessment information about the client were detailed and accurate. There is always open discussion around care plans. [In my experience] the staff are very quick to inform our department of any changes, and to seek appropriate advice from other healthcare professionals. Any incidences in which I have been involved, I have found the staff very cooperative and willing to try to resolve concerns. This is a wonderful place, people are nice, and the service and food are good. If I won a lot of money I would not move from this room but would pay for an additional room to use as my sitting room. Can ask for anything. Have as many baths as I want to. Dont have anything to worry about - millionaire lifestyle here. First class service here and excellent meals. I like the calmness here. I could not believe the effect of this place on me, making me feel safe and secure particularly as my mobility is restricted. Staff are calm and collected. We were amazed at what we saw [when looking at choosing a home] here - killed all our perceptions of what care homes are like. And it’s lived up to this since. Visiting is open and we visit almost everyday. The home is always spotless - second to none. Nursing care is excellent. Its so easy going here, very good staff, there is always laughter. This is like a fire star hotel. No complaints or concerns whatsoever. This home looks after residents extremely well. Staff are very patient with residents, even though some residents can be difficult. Situations extremely well handled. Good entertainment here and go out on trips. All care staff and nurses - brilliant. Care Homes for Older People Page 8 of 31 What has improved since the last inspection? 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 Care Homes for Older People Page 9 of 31 240 7535. Care Homes for Older People Page 10 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 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be sure the home can meet their assessed needs. Evidence: There is a statement of purpose and service user guide in place, providing good information about the home, its facilities and services. To assist residents, a copy of the documents is made available in all bedrooms for ease of access. Where possible the home manager visits prospective residents in their current place of occupation to determine whether the home is suitable to meet their current individual needs. Indeed since the new manager’s appointment, the system has been made more robust to ensure prospective residents do not pose potential risks to other residents and indeed staff. Information is also sought from other agencies involved in the prospective residents care, including care managers and healthcare professionals. Residents are initially admitted to the home on a trial basis. Where there is evidence Care Homes for Older People Page 12 of 31 Evidence: that the placement is not suitable, the home works with other professionals to find more appropriate care facilities. Not all prospective residents are able to visit the home prior to a decision of admission being made. Where this is the case, advocates or relatives visit on their behalf. Because of anxieties which may occur when residential care is being considered, the home does not pressurise prospective residents into making quick decisions. Indeed a survey respondent added The management team was very considerate and helpful while [relative] was making up their mind about the home. They were re-assuring without pressurising them to accepting a place. And an advocate remarked They kept a place for [resident] whilst the care manager was sorting out the financial implications. I was grateful for this. As a welcoming gesture, new residents are provided with a plant and greetings card on admission. This is good practice as it helps to minimise any anxieties new residents may have about moving into a care home. The home is not registered for intermediate care. Standard 6 is not applicable. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are met with evidence of good multidisciplinary working taking place on a regular basis. Evidence: For case tracking purposes, the care records of five residents were inspected. The sample was taken from the three units operational at the time of the visit. Records contained a care plan and a range of supporting clinical and health and safety risk assessments. These included moving and handling, lap belts, bedrails, nutrition, falls, continence, skin integrity (Waterlow), wound charts and body maps. A behaviour assessment scale of later life assessment (BASOLL) was seen in one care record, although it had not been completed. Care plans follow the activities of daily living model and are composed from information gathered at the pre admission and admission process. Baseline observations are taken and recorded on admission. This is good practice. Specialist input is sought and provided from other clinicians where there is an assessed need. This includes a Psycho-geriatrician, Community Psychiatric Nurses, Speech and Language Therapist, and Physiotherapist. Residents also receive Care Homes for Older People Page 14 of 31 Evidence: treatments from allied healthcare professionals such as dentists, opticians and chiropodists. Generally care plans inspected provided the information gathered during interviews with residents. In each case the care records provided some person centred care information. The staff on the physical disability unit should be congratulated on the level of detail seen in the two care records inspected on that unit. Daily records are maintained and give a picture of the individual residents quality of day experiences as well as information on their medical condition. However a number of meaningless phrases such as hygiene needs met, had a comfortable day, settled day and safety maintained were seen. In two cases correction fluid had been used to change the content of records. Registered nurses must ensure they maintain all care records in accordance with their professional body’s guidance on good record keeping. This includes contents and corrections. The medication administration record (MAR) charts relating to the five residents were inspected. In the main these had been completed as required by the registered nurses’ professional body. However where handwritten additions had been recorded on a number of MAR charts, the entries had not been signed by the person making the entry or countersigned by a witness, as is good practice. A number of residents take medicines for pain relief. Care plans are in place. Pain assessments are available to monitor the effectiveness of treatment plans, although they were not seen in use on this visit. The pain component for one resident indicated the plan is reviewed monthly and that a non-opioid analgesia had been discontinued. However the inspection of the residents MAR chart indicated they are prescribed and receive opioid analgesia. But it was difficult to establish the reason for this medication and whether it replaced the non-opioid one. Residents spoken with said staff assist them with their personal hygiene needs in a way which protects their privacy and dignity. Staff were seen interacting with residents in a cheerful, non-patronising and re-assuring way. All residents were seen suitably dressed for the time of day and season and to the level of detail where this is obviously important to them to maintain their self-respect and self-esteem. Some residents had just or had recently used the services of the homes hairdresser. The home has a designated room for this purpose. Most of the residents living at the home will do so for the rest of their lives. So that residents spiritual and cultural wishes are carried out in the event of death and dying, as per their individual wishes, information is sought. Care records seen contained some funeral arrangements information and a number had references to the residents Care Homes for Older People Page 15 of 31 Evidence: religion. However where religion obviously played a big part in residents lives, in two specific cases the information was limited. Some staff will shortly be attending the Liverpool Care Pathway training courses facilitated by a local hospital. And a number of registered nurses have attended syringe driver courses. This is good practice for the purposes of pain management and palliative care. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals and activities offer both choice and variety. Residents are supported in attaining their lifestyle preferences. Evidence: Arrangements are made for residents to take part in structured activities, socialise with others and to be independent as possible. Residents are provided with a weekly activities timetable. This includes information on forthcoming activities including arts and crafts, reminiscing, knitting for Africa, Tuesdays book club, cooking and bingo. Many residents on one particular unit were engrossed in a game of bingo during the visit there. External activity entertainers visit the home and a poster for a forthcoming Music for Health session was displayed. The home has a mini bus and car for residents to use for trips out. A Holy Communion service takes place at the home on a monthly basis. And arrangements are made for lay people of other denominations to visit individual residents where this is required. Not all residents like to or indeed can partake in group activities. Where this is the case, one to support is provided. Some residents prefer to spend their time in the privacy of their rooms watching the TV, listening to the radio, model making or reading. However, some survey respondents are of the opinion that the current provision is not enough in all cases. Respondents Care Homes for Older People Page 17 of 31 Evidence: comments included We could do better by organising more activities for residents. We could dedicate more time to social activities for our clients. There are limited day activities and clients are left in the lounge with the TV. The service needs to focus more on individual social and recreational needs of its residents. And More stimulation/activities on the YPD unit. The home employs two activities coordinators. An additional activities coordinator has just been appointed. This is timely and should help in enhancing the current provision for the benefit of all residents. Visitors were seen coming and going throughout the duration of the inspection. Visitors are offered refreshments and can visit any time. Residents special occasions are celebrated with a cake and greetings card. Each unit has a dining room or dining area. The rooms are nicely decorated and furnished. Tables had been laid in preparation of meals to be served and provided a good atmosphere in which residents can enjoy their meals. Some residents require assistance or prompting with their meals and staff were seen assisting some residents an unhurried and encouraging manner. Menus provide choices at all servings and cooked breakfasts are available every day. In addition to the formal menus, additional table top menus provide further choices. Comments about homes meals included Its very rare for dad not to enjoy both the quality and quantity of the food. I enjoy the meals although my own preference is for plain cooking. But I can ask for anything. Excellent meals. Meals are good. Very good food. Despite these comments a couple of respondents recorded The soft diet is bland, boring and repetitive. And I sometimes like the meals - more older-people type meals required. In order to improve the variety of meals, menus have been changed twice to take account of residents views. Residents are also able to enjoy a glass of wine with lunch and dinner if that is their wish. Other drinks were seen in plentiful supply. Although meals were not sampled during this visit, they smelt and looked appetising. And the home achieved a 5 star Dining Award in 2007. The home has facilities to ensure all residents are appropriately weighed so their nutritional needs are met. The devices are calibrated to ensure accuracy. This is good practice. 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. Residents and their advocates can be satisfied their concerns and complaints are listened to and acted upon. Evidence: Information is conspicuously displayed in the entrance vestibule informing residents, visitors and staff of the providers complaints procedures. This includes our contact details. This information is also included in the homes Statement of Purpose and Service User Guide. Residents and visitors spoken with during the visit knew what to do if they had a concern or were unhappy about any aspect of their care. The AQAA records the home has safeguarding adults and whistle blowing policies. Staff interviewed described appropriately the action they would take if they suspected abuse had taken place. The AQAA also records the home has received eight complaints about the service in the last 12 months. Of these two were upheld. In order for residents to exercise their civil duties, arrangements are made for them to vote in local and general elections if they so wish. Care Homes for Older People Page 19 of 31 Evidence: 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment creates an excellent home for residents to live in. Evidence: Since registration, the home has been sympathetically extended to accommodate up to 123 residents requiring care. The home is now divided into four units. The premises internally and externally are kept in an excellent condition. All areas visited were fresh, clean, warm and odour free. Decorations and furnishings throughout the home are of a high standard. And the standard of cleaning throughout is excellent. Indeed many survey respondents commented on the cleanliness of the home and residents and visitors spoken with during the visit indicated this was the standard at all times. Staff should be congratulated on this. The grounds have been designed to enable residents to enjoy the gardens when good weather allows. Residents are encouraged to assist in the planting of borders and pots. There is now an allotment area. Indeed a resident spoke of his enjoyment of helping to plant and grow flowers and vegetables. The vegetables were used in some of the homes meals. The home has a number of sluice rooms for the safe storage and disposal of clinical waste and bodily fluids. As is good practice they are fitted with locks. However on Care Homes for Older People Page 21 of 31 Evidence: inspection it was identified a number had been left unlocked, presenting potential risks to residents and visitors in the vicinity. Corridors are fitted with handrails and are of a size, which enable residents to remain as independent as possible. Indeed a resident was seen going about his business in his self-propelling wheelchair during the visit. Since the last visit the home has increased its range of hoists and slings. These are used for the safe transfer of residents. For hearing impaired residents, loop systems have been installed in two of the lounges. And the home has increased its range and number of pressure relieving/preventative equipment, including mattresses. Since the last visit the home has had a fire safety inspection by an officer of the local brigade. No requirements or recommendations were made. Although the home has not been provided with a report of the visit, the officer said he was impressed by some new evacuation equipment the home has recently acquired. Although the home has not had an inspection from the areas environmental health department for some time, it is regularly inspected by an independent environmental company as part of the organisations quality assurance programme. Bedrooms visited had been individualised with personal effects. To accommodate one residents hobby, an extension has been added to a work unit to provide more usable space. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive care and support from a happy, enthusiastic, caring and trained workforce. Evidence: As well as care staff, staff are employed for administration, reception, cooking, cleaning, laundry, maintenance and gardening. Staff rotas are maintained and indicated the home is staffed 24 hours a day. Staff were seen carrying out their duties in an unhurried manner and being attentive to residents. Respondents comments to staffing was mixed and included The carers and nurses are very willing but they are limited by time and the demands of other residents. It seems that sometimes the home is short staffed, particularly at weekends. I try not to ask too much of the staff as I realise they are exceptionally busy. The staffs response depends on how many are on duty and what other residents are requiring. I have never known the staffing levels to be dropped when I work. Its excellent here, despite staff being stretched at times. And Usually have enough staff according to the number of residents. The home manager has recently reviewed staff numbers and skill mix and some changes have been made, resulting in the recent appointment of a number of registered nurses increasing the ratio of registered nurse cover on two particular units. The new manager has also introduced the post of a Night Sister. And reception cover is now available at weekends. Care Homes for Older People Page 23 of 31 Evidence: During May 2008 the 11 bedded Marconi Unit closed, as it posed operational difficulties. However its re-opening is imminent. The unit will now be occupied by less dependent residents, which should ensure staffing arrangements are easier to manage. Marconi is a stand alone unit and will be staffed separately from the other nearby units. New staff are required to complete an induction programme. Staff interviewed confirmed they had received induction training and described the subjects and length of their individual programmes. The provider has devised its own apprenticeship training course. This works in tandem with the Skills for Care foundation course. When completed, staff are expected to commence on their NVQ level 2 training course. Ofsted recently visited the site to inspect the providers scheme, and meet with the learning and development team. Positive feedback was provided to the provider. And the home is in discussions with Christ Church, Canterbury to provide student nurse placements. It is hoped that the arrangement will allow some of the homes registered nurses to attend clinical and other appropriate courses at the University. This arrangement should assist registered nurses in maintaining their professional skills and development in line with their Post Registration Education and Practice requirements. The training matrix supplied in support of this visit indicates that most staff this year have received mandatory training in subjects including health and safety, protection of vulnerable adults and infection control. Some staff have also received training in COSHH, moving and handling, customer service, food safety and first aid. In addition some staff have received training in subjects including Tissue Viability; Yesterday, Tomorrow and Today, which interlinks with that of the Alzheimers Society; Catheterization; Immunisation; Adult Abuse; Tracheotomy Management; Brain and Spinal Injuries; Managing Syringe Drivers, Mental Capacity Act - train the trainers course and Venepuncture. And almost 50 of untrained care staff are now trained to NVQ level II or above. Despite the above training it was disappointing to see that staff have not received challenging behaviour or break away technique training, even though some residents may present aggressive behaviours. Indeed a review of the accident book indicated a carer had recently sustained an injury while supporting a resident who became aggressive. The Commission is also aware of a matter resulting in a safeguarding investigation which may have been prevented if staff had received such training. For the protection of residents and staff, staff must receive training appropriate to their roles and the assessed needs of current residents. The personnel files of four members of staff were inspected. As part of the homes Care Homes for Older People Page 24 of 31 Evidence: vetting practices, references are sought and obtained, POVAFirst is accessed and Criminal Record Bureau checks undertaken. Where there is a need, work permits are obtained. The current application form requires new staff to provide full employment histories. In the cases of the two most recently employed staff it was difficult to obtain a full employment history as there was an explained gap in one case and conflicting information on the application form and accompanying CV in the other case. For residents protection all employment gaps and conflicting information must be investigated and the findings recorded. During 2006 we published guidance to assist providers and managers in the development of their recruitment procedures and practices. The publications in question are called Safe and Sound? Checking the suitability of new care staff in regulated social care services and Better safe than sorry - Improving the system that safeguards adults living in care homes. Both publications are available from our website - www.csci.org.uk. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run home. The home reviews aspects of its performance through a programme of self-review and consultations including the views of residents, advocates and staff. Evidence: Since the last inspection a new manager has been appointed and registered with us. The registered manager has worked in care for the last 28 years, qualified as a registered nurse in 1985 and has held management positions in a number of care homes. He also holds a Certificate in Management Studies. Throughout the visits the registered manager was open and frank about the home and his desire to continue on the improvements and changes which he has already brought about since his appointment. Residents, staff and visitors spoken openly throughout both inspection days and were eager to put their views forward. Indeed one visitor made sure of voicing their views Care Homes for Older People Page 26 of 31 Evidence: on the home by specifically asking to be interviewed. Staff have ready access to the registered manager and many instances were seen of this during the visit. Both the registered manager and clinical lead manager try to go around the home every day to meet with residents and staff. Comments about the homes manager included Manager is totally supportive of my professional development. The manager is very proactive in his management style with the needs of the residents being paramount. His approach is very professional leading to motivation within the staff team who he supports and guides as necessary and The manager is always available if I need him and very supportive. To obtain views and opinions of the service, various meetings are arranged for residents and staff to meet with management on a regular basis. The meetings are recorded. Because relatives meetings were not successful the registered manager has introduced monthly surgeries and these have proved more effective. The provider uses an external company to carry out annual satisfaction surveys of the users of this home. When the information is collated, the home is provided with an analysis of the findings. The menus have again been changed following feedback received by residents. And the home is recognised by Investors in People for quality assurance purposes. The AQAA indicates the home has current policies and procedures for staff to refer to when carrying out particular duties. The AQAA states that the home has policies for infection control and aggression towards staff. The AQAA also states that all staff have received infection control training. This is good practice. The homes infection control policy refers to personal protective equipment. This policy cross references to the homes health and safety policy, which details the personal protective equipment, including aprons, gloves and goggles. However whereas the home has a ready supply of aprons and gloves, it does not keep any goggles on site for staff to easily access where there is an identified need. This may be relevant when supporting residents who present challenging behaviours, such as spitting. Whilst acknowledging that seeing staff in eye protection when being assisted with care needs could alarm residents and or even escalate a delicate situation, the provider has a duty of care to staff to ensure appropriate protective equipment is available to them at all times. Specialist advice should be obtained. Personnel files inspected contained signed and dated evidence of staff having received formal supervision. However it was identified on this visit that supervisors do not always keep records of all subjects discussed. This could present problems if the content of the formal supervision were required for auditing purposes. Some senior staff have been delegated the responsibility of giving supervision to staff in their units. Two of the three senior staff interviewed said they had received training for this Care Homes for Older People Page 27 of 31 Evidence: important role. Supervision takes place in different ways and includes one to one meetings, group meetings and clinical observation. The home aims to ensure all staff receive supervision about six times a year as recommended. Four of the five returned staff survey forms indicated they regularly meet with their manager for support and discussion on how they are working. However, one care assistant seemed a little unsure as to whether they had received supervision or not, although their personnel file contained signed records of attendance. The clinical nurse manager endeavours to visit each unit every morning and discusses various matters with staff. This is good practice. However some staff interviewed confused this with formal supervision also. The AQAA records the homes equipment is serviced and or tested as recommended by the manufacturer or other regulatory body. The home is not responsible for residents personal allowances. If a purchase is made or an item acquired on behalf of a resident, the home invoices the resident and or their advocate for settlement. Care Homes for Older People Page 28 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 29 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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. 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