Inspection on 09/04/08 for Windermere Rest Home

This inspection was carried out on 9th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Windermere Rest Home 09/04/09

Windermere Rest Home 18/04/07

Windermere Rest Home 05/10/06

Windermere Rest Home 13/12/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Windermere Rest Home 23/25 Windermere Road Southend-on-Sea Essex SS1 2RF Lead Inspector Ms Vicky Dutton Unannounced Inspection 9th April 2008 09:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000065465.V362145.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000065465.V362145.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Windermere Rest Home Address 23/25 Windermere Road Southend-on-Sea Essex SS1 2RF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01702 303647 Mr Kumarasingham Dharmasingham & Mrs Mithila Dharmasingham Manager post vacant Care Home 10 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (10) of places DS0000065465.V362145.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Mr and Mrs Dharmasingham have agreed POVA training within nine months of registration. Mr and Mrs Dharmasingham have agreed Health and Safety training within one year of registration. Thermosatic controlled values on all hot water taps accessible to residents. This work to be carried out within six months of registration. Radiator covers to be provided to all remaining radiators. This work to be carried out within one year of registration. To provide locks on all bedroom doors enabling access from outside to comply with fire regulations. This work to be carried out within nine months of registration, with Risk Assessment and Fire Department approval of them in the meantime. 18th April 2007 Date of last inspection Brief Description of the Service: Windermere Rest Home is a small, privately owned residential home providing accommodation and care for ten people who may have dementia. Accommodation consists of ten single bedrooms, a communal lounge/dining room, kitchen, two bathrooms, laundry and office. Each bedroom has a call bell facility and a TV point. A shaft lift is available to provide access to both floors. There is a very small, enclosed garden to the rear of the home. The home is situated in a residential area of Southend on Sea within easy access of the seafront, train links, bus services and local shops. The home provides display permits to allow visitors to use a private car park opposite the home. A Statement of Purpose and Service User Guide were not available at the time of this inspection. A copy of the last inspection report was available in the hall opposite the office. The manager, who is not yet registered with CSCI, was unsure of the current scale of charges but said that they started from £ 431.00 per week. Extras charges are for hairdressing, chiropody and newspapers. DS0000065465.V362145.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced ‘key’ site visit. At this visit we (CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are facilitated to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. The site visit took place over a period of seven and a half hours. A partial tour of the premises was undertaken, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. Prior to the site visit the home had completed and sent in to CSCI their Annual Quality Assurance Assessment (AQAA). This outlined how the home feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives involved professionals and staff. Only two of these were returned. The views expressed at the site visit and in survey responses have been incorporated into this report. The inspector was assisted at the site visit by the manager, and other members of the staff team. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents and relatives and for their help throughout the inspection process. What the service does well: Windermere Rest Home is a small care home that provides people with a more intimate and ‘family’ feel home. Staff know the people living there well, and have a good understanding of their individual needs, likes and dislikes. Visitors are always made welcome and can visit at any reasonable time. DS0000065465.V362145.R01.S.doc Version 5.2 Page 6 Staff are encouraged to undertake training, including National Vocational Qualifications, so that they have the right skills and understanding to meet peoples’ needs. What has improved since the last inspection? What they could do better: So that people receive good and consistent care management need to ensure adequate staff are available at all times to meet all of their needs. The level of care staff provided needs to be kept under review and be flexible so that people always have enough staff available. People should be able to undertake activities such as using the local community or attending church if they wish with support from staff. Adequate domestic staff need to be provided so that the home is kept clean and hygienic at all times. At the moment menus at the home are limited for people. People living at the home should have the opportunity and be actively involved in having choices about menus and mealtimes have the opportunity to be consulted with about menus and meal times. Although a lot of staff training has taken place in the last year there are still some gaps both in core areas such as first aid and infection control, and in specialist areas such as dementia care and managing challenging behaviour. DS0000065465.V362145.R01.S.doc Version 5.2 Page 7 When staff start work at the home they have not benefited from undergoing a robust induction process that will assist them in learning their role and carrying out their duties. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000065465.V362145.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000065465.V362145.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People wanting to move into the home can be assured that their needs would be met, based on a thorough assessment, but would not receive sufficient written information to assist in the decision making process. EVIDENCE: The Home’s Statement of Purpose and Service Users Guide are currently being updated and only old versions were available. The manager confirmed that people interested in moving into the home are only given verbal information during the assessment process, and encouraged to visit before moving in. The manager said that social workers were also usually involved in the admission process, and they were able to give people information. People and their families or carers should have access to good written information about the home to help them in making informed choices. DS0000065465.V362145.R01.S.doc Version 5.2 Page 10 The files of two people who had recently moved in were viewed and showed that good pre-admission assessments had been carried out by the manager. Assessment and other Information was also available from local authority social services departments who had been involved with people’s admission. One person had been admitted at quite short notice the day before the site visit. There was a good level of information available to enable staff to offer them appropriate care. Staff spoken with already had a good awareness of their care needs. One person had been admitted to the home, and although they were diagnosed with dementia, they were also diagnosed with a significant condition relating to their mental health. Staff had not had any relevant training in this area to assist in understanding their needs. Staff felt that the main need was for dementia care. Intermediate care is not provided at Windermere Rest Home. DS0000065465.V362145.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to receive the personal and health care support they need. They can also now be more confident that their medication will be managed properly so that they are cared for safely. EVIDENCE: People spoken with were happy with the care they were receiving at Windermere Rest Home. A relative said that ‘Staff are in the main friendly and things have improved greatly under the new manager.’ Good care plans were in place that showed that peoples’ needs had been properly assessed. Care plans were signed to show that they had been discussed with the person or a family member. They provided clear and detailed information for staff as to how to care for people in line with their needs and preferences. Staff spoken with showed a detailed knowledge of individual peoples’ needs, and how they liked to be cared for. Through discussion care staff demonstrated that they could be flexible in their approach to care in accordance with individual preferences and day to day choices. DS0000065465.V362145.R01.S.doc Version 5.2 Page 12 So that people are cared for safely, any risks associated with their care had been assessed and planned for. This included assessments for falls and the use of bed rails. People living at Windermere Rest Home can generally expect their health care needs to be met. Peoples’ health is monitored, and assessments undertaken, and kept under review for such areas as nutrition and pressure area care. Good nutrition records are maintained to ensure that peoples’ diet is monitored, and action taken quickly if there are any concerns. Documentation viewed showed that people are supported to see appropriate healthcare professionals to meet their needs. People have not previously had access to regular dental checks and care. The manager said that this is now arranged. Staff have undertaken training to help them understand people’s needs and support them. For example on the day of the site visit a training session in relation to continence management was planned. The management of medication has improved since the previous inspection. People can now be confident that this aspect of their care is being well managed. Records viewed were properly maintained, and the system was in good order. The manager undertakes a weekly audit to ensure that the system and records are properly maintained at all times. Staff have received training in managing medication, with a number having just completed this in March of this year. This shows that staff are kept up to date. Management do need to seek advice from their pharmacist to ensure that current arrangements for medicine storage are suitable, and meet the requirements of the relevant legislation. Also the home is hampered in managing communications between themselves, the pharmacy and the doctor’s surgery because they do not have a fax machine. Regulations state that all homes should have this facility. During the day of the site visit staff interacted well with people and respected their need for privacy. However, staff and management need to show respect for people, and demonstrate that they are valued as individuals at all times. For example, one person had been admitted into a room that still had a bad odour problem from the previous occupant, the walls were still full of picture hooks from their pictures, the radiator cover was bare chipboard and there was a light bulb missing from the fitment. This does not show a valuing people ethos. The manager said that the carpet in this room was to be replaced to solve the odour problem. Although the National Minimum Standard in relation to dying and death was not fully assessed at this visit, it was positive to see that staff had discussed end of life issues with people and their families. This information had been recorded. DS0000065465.V362145.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to have some opportunities for occupation and activity within the home, but cannot expect staff support to access the local community. People can expect to enjoy the food provided, but not expect the menus to be very varied. EVIDENCE: People living at Windermere now have more opportunities for activity and occupation. Those spoken with seemed happy and said that they did not often get bored. Care plans include an activities assessment, and a record of activities undertaken is now kept for each person. Activities recorded included card playing, reminiscence, arts and crafts, and balloon game. People are able to help with tasks such as washing up. An entertainer had visited the home, a mobile library visits on a regular basis and the manager said that they were trying to arrange for a Pets as Therapy (PAT) dog to attend. A number of people enjoy having daily newspapers. Although an ‘activities programme’ is displayed on a notice board, staff say this is not used and activities take place on an ad hoc basis. Another notice was on display about hairdresser visits. This said that the next visit would be on 27/11/07. The manager removed this, but it is concerning that the notice had been there for four months with DS0000065465.V362145.R01.S.doc Version 5.2 Page 14 nobody noticing or dealing with it. Although good progress has been made in providing more opportunities for stimulation and occupation, more could be done. There is still some feeling from staff that people living at the home are not interested in activities. Unless people have relatives or friends to take them out, they are not able to have community access. The manager thought that staff were not allowed to take people out for ‘insurance reasons,’ also staffing levels would make this difficult. Although one person is able to attend a church group on a weekly basis, there is no provision for other people to fulfil any spiritual needs. The television in the lounge remained on throughout the visit. It was noticed that for older people whose eyesight may not be as good, the television was quite small for the size of the room. One person said ‘a bigger one would be nice.’ In a quality assurance exercise undertaken by the home in January, people involved with the home also felt that more could be done in relation to activities. ‘A little more entertainment would be nice,’ and, ‘more activities and entertainment.’ On a CSCI survey one person felt that the situation was improving and said that the new manager: ‘has also improved menus and is looking at types of entertainment for the residents.’ Visiting is open and people are able to receive visitors at any time. Management should consider how they present information to visitors. A notice by the front door ‘Visitors Records’ talks of ‘how visitors are to be controlled,’ and also refers to a ‘receptionist’ which the home does not have. During the site visit staff respected the choices people made. It was noted that people were able to go where they wished, spending time in their rooms and elsewhere. People’s rooms were homely and showed that they could bring their individual personal possessions into the home when they moved in. People spoken with were happy with the food provided. One said that they ‘enjoyed the cooked breakfast at the weekend.’ The home works to a two weekly rotating menu that provides a choice at each meal. The manager said that in reality a greater choice is offered than shown on the menu. However a two weekly rotating menu may not provide people with sufficient variety over time. People should be consulted with, and have the opportunity to make suggestions and changes. The manager and staff do not have autonomy over the purchase of foodstuffs, as this is managed by the providers and delivered to the home. Staff may not therefore be able to be flexible and cater for people’s sudden wishes or choices. Staff said that although some fresh fruit and vegetables are provided the choice can be limited. The two weekly menu is displayed in full on the notice board, but this will not assist people with cognitive difficulties in knowing that they are having to eat that day. On the day of the site visit people did not know what they were having for lunch. At breakfast time people were having their breakfast from bare tables with no mats or tablecloths. At lunchtime tablemats were used. The dining area would be quite cramped should all ten people choose to eat there. Although one member of staff was noted to stand and assist someone with their food, which is not good practice, staff generally offered people sensitive support. DS0000065465.V362145.R01.S.doc Version 5.2 Page 15 The main meals of the day are quite closely spaced which may not help people to have a good appetite and eat well. People were still enjoying breakfast after 09.00. Lunch was from 12.00 and tea was said to start at 16.30. The manager said that they were trying to move tea to a slightly later time. DS0000065465.V362145.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People will be able to raise concerns about the service and be confident that their concerns will be listened to and taken seriously. They cannot expect that clear procedures are in place to assist staff in protecting them from abuse. EVIDENCE: A complaints procedure was available and on display for people on a notice board outside the office. The policy on display was not very encouraging to people, ‘not all complaints are valid and the complainant will be made aware of this.’ The complaints procedure also needs updating to make it clear that we (CSCI) do not have the authority to investigate specific complaints, but that any issues, complaints or concerns can be taken to the Local Authority who do have this duty. Since the previous inspection eleven complaints had been recorded. This was positive in that it showed that issues minor or otherwise are recorded and managed. People spoken with and on surveys said that they knew how to make a complaint. Complaints had been managed appropriately by the home and the outcomes for people were recorded. A training matrix showed that most staff had last undertaken training in safeguarding adults in 2006. Staff spoken with knew what whistle blowing meant. One complaint made about the home had been investigated by Social Services under safeguarding procedures and had been found to be unsubstantiated. The manager said that the home’s own policy/procedure on safeguarding was being updated and was not available. A 2004 document DS0000065465.V362145.R01.S.doc Version 5.2 Page 17 ‘POVA Scheme – A Practical Guide’ and a flowchart was the only guidance available. Staff do not have access to up to date guidance and relevant contact numbers, so that they can deal with any incident quickly and competently. Some people living at Windermere can show challenging behaviour. Staff have not received any training specific to this to help them to understand and meet peoples’ needs. Three staff have yet to receive training in dementia care that may also assist understanding. A relative expressed concern about this. ‘Quite a few of the residents have various degrees of dementia. I dont know whether staff have been trained to handle situations when the residents become violent.’ DS0000065465.V362145.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to live in a homely place, but not expect that their home will always fully clean and free from unpleasant odours. EVIDENCE: Windermere Rest Home is situated in a residential area. During the daytime in the week the area is very busy and often no parking is available. An arrangement is in place with a nearby private parking area, but unless people know the home they will not know this, and visitors may be frustrated. One complaint recorded related to the fact that a visiting professional could not find a parking space, so had not carried out the planned visit. Since the previous inspection the provider has shown a commitment to improving the environment. Some areas have been redecorated, and some carpets replaced. A refurbishment programme to upgrade other areas of the home is in place. Until then many areas of the home are still looking tired and DS0000065465.V362145.R01.S.doc Version 5.2 Page 19 some furnishings are in poor condition. There was a lack of attention to detail indicated by things such as the living room curtains hanging down. A relative said that, ‘the home has greatly improved in recent months both in management and in décor.’ The home is registered to provide care for people who have dementia. Limited orientation signage or other devices were in place that might assist in meeting peoples’ needs. People spoken with were generally happy with the accommodation provided. Their rooms were a good size and had been personalised and made homely to their individual tastes. The manager said that when rooms are redecorated people are being given a choice about colour. Although people can lock their bedroom doors from the inside they cannot choose to keep their rooms locked when they are elsewhere. On the day of the site visit odour control in some areas was poor. Many areas, including the living area and laundry showed that good cleaning and deep cleaning routines are not in place. The manager said that they are developing cleaning schedules, so that all rooms are deep cleaned on a rotational basis. A dedicated cleaner is only provided for six hours on one day of the week. The rest of the time care staff are expected to keep the home clean and tidy. Observations at this inspection show that these arrangements are not being effective in providing people with a clean and hygienic place to live. Policies and procedures were available relating to infection control. Staff practice during the site visit was satisfactory, and staff used appropriate protective clothing as they moved between different tasks of kitchen duties and carrying out personal care. However from the training matrix viewed, staff training in infection control is poor, with only three staff having completed this some time ago in 2003 and 2005. The improvement plan submitted following the previous inspection of April 2007, said that staff had received basic infection control training from the home’s consultant and that external training was to be found and provided. DS0000065465.V362145.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can generally be confident that they receive care from safely recruited and well trained staff. They cannot however be sure that sufficient staff will always be available to meet all of their needs. EVIDENCE: People spoken with said that staff were ‘nice,’ and ‘always friendly.’ Good interactions between staff and people living at the home were observed throughout the day. A relative said, ‘The staff are caring people and do their best.’ Staffing levels are currently maintained at two care staff during the day. At night there is one awake member of staff and one ‘sleeping in’ member of staff. Rotas viewed showed that these levels are being maintained. The manager’s hours are supernumerary during weekday mornings, so three people are on duty during this time. During weekday afternoons the manager is one of the two members of staff on duty. In addition to caring for people care staff undertake laundry and cleaning/tiding duties and carry out cooking duties. These arrangements mean that there are times, as observed at the site visit where people are left alone in the lounge without any staff monitoring for some time. They also reduce the flexibility of the service, for example insufficient time/staff available to take people out to access the community. A relative said ‘I am concerned about staff levels. I have no complaints against any of the staff. I am concerned about staffing levels because quite a few of DS0000065465.V362145.R01.S.doc Version 5.2 Page 21 the residents need full time care [relative included] toileting - washing dressing - feeding themselves. I only ever see two staff on duty - this often includes the managers and it is insufficient to deal with more than one person at a time. Also one of the two staff has to prepare and cook meals. I believe staff shortages means that residents dont always get the care they should.’ The manager and staff feel that current staffing levels are sufficient. Staff said that at the moment one person needed the assistance of two staff for personal care. Staffing levels need to be kept under review and be flexible to meet peoples changing needs. Of a staff group of eleven care staff a training matrix viewed, and the manager confirmed, that four care staff have a National Vocational Qualification (NVQ) at level 2 or above. Two further staff have an equivalent qualification. A further three staff are currently undertaking an NVQ. This shows that management have a commitment to providing well trained staff, and have achieved the standard advised of having 50 of the staff group have an NVQ at level two or above. The files of two recently recruited staff were viewed. These showed that all appropriate checks to protect people living at the home were carried out before staff started to work there. When staff start working at the home they should have a comprehensive induction, based on Skills for Care induction standards, over the first few weeks of their employment. This should assist them to understand all aspects of peoples’ care needs, the home’s policies and procedures and other aspects that will enable them to care well and safely for people. Currently a basic induction takes place over the first four days. A proper induction based on Skills for Care Standards has not so far been undertaken with any new staff. One member of staff had completed a Skills for Care induction at a previous employment. No other staff are identified as having completed this. Staff undertake a good range of basic training although there are shortfalls, and areas where updates are required. Four staff have not yet undertaken any training in dementia care. DS0000065465.V362145.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect that management at the home is gradually improving the quality of life for people living there, and that their views about the service will be sought. EVIDENCE: Windermere Rest Home has been without a registered manager since August 2006. Although a consultant has been overseeing the home, and has provided some consistency, the lack of a permanent manager has hampered improvements being achieved and maintained. The latest manager has been in post since October 2007, and has made good progress in addressing some of the issues and shortfalls identified at the previous inspection. A relative said ‘I had many worries about the home but the latest manager has made a great DS0000065465.V362145.R01.S.doc Version 5.2 Page 23 difference to the atmosphere and ambience of the home. She has also made great efforts to get to know each resident and meet their needs.’ The manager has a NVQ at level three which was achieved in 2001, so does not yet have the advised qualifications for management of a care home. The manager was unsure of the Providers intention with regard to applying to CSCI for registration. Quality assurance processes are being developed. A survey was given out to relatives and some people living at the home in January of this year. These had provided positive feedback about the service. The provider undertakes regular visits as required. Some peoples’ personal allowances are held for safekeeping by the home. Although balances were accurate it was noted that the hairdresser does not issue receipts, and a chiropody receipt was missing on another balance sheet. This does not provide a proper audit trail. People need to be assured that their affairs are being managed properly. The manager undertook to rectify theses issues. Some health and safety issues were noted during the visit. A radiator in the downstairs bathroom was not covered and could pose a hazard. Disposable gloves were available in areas of the home. Although not an immediate hazard to the existing people in the home, safe storage of these items should be considered. It was noticed that external fire exits were locked and the keys missing from the chains. This was said to be due to the behaviour of one person who constantly removed them. The manager said that the person in charge always had the keys on them, so that the doors could be opened quickly in the event of an emergency. The home’s fire risk assessment did not reflect this practice. The manager was advised to seek urgent advice from the fire service as to how to better manage this situation, as the current method has the potential to leave staff and the people in their care at risk. In a follow phone call to the manager, it was confirmed that the keys had been replaced by the doors, where they were accessible to staff. Fire records were well maintained and showed that the system is regularly tested and serviced. A current electrical certificate could not be found. It was agreed that this would be faxed to CSCI when located. Staff training in core areas covering health and safety is generally satisfactory, although some improvements and updates are needed. For example not all staff have received training in food hygiene, and only the manager and one member of staff have had recent training in first aid. DS0000065465.V362145.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 DS0000065465.V362145.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16 (2) Requirement People living at the home must be supported to maintain links with the local community according to their wishes. This is a repeat requirement. The previous timescales of 01/04/06, 31/03/07 and 31/07/07 were not met. 2. OP18 13(6) Arrangements must be made and implemented to ensure that so far as it is possible people are protected from abuse, harm and neglect. This refers to the need to ensure that proper safeguarding procedures are in place that are understood and followed by all staff. Suitable arrangements must be in place so that people live in a clean and hygienic environment where the risk of infection in minimised. There must be enough suitably qualified, competent and experienced persons working at DS0000065465.V362145.R01.S.doc Timescale for action 09/04/08 14/05/08 3. OP22 13(3) 14/05/08 4. OP27 18 01/07/08 Version 5.2 Page 26 the home to meet the needs of the people living there including. This includes sufficient domestic staff. This is a repeat requirement. The previous timescales of 01/06/06, 31/03/07 and 31/07/07 were not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations An up to date Service Users Guide and Statement of Purpose should always be available so that people can access good written information about the home. A fax machine should be provided to assist staff in managing communications and delivering a good service to people. The provision of a larger television for the home’s lounge should be considered to enhance people’s enjoyment. So that people are offered good care and a consistent approach staff should be offered training in managing challenging behaviour. The premises should be assessed with reference to people’s dementia care needs, with a view to providing any appropriate signage or aids to daily living that would assist them. Staff induction should be carried out in line with the standards laid down by Skills for Care. So that people potentially benefit from living in a home that has stable management, the registered provider DS0000065465.V362145.R01.S.doc Version 5.2 Page 27 2. OP9 3. 4. OP12 OP18 5. OP22 6. 7. OP30 OP31 should ensure that an application is submitted to CSCI for a registered manager for the home. DS0000065465.V362145.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000065465.V362145.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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