Inspection on 24/09/08 for Winterbrook Nursing Home

This inspection was carried out on 24th September 2008.

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

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

Other inspections for this house

Winterbrook Nursing Home 27/09/07

Winterbrook Nursing Home 19/07/06

Winterbrook Nursing Home 16/01/06

Winterbrook Nursing Home 20/05/05

Winterbrook Nursing Home 10/02/05

Winterbrook Nursing Home 19/07/04

Winterbrook Nursing Home 02/02/04

Winterbrook Nursing Home 01/12/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Winterbrook Nursing Home 18 Winterbrook Wallingford Oxfordshire OX10 9EF     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: Ruth Lough     Date: 2 4 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 33 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 33 Information about the care home Name of care home: Address: Winterbrook Nursing Home 18 Winterbrook Wallingford Oxfordshire OX10 9EF 01491833922 01491836166 winterbrookhome@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Selvie Naidoo Type of registration: Number of places registered: Mr Harbhajan Surdur,Dr Ramnath Narayan care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 26. 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: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Winterbrook Nursing Home is a care home owned by a partnership of two individuals, and provides care and accommodation for 26 individuals. The home is set in about an acre of gardens, off a main road and bus route and about half a mile south of Wallingford, Oxfordshire. The house was converted for use as a nursing home in 1990. The town centre is nearby, and the home is easily accessible by public transport. The private accommodation is arranged over two floors with a passenger lift and is a Care Homes for Older People Page 4 of 33 Over 65 0 0 Brief description of the care home mixture of single and double rooms. Communal rooms include two sitting rooms and a dining room. The new manager is in the process of becoming registered with CSCI, and manages the home with support from the owners who visit regularly. There is a nurse on duty over the 24 hours, supported by a team of carers, and the activities coordinator and housekeeping staff who work part-time. The fees range from #542 to #772 weekly. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection process generated from the adequate findings identified at the last assessment of the quality of the service by the commission in September 2008. This inspection process included reviewing information provided by the service before a one-day visit to the home. During the day the records for care planning, recruitment, and administration of the service were assessed. The people who use the service were consulted about their opinion of what is provided, through surveys and during the day. Five surveys were returned to the commission at the time of writing this report. We took the opportunity Care Homes for Older People Page 6 of 33 to speak to staff and relatives during the day of the visit. From this visit it was found that the requirements made previously had been met, although some of the recommendations that were made to improve the service during the last inspection process have not been fully taken into consideration. There were a few areas that will need to continue to improve as to protect the people they support and three requirements were made to reflect this. A number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. What the care home does well: 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 240 7535. Care Homes for Older People Page 8 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people who wish to go and live in the home are not given the most up to date information about the home as to make an informed choice about living there. The assessment process does not fully support that sufficient information is taken about the persons well being before they are admitted to the home. Evidence: Both of the documents that were reviewed included in detail the majority of the required information. However, the changes to the registered manager position in July of this year had not been included. This was in particular the information about her skills, qualifications, and competencies. They will also need to amend the information about the complaints process with reference to the role of the commissions in regard to any complaints made to the home. The manager was advised to look at the presentation of these documents as they are Care Homes for Older People Page 10 of 33 Evidence: quite lengthy and may not be a suitable format to ensure that the staff understand how to meet the needs of all their residents. The assessment records for three people living in the service were reviewed as see if the individual’s needs are identified before they are admitted. Of the three records selected, only one person had been admitted since the last inspection process. Two records had copies of the initial assessment of the persons care needs in their care files, one was missing but was later located in other records. The two records for the people admitted prior to the last inspection contained minimum information about the person’s medical needs and personal history of the person concerned. Choices for how they wish to live, interests, and any religious observances are not noted in detail. The one completed this year was a little more informative but there were still areas of the document not written in and therefore it is uncertain that key questions about the persons needs were assessed. Care Homes for Older People Page 11 of 33 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. The personal care and health needs of the people who live in the home are being met and they are protected by the improved medication administration practices. Evidence: The care planning records, for all the people living in the home, are held together, in a Standex system. For the number of service users this is within two central files. From observation these were not labelled well and it was difficult to find the appropriate persons records without opening each section to find them. Through discussion with staff and as the various topics of care planning, including medication administration were examined it was apparent that staff were making additional records outside this system as to accommodate the tasks or areas of care they carry out. What was difficult to establish was how all these additional records were fed back into the care planning and reviews of care. The manager also supplied further information that any key events arranged, such as hospital visits or treatment, for the person concerned were recorded in the daily diary/ Care Homes for Older People Page 12 of 33 Evidence: handover records for staff to read. There is set topic areas in the care planning for each individual with some of the information completed with good detail and giving staff specific instruction to meet the person’s needs. Other records had less information and could be improved. Risk assessments are included as part of the care planning, the sample seen indicated that there was a wide variation of quality for these. Some of their significant healthcare needs are recorded in the care planning, although better detail could be included. The records did evidence the involvement of the individual for the care planning and any reviews that were carried out. The reviews are carried out regularly and staff record routinely in the daily outcomes the tasks and some of the activities the individual has been supported with. Again these are not kept with the care planning records, so staff do not have the opportunity to update the changes in the planned care as they occur. They use a variety of monitoring tools to observe the health and wellbeing of the individual they include those for their nutritional state, dependency levels, and continence. Although they monitor dependency levels there is no indication that these are used for staffing levels. There was evidence in some of the other notes available to confirm that individuals are supported to access external health care treatment including dental, podiatry, and opticians. The manager provided information in the Annual Quality Assurance Assessment, selfassessment document that there were some key policies and procedures not in place, particularly those relevant to providing care and support. An example of those missing were: clinical procedures, continence promotion, and pressure relief. It was confirmed through discussion with the deputy manager that some of these were still not in place and she was in the process of developing them. The processes and practices for medication storage and administration were reviewed. This was to see if the deficits identified during the last inspection process had been eliminated and to see if the people who use the service are protected by safe practices. The medication needs of the individual are identified in the assessment of need process before their enter the home. From this point the home keep this information Care Homes for Older People Page 13 of 33 Evidence: with the persons MAR(Medication Administration Record)and amend with changes as they occur. As previously identified the records for carers applying topical medications is noted separately so the MAR(Medication Administration Record) does not reflect that they have been given these, as prescribed. The medication is supplied to the home in Dosette boxes provided by a local pharmacy. This is a relatively new system that has been put in place and the home has adapted specific storage space for these cassettes of medication. With this they have also improved the recording mechanisms for medication entering and leaving the home that was an area of concern at the last inspection process. The records and storage for the Controlled Drugs were reviewed, as again this was an area of concern found previously. They have replaced the storage cabinet for this purpose with one that accommodates the size and volume of medications they have and ensures that they are now kept within the Misuse of Drugs (Safe Custody) Regulations 1973. The specific register for any administration of Controlled Drugs appears to be completed appropriately by the nursing staff. Through discussion with senior nursing staff it was apparent that at present, none of the people living in the home are able to self- medicate. Through looking through what policies and procedures that they have in place it was difficult to identify that they have a specific policy or any accompanying risk assessment processes for selfadministration of medications should a person wishing to do so come to live in the home. The privacy and dignity of some of the residents in the home may be compromised, by the limited mobile screening that is used between the four bedrooms that are shared. Although highlighted in the previous inspection report that there were insufficient strategies put in place for adequate screening they have not implemented changes to improve this. If the shared bedrooms are used for two residents it would be far more appropriate to provide something that can offer better privacy and is permanently available to use. The information obtained about individuals personal choices for care if their health deteriorates significantly and at the end of their life is not recorded in great detail. One care record that was reviewed did have a little information but it was focussed on the persons choices of care after their death. The others had nothing recorded so it could be assumed that their choices had not been obtained. The deputy manager did express that this had been identified as an area they would like to improve within the care planning for each individual. Care Homes for Older People Page 14 of 33 Care Homes for Older People Page 15 of 33 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. The people living in the home are provided with some support to maintain their interests and chosen activities. Evidence: The care planning records that were reviewed did not support that much information about the individuals interests, hobbies, or religious observancies had been obtained. The home employs a specific member of staff to provide, on a part- time basis of 20 hours per week, support for activities. This is usually a mixture of group and some individual activities for a few hours during mornings and afternoons in the week. There is no formal structure for this at weekends. The activities organiser maintains her own records for highlighting person choices and wishes for some of the people she supports, the majority of which is brief summary and has been obtained through the contact made since the person had been admitted to the home. As identified in regard to the assessment process of people coming into the home, the records seen did not give a good picture of the personality, interests or leisure choices of the person concerned. Staff did demonstrate that they had a far Care Homes for Older People Page 16 of 33 Evidence: greater knowledge of the individual that what was recorded. This included stating that one resident continued to visit his club during the week, although this had not been recorded in the care plan. The activities organiser records the participation of individuals in separate records from the care planning documents but not the individuals enjoyment or involvement of the activity taking place. From information provided, including photographs on display in the home, there is a variety of activities provided including those that involve the local community. Recents events that have taken place have been a Strawberry Tea and a visit from the town mayor. Usually there is a regular programme of games, quizzes and gentle exercises. Some aromatherapy is also available for individuals that is provided by the activities organiser herself. The manager has already identified in the information submitted to the commission before the inspection visit that they wish to improve and develop the activities on offer to the residents. It was difficult to establish what staff do to provide stimulation and activities for those people who remain in their bedrooms as there were no individual activity plans. Of the five surveys returned to the commission, four confirmed that there was always something that they could join in with. One, completed by a relative, stated that the person concerned was unable to participate. One relative who we spoke to during the day did emphasise that their parent who had now got poor sight and ill health had limited her ability to use her hands, restricted her involvement in some of the activities. So there was little she could do. What they did say was she like listening had enjoyed in the past story tapes. However, this information was not found recorded in the care notes that were reviewed and staff had not implemented anything to continue with this. During the day of the inspection visit the activities organiser was engaging those residents who were present in the dining room/ conservatory, with a quiz. It was quite evident that all of the people in the room were enjoying what was going on. However, we observed that the majority of the people sitting in this room were in wheelchairs and had been in this room for most of the morning and afternoon. From information provided by staff, some but not all of the resident sitting here, require to use wheelchairs as mobility aids and most did not have sufficient foot rest supports or sufficient pressure relieving cushions. The dining room is equipped with the necessary tables and chairs for meal times, but no comfortable soft seating. The sitting/ lounge room at the front appeared to be underused by the residents in the home. Care Homes for Older People Page 17 of 33 Evidence: There is a small team of catering staff employed for seven days a week to provide the meals in the home. During discussion with the catering staff on duty during our visit to the home there is a planned ratational menu that has been developed from the information obtained by the care staff about personal choices and dietary needs for meals. They also confirmed that alternatives to the planned meal were on offer should they be required, although this was not displayed on the menu boards in the kitchen or in the corridor for residents to see. Comments from the people living in the home and from the surveys returned to the commission did show a variable opinion of the meals provided. Some though the meals were good and one respondant stated in a survey sometimes the breakfasts were as late as 10:30 in the morning. This concern had been raised during the two last inspection processes of the home but there was no evidence of this occuring on the day of this inspection. Care Homes for Older People Page 18 of 33 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. The people who use the service can be confident their concerns or complaints will be listened to and acted upon. There are processes in place to protect them from possible harm or abuse. Evidence: The information, records and correspondance for the management of complaints was reviewed as to see what they have in place and how they responde to concerns raised. The people who use the service confirmed in the surveys and when we spoke to them that they were aware of the complaints procedure and they were confident any concerns would be listened to. The complaints procedure is included in the Statement of Purpose and Service User Guide documents and on display in the home. From information provided by the manager in the pre- inspection information submitted to the commission it was identified that five complaints had been received by the service since the last inspection process. One of these had been upheld. The records for these complaints were reviewed and it was identified that they were investigated and suitable action taken to rectify any concerns. It was also seen that they could improve how they record and manage minor concerns and the complaints made as to log and monitor trends more effectively. This was discussed with the deputy manager at the time of the inspection. Care Homes for Older People Page 19 of 33 Evidence: The commission has been in receipt of information about the service since the last inspection process, one was given anonymously in regard to concerns about staffing levels and the other was from a professional about medication practices. The latter was made to the commission at a similar time of the last inspection visit to the service where these concerns had already been identified. Both comments made about the service were taken into consideration for the evidence gathering for this inspection process. The home was able to provide information about some of the compliments it has received about the support it provides and the staff working there. As yet they have not found an effective method of monitoring either the complaints or concerns, or feeding back the compliments to staff. They could use the information from these for develping their quality assurance processes The information provided to staff and the processes in place in the home for safeguarding the residents from possible abuse were reviewed. This was to see if staff have had the required training and are able to handle any concerns, if raised. The manager informed us in the Annual Quality Assurance Assessment, selfassessment document that the training programme for staff has improved for this topic. The information in the staffs employment records that were reviewed, did reflect this. The policy and procedure in the home did direct the staff to the local interagency procedure, a copy of which was available to staff within the office of the home for them to read. The staff we spoke to during the day did indicate that they knew what to do should a concern arise. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained well and meets the needs of the people who live there. They should ensure that they have the best practices in place for minimising the risk of the spread of infection around the home. Evidence: The home can offer accommodation to twenty – six residents in twenty two rooms over two floors. There are three areas that can be used as communal spaces, all on the ground floor, one of which leads to the rear garden of the home. The home itself is positioned off one of the main roads leading to the town centre of Wallingford. It has grounds totally surrounding the building including good car parking space and suitable access for vehicles to pick up and drop off residents to the front of the property. From reviewing the external spaces available to the residents it was apparent that there were several areas they could improve to give better protection and facilities for them to use. Recommendations were passed back to the management of the home during the inspection visit. Some of the key points were in reference to improving the security of the building from the main road and providing appropriate shelter for residents who wish to smoke outside. The storage of the rubbish and clinical waste Care Homes for Older People Page 21 of 33 Evidence: collection bins away from the main building would improve the outlook and control of infection for the people living in the home. They could make better use of the garden areas for the residents, and although a ramp has been built to the external area of the conservatory the areas leading off this do not provide a paved area for residents to sit to enjoy the garden. To the front of the building they have provided some seating for those who wish to observe the passage of people coming and going from the home. The manager provided information in between inspection processes that improvements had been made to the environment of the home. This could be seen during this visit with some redecoration and carpet replacements in both communal and private rooms. However, some of the bedroom furniture that was seen in a small number of the rooms was looking worn, had broken handles, and the laminated surfaces, chipped. Furniture in this condition could cause injury to the residents and staff and compromise the management of the control of infection. This information was passed back to the manager during the inspection. As previously identified they do need to improve the facilities for screening in the shared rooms for privacy and in addition to this make appropriate storage for personal toiletries and towels in the en suites. It was difficult to establish which items belonged to individuals, as there appeared to be no clear labelling or separation of dental pots, soap, towels etc. This practice puts the residents at a higher risk of contacting infection and actions should be taken to reduce them. The home has various lifting hoists for moving some of the residents who have limited mobility. A number of these hoists were stored in bedrooms around the building. From information provided by the senior staff a number of these are shared between residents and are moved between the rooms when required. It was unclear what protocol they have in place for the use of the slings for these hoists to prevent them being used from person to person. This again could compromise infection control in the home. The home does not have designated storage space for equipment within the building as again with the hoists in bedrooms spare wheel chairs other items were left in various places. The visiting hairdresser was present during the day and was using a residents bedroom opposite the bathroom where they were working for drying their hair. The manager did say that they had obtained permission from the residents family for this but they had not got this in writing. They should look to see if they could use a communal space for this activity as if the resident wanted to stay in their room for privacy – this would make it difficult. Generally, most of the areas of the home were observed to be clean, and hygienic. The Care Homes for Older People Page 22 of 33 Evidence: one area of concern was the upstairs sluice room, this was untidy, staff would not be able to access the sink to wash their hands because of items left in front of the taps, and the sluice sink was dirty and encrusted with lime-scale. The area also had unpleasant odour. The deputy manager did state that the nursing and care staff were responsible for this area and that it would be cleaned immediately. On relative on behalf of a resident wrote, Credit to the cleaners, in regard to the cleanliness of the home in a survey returned to the commission. Care Homes for Older People Page 23 of 33 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. The employment records do not support that enough care has been taken to ensure that staff have been recruited and employed safely and that the people who they support are protected. Evidence: The five respondents to the commissions surveys all confirmed that the staff listened to them and that there were enough staff available when they needed them. A selection of records for the recruitment, employment and training of the staff working in the home were reviewed to see if improvements have been made since the last inspection visit. Deficits that were identified previously were the number and skill mix of staff to meet the residents needs. For the purpose of this inspection the recruitment records for three staff were reviewed. One of whom had been employed after the last inspection visit to the service and included the records of a registered nurse as to see what professional checks are carried out. The rota for the month of September was also looked at to see the work patterns and numbers of staff on duty. The staff rota shows that a Registered Nurse is on duty each shift, supported with four carers during the morning and evening, and one at night. Additionally the Deputy Manager appears to be working at least six days per week during the day to support Care Homes for Older People Page 24 of 33 Evidence: the care staff. Again it could be seen that a number of staff work very long hours, around twelve hours, some for five to seven days per week. But the concern about staff signing an agreement to work in excess of the European Working Time Directive had been addressed as copies were seen in the staff files reviewed. Through discussion with the manager and some of the staff it was confirmed that this was their choice to work the longer shifts. However, as previously stated the dependency needs of the people they support is undertaken and reviewed regularly, but there was no evidence available to support this led the manager to ensure that the staffing levels matched these. During the day we observed no undue delay in staff providing support to the people in the home. But it was evident in the comments from relatives and some residents that there remains areas, such as late support with breakfasts and a weak activities provision at times that reflect that the stretched staffing levels may effect the outcomes for the quality of life for some of the people living in the home. The Manager and Deputy Manager were able to provide information about the qualifications of the staff which including some of the senior staff who have commenced undertaking NVQ 4 and Registered Managers Award. The majority of all the care staff have either achieved or are working towards an NVQ 2 or 3. The manager provided information following the last inspection process that they had improved the recruitment practices for new staff, including the interview meeting and the assessment of their competencies. She also added that a Criminal Records Bureau check is now mandatory and that the intended probationary period had been extended to six months. This was difficult to assess if this had been put in place as they had not recruited or employed a new member of staff since the period of May of this year when we were informed. What was identified was that there were gaps in the information they hold about the three members of staff whose records we reviewed. For one, a Registered Nurse, who had been working in the home for a very long period of time, there was minimal information. None of the individuals personal details, health status, training, or other current employment had been reviewed since the initial employment. A Criminal Records Bureau check had been carried out in 2004 and a copy of their Nursing and Midwifery Council registration card current till early 2009 had been taken. However, they should evidence that they carry out regular checks for the status of the Registered Nurses in between viewing the registration card as to establish they are still fit for practice. The records for the other two members of staff did further support that improvements Care Homes for Older People Page 25 of 33 Evidence: need to be implemented. The previous application forms did not request the person completing it to clarify the position of the referees in relation to them, a declaration of why they ceased to work in a previous care environment and better information about their health status. Neither were these topics pursued in the interview and selection process carried out. The Deputy Manager was able to provide a copy of the new planned application forms that should answer these queries. Only one person had two references in their information, both of which appear to be personal not previous employers. They have a checklist included in the employment records to aid ensuring that they have all the required information, although the ones seen had not been used effectively. Not all the records showed that individuals had been given a job description, some had copies of their contractual agreements of employment. The Manager and Deputy manager provided information about the training that staff have received and what they plan to make available in the future. Since the last inspection they have accessed a new induction programme for staff that meets the common induction standards and includes some of the core topics for safe working practices. A review of the information given showed that the majority of the training has been revisiting some of the key topics of training for the staffs roles in care. These have included moving and handling, fire, and first aid. Some of the staff have attended some training for dementia care, communication, and infection control. They were also able to inform of some of the planned training will include palliative care. They were advised to look at how they can provide staff with some further training for some of the key needs of the people they support such as continence care or those specific to the health conditions of the people living in the home. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home has improved the outcomes for, and experiences of, the people living there. Evidence: The Registered Manager has been in her post since June 2008. As a Registered Nurse she has been working for the provider before taking up this new role and therefore is familiar with the provider organisation and it policies and procedures. The Manager is in the home five days per week in a supervisory and management role. The Deputy Manager who appears to be working in the home on average six to seven days per week, according to the duty rota, combines some administration support with a caring role with the people requiring support. Both the Manager and Deputy Manager are at present undertaking the Registered Managers Award to enhance their skills. Care Homes for Older People Page 27 of 33 Evidence: The home has a number of quality assurance processes in place that now includes the Regulation 26 visit by the providers that had not been carried out fully as identified at the last inspection process. The people living in the home are given the opportunity to comment formally about the service in the six monthly surveys that are carried out. Additionally the new manager has commenced a regular pattern of residents and relatives meetings where they are able to comment of what is provided. The programme of supervision, appraisal, and staff meetings has improved and a sample of the records for these, were reviewed. They have also started looking at the processes for monitoring the quality of the environment and have just commenced developing a room audit tool for individuals bedrooms and want to extend this to the communal spaces. They were advised to look at extending what they currently carry out for their record keeping for the care records, recruitment and employment processes as to have better control of what is in place and ensuring there are no gaps. From information provided and during the course of the inspection it was still apparent that there were a number of core policies and procedures not in place. This was identified at the last inspection in September 2007 and has not been implemented. Although these do not directly have an impact on the outcomes for the people living in the home they are key to ensuring that the service is run in the best interests of the people living there. The records for Fire Safety were assessed as a sample of the quality of the safe working practices carried out in the home. This was an area identified during the last inspection process as having not been carried out fully as to protect those living and working in the home. The provider has implemented a contractual arrangement with a Fire Safety specialist to ensure that the home is now compliant to the regulations. A new fire safety risk assessment is in place and new safety measures have been implemented, such as fire closures. One of the communal rooms fire doors were seen on the day of inspection to be propped open with wedges and not held within the appropriate fire door closure mechanisms. This was dealt with immediately and the provider established that this was due to staff knowledge and that minor repairs needed to be implemented temporarily, until full repairs had been carried out. It must be noted that the Fire Safety specialist visited the home immediately contacted to ensure the safety of the residents was not compromised. Care Homes for Older People Page 28 of 33 Evidence: There were a number of small concerns about the arrangements for the control of infection identified in the body of this report, the key points for this were the cleanliness of a sluice room and the management of personal toiletries in the shared accommodation. Care Homes for Older People Page 29 of 33 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 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 10 16 That suitable screening is 30/11/2008 placed in the shared accommodation to protect the privacy and dignity of the the people living there. You should ensure that if residents have to share bedrooms you provide substantial screening that provides good privacy and protects their dignity when personal care if being provided. 2 26 13 That suitable systems are put in place to ensure that residents sharing accommodation are not at risk from the spread of infection. The personal toiletries and linen should be kept separately to ensure that they are used for the appropriate person. 08/11/2008 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 1 4 That the Statement of Purpose and Service User Guide provide the required information. 22/10/2008 Care Homes for Older People Page 31 of 33 You should ensure that the prospective people who may wish to use your service are given the necessary information as to make an informed choice to come and live in the home. 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 32 of 33 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 © (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. 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