Care Home: Alston View Nursing & Residential Home

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What the care home does well Detailed information was collected about people before they were admitted to the home to determine whether they could be looked after properly. Residents were provided with a range of specialised equipment and aids to maintain their comfort and safety and to help them to maintain their independence wherever possible. Residents health was monitored and advice and support was sought from other specialists if there were any changes or concerns. Residents were offered a healthy, varied and nutritious diet and they made positive comments about the meals including `the food is very nice`, `the meals are good` and `the meals are fine`; they confirmed that alternatives to the menu were available. Medicines were managed safely and the records were accurate. The home was safe, clean, comfortable and well maintained. Residents said they liked their rooms and had brought in personal items to enhance the homely feel. Residents surveys indicated that the home was `fresh and clean`. Staff were provided in sufficient numbers to meet residents needs; one resident said `I only have to press the buzzer and staff come`. Residents and their relatives were consulted about the running of the home and able to air their views about whether their needs and expectations were being met. What has improved since the last inspection? Residents were provided with a range of activities, excursions and entertainments to meet their social needs and expectations; residents also said they could spend time in their rooms if they preferred. Survey information indicated that there were suitable activities provided. All residents were now provided with a copy of the terms and conditions or contract between themselves and the home; this would ensure they were aware of their rights and obligations whilst living at Alston View. Systems that monitored whether staff were following procedures and whether residents were receiving the right care had been developed; these need to be further improved to ensure any gaps in care or record keeping were identified. The training for some staff had improved; this would ensure staff had the skills and knowledge to do their work properly. What the care home could do better: The information about the home needs to be improved to provide prospective and existing residents and their relatives with up to date information about the services offered at Alston View. Residents must receive confirmation in writing that the home can meet their needs; this would give them assurances that the home had the necessary equipment, staff and expertise for them to receive the care they need. The care plans need to include more detail about residents needs, likes, dislikes, routines and preferences to ensure they receive the care they need and want. Residents and their relatives should be involved in the development and ongoing review of their care plan; this would ensure they were involved in decisions about their care. Residents said they received the care and support they needed. Staff need to be provided with clearer guidance to help them to manage all aspects of residents medicines safely.A clear record of all complaints should be made, including details of the investigation and any action taken; this would show that the home takes complaints seriously and uses the information to improve the service. The safeguarding procedures must be developed to provide clear information for staff in the event that any abuse or neglect was suspected. All staff need to be provided with regular safeguarding training to ensure they respond appropriately to any report or suspicion of abuse or neglect. Not all staff had received the induction or ongoing training they needed to give them the skills and knowledge to meet residents needs and to keep people safe. A training plan should be in place to identify any training and development needs and the skill and knowledge of existing staff. Safe recruitment procedures had not been followed and could place residents at risk of being cared for by unsuitable people; new staff must not start work in the home until all the required checks were in place. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alston View Nursing & Residential Home Fell Brow Longridge Preston Lancashire PR3 3NT     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: Marie Matthews     Date: 2 4 1 1 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 32 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 32 Information about the care home Name of care home: Address: Alston View Nursing & Residential Home Fell Brow Longridge Preston Lancashire PR3 3NT 01772782010 01772785649 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: MPS (Investments) Limited, Green & Co care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following categories of service only. Care home with Nursing - code N, to people 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 - Code OP. Physical disability - Code PD The maximum number of people who can be accommodated is: 50 Date of last inspection Brief description of the care home Alston View provides long and short stay care for up to fifty residents who need personal or nursing care and is owned by MPS (Investments) Limited, Green & Co. The home is located in the village of Longridge where access to shops, a church and other facilities are within walking distance. Alston View is a modern purpose built home on three floors which overlooks landscaped grounds to the side and rear of the home; a small car park is available for visitors and there is a passenger lift to access all floors. There are forty eight single rooms and one shared room; all of the rooms are en-suite Care Homes for Older People Page 4 of 32 Over 65 50 0 0 50 Brief description of the care home with the exception of two single rooms. There are comfortable lounge and dining areas located on each floor of the home. The information about the services offered by the home is provided in the form of a service user guide and is available to existing and prospective residents and their relatives. On the day of the inspection visit the weekly fees ranged from £361.00 to £604.00. Items not included in the fee include hairdressing, private chiropody, newspapers and personal toiletries. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key unannounced inspection, including a visit to the home, took place on 24th November 2008. The last inspection on this service was completed on the 9th and 14th August 2006 and a further review of the service completed on 3rd December 2007. The inspection process involved looking at records, a tour of the home, discussions with the registered manager, three staff, one visitor and five residents. The service sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved over the past twelve months and where further improvements were needed. Information was also gathered from survey forms filled in by staff and residents. The inspection visit also looked at things that should have been done since the last visit and a number of areas that affect peoples lives. Care Homes for Older People Page 6 of 32 Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The information about the home needs to be improved to provide prospective and existing residents and their relatives with up to date information about the services offered at Alston View. Residents must receive confirmation in writing that the home can meet their needs; this would give them assurances that the home had the necessary equipment, staff and expertise for them to receive the care they need. The care plans need to include more detail about residents needs, likes, dislikes, routines and preferences to ensure they receive the care they need and want. Residents and their relatives should be involved in the development and ongoing review of their care plan; this would ensure they were involved in decisions about their care. Residents said they received the care and support they needed. Staff need to be provided with clearer guidance to help them to manage all aspects of residents medicines safely. Care Homes for Older People Page 8 of 32 A clear record of all complaints should be made, including details of the investigation and any action taken; this would show that the home takes complaints seriously and uses the information to improve the service. The safeguarding procedures must be developed to provide clear information for staff in the event that any abuse or neglect was suspected. All staff need to be provided with regular safeguarding training to ensure they respond appropriately to any report or suspicion of abuse or neglect. Not all staff had received the induction or ongoing training they needed to give them the skills and knowledge to meet residents needs and to keep people safe. A training plan should be in place to identify any training and development needs and the skill and knowledge of existing staff. Safe recruitment procedures had not been followed and could place residents at risk of being cared for by unsuitable people; new staff must not start work in the home until all the required checks were in place. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information about services offered at Alston View could be improved to help people to decide whether the home was suitable for them and whether their needs would be met. Useful information was collected about prospective residents to help to decide whether Alston View was the right place for them. Evidence: The information about the home needed to be reviewed to ensure people were given complete and accurate information about services and facilities at Alston View. People were given a useful information pack but this did not include a summary of the last report, a copy of terms and conditions or service user views and the complaints and commission contact information was incorrect. A copy of the service user guide was available in the entrance hall and was available to new and existing residents and their families; one visitor said she had been shown around the home and had found the information pack very useful. Residents surveyed said they had been given enough Care Homes for Older People Page 11 of 32 Evidence: information about available services. The information was not yet available in any other format but the registered manager said this would be considered. Three residents files were looked at in detail; all three included a copy of the terms and conditions or contracts that would ensure they were aware of their rights and obligations whilst residing at the home. People were only admitted to the home when a full needs assessment had been undertaken to help determine whether their needs could be met and whether the home was the right place for them; other people were involved in the assessment process to ensure all aspects of peoples needs were considered. It was noted that the assessment record needed to be dated on the date of the assessment and there were no care management assessments from the local authority; the registered manager was advised to contact the local authority prior to a residents admission to ensure they had all the information to help them to meet peoples needs. The home still did not send letters confirming that residents needs would be met; confirmation would reassure residents and their families that they would be looked after properly. Staff had a range of skills, ability and qualifications to help them to meet the needs of residents in the home; there were registered nurses available to provide nursing care. Staff records showed that the provision of training had improved to ensure staff had the necessary skills and ability to care for the residents in the home; it was recommended that a training matrix or plan should be developed to clearly show an overall view of training provided and planned for all staff, see standard 30. Care Homes for Older People Page 12 of 32 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 standard of care planning needs to be improved as the detail in the care plans did not fully reflect the care and attention that was required and could result in residents not having their needs met. Residents medicines had been managed safely although some procedures need further development to provide staff with safe guidance in all aspects. Evidence: Three residents care plans were looked at in detail. The care plans had been generated from initial assessment information although the plans did not clearly detail residents needs and how they would be met; this means that residents were at risk of not receiving the care that they need. The care plans had been reviewed each month by registered nurses although had not always been updated to reflect current care needs; there was not enough evidence to support that residents or their relatives had been involved in decisions about care. There was limited information about residents likes, dislikes and personal preferences; this information should be included as part of the care planning as it would ensure Care Homes for Older People Page 13 of 32 Evidence: residents were involved in decisions about their care and recieved the care they wanted. (See standard 12). One resident had a sacral sore yet the information regarding the treatment and care needed was stored seperate to the care plan and could result in the resident not receiving the care they needed. Staff should ensure residents health and care needs were recorded as the detail in the care plans did not reflect the care and attention that was being given. There were a range of assessments to monitor whether residents safety and wellbeing was at risk; some of these were incomplete and had not been reviewed since admission which means the care being given may not be appropriate. The assessments to monitor residents nutritional status and dependency levels were scored although there was no information or protocols to help staff decide what preventative action should be taken. Two of the residents had been assessed as being at risk of falls and bed rails had been provided to reduce this risk; however only one resident had an assessment in place to determine whether the use of bed rails was appropriate and neither had a care plan that identified that the person was at risk of falls and what interventions were in place. There was evidence that residents health had been monitored and appropriate health specialists had been contacted for advice and support in response to any changes. Residents said they were happy with the care and support they received and one visitor said she was kept up to date and informed. Residents surveyed said staff listened to them and acted on what they said. Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. The registered manager said monthly checks of care plans had been introduced to identify whether the care plans were accurate, whether staff were following policies and procedures and whether residents were recieving the care they needed and wanted. Information was provided to assist with improving the way care plans were monitored as a number of concerns had been identified during the inspection visit (see standard 38). There were clear procedures to guide staff with the safe management of medicines although it was recommended that procedures were developed to support staff with their decisions to administer as needed or PRN medicines, handwritten entries on medicine records, verbal changes to directions, medicines provided for leave away from the home, provision of homely remedies and decisions around covert administration; clear procedures would ensure residents medicines would be managed safely. Prescriptions need to be checked by the home prior to dispensing to prevent any errors or mis handling. There were no residents who were managing their own medicines; their were records giving staff permission to take on this responsibility although these Care Homes for Older People Page 14 of 32 Evidence: were not signed. Records were checked and found to be accurate and storage was secure and appropriate. It was recommended that systems were developed to monitor the safe management of medicines as the current visual audits had not identified some shortfalls found during the inspection; information was provided to assist with this process (see standard 38). Nursing staff should also be provided with up to date information about medicines; this would help them to identify if the medication is appropriate for each resident. Staff were observed interacting with residents and visitors in a friendly but respectful way. One resident said she had been visited by her general practitioner (GP) in the privacy of her room. Staff were provided with training to support them with maintaining residents privacy and dignity. The registered manager said that one registered nurse had a recognised qualification in palliative care and another nurse was undertaking specialised training; this would ensure staff had the right support to help them to care for dying residents and their family and friends. There were procedures to support staff with dying and death and the home had developed links with appropriate health specialists to help them to improve their service. The care plans did not include evidence that residents had been consulted regarding their thoughts and decisions about death and dying however the registered manager said this was being developed. Care Homes for Older People Page 15 of 32 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 provision of activities and entertainments had improved to ensure residents diverse social and recreational needs were met. Residents received a healthy, varied diet that was suited to their individual preferences and dietary requirements. Evidence: Records showed that the provision of suitable activities, excursions and entertainments had improved; residents confirmed this. However it was unclear who had participated in the activity and whether it had been enjoyed; this made it difficult to determine whether residents social needs and expectations were being met either as a group or on a one to one basis. A summary of each residents social history had been completed with assistance from close family and a social history tool had been commenced and contained brief nformation about hobbies and interests. Detailed information regarding residents likes and dislikes and preferences and routines should be included in the care plan; this would help staff to provide suitable and meaningful activities for each individual. One resident was observed planning a trip out to the local shops and records showed that other excursions had taken place to local leisure and shopping facilities. Staff said routines were as flexible as they could be, some residents preferred to stay Care Homes for Older People Page 16 of 32 Evidence: in bed until late, watch TV or dine in their rooms and this would be respected; residents confirmed this. Residents said their visitors were made to feel welcome and could visit at any reasonable time and visit in any area of the home. From discussions with residents and looking at records it was clear that residents were offered a varied and nutritious diet; residents confirmed they were given a choice of meal and that alternatives to the menu were also available. Comments included the food is very nice, the meals are good and the meals are fine. There were seperate dining areas that were clean and bright, tables were appropriately set with condiments and appropriate utensils. Staff were in attendance in all areas to provide support and assistance where needed; mealtimes were unhurried and residents were able to finish their meals at their own pace. Care Homes for Older People Page 17 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People knew how to complain and were confident they would be listened to however all complaints must be recorded according to procedure and people should have access to accurate guidance. The safeguarding procedures and provision of safeguarding training need to be improved to ensure all staff had the skills and knowledge to respond appropriately to any suspicions of abuse or neglect. Evidence: The complaints procedure was clear and displayed in the entrance hall and in the service user guide; however the contact information for the Commission for Social Care Inspection (CSCI) was incorrect. The records indicated there had been one verbal complaint made but there was no record of the conversation other than the complainant had been advised to put the complaint in writing and had not done so; this was not good practice as all concerns and complaints should be recorded and responded to according to procedure and used to improve the service. People were aware of whom to speak to if they were unhappy and the registered manager said that small problems were discussed before they became concerns or complaints. Staff had access to clear procedures to support them to report any bad practice and to protect residents from harm. Procedures were also available to help staff to safeguard residents finances and to support staff with responding safely and appropriately to any verbal and physical aggression. Care Homes for Older People Page 18 of 32 Evidence: The safeguarding adults procedures included the correct contact numbers of the agencies who would be involved in a safeguarding alert however there was no information to help staff to recognise the signs and symptoms of abuse and neglect or to help them to manage the situation and keep residents safe from further harm. In the absence of a training matrix (see standard 30) it was unclear how many staff had received safeguarding training although the following day the registered manager advised that just over half of the staff had received training; staff need safeguarding training to help them to protect residents and to recognise and respond appropriately to any signs of abuse or neglect. The registered manager was strongly advised to ensure all staff were provided with formal training to help them to recognise and respond to any abuse or neglect; it was noted that this shortfall had been raised following the inspections of 2005 and 2006 and was still outstanding. The use of equipment for restraint and keeping people safe such as bed rails had not always been risk assessed; this had been referred to under standard 8. Care Homes for Older People Page 19 of 32 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. Residents lived in a clean, safe, comfortable and well maintained environment. Evidence: During a tour it was clear that the home was well maintained, safe and comfortable and was equipped with the specialist equipment and adaptations to meet residents individual needs. There were a selection of comfortably furnished communal areas to enable people a choice of where to sit and meet with family and friends. Residents rooms were clean and bright and most had been personalised with treasured possessions. Residents said they were happy with their rooms. It was noted that most rooms were not fitted with locks which would promote residents rights to privacy; this was discussed with the registered manager and recommendations were made. There was a development plan that supported ongoing and future improvements; this ensured the home would continue to be a pleasant place to live. Residents said the home was clean and free from odour. Staff had received training and had access to clear infection control plans to ensure the risk of cross infection was reduced. Some bedrooms had en suite facilities whilst others were provided with commodes; well equipped bathrooms and toilets were easily accessible from bedrooms and communal Care Homes for Older People Page 20 of 32 Evidence: areas. A large number of double glazed windows were faulty; this had been identified at the inspection visit of December 2006. The registered manager had obtained quotes and was awaiting a decision from senior management to progress the work which would improve the outlook from bedroom and communal areas. It was noted that the sluices were still unlocked allowing residents and visitors access to cleaning products; these areas should be locked to ensure people were safe. Locks were applied during the inspection and these areas made safe. Grounds were safe and attractive and garden furniture was provided for residents and their relatives to enjoy in the warmer months. The home complied with the fire services and environmental health department and recent inspections had taken place; this ensured the home was a safe place for residents to live in. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team were provided in sufficient numbers to meet peoples needs. However new staff had not been recruited safely and had not received appropriate training which could put people at risk. Evidence: The staff rotas were clear and residents said there were generally sufficient staff to meet their needs; one resident said I only have to press the buzzer and staff come to help me whilst another said they are sometimes slow to answer the buzzer. Staff commented there were usually sufficient staff although one member of staff said staffing can be problematic at times; the manager advised that night time staffing had been increased from this week in response to concerns raised by staff. The registered manager was advised that all staff should be included on the staffing rota including their role and hours worked; this would help to determine whether sufficient staff were provided and provide an accurate checklist in the case of a fire. Residents appeared to know the staff team well and made positive comments about the staff; one said staff are very nice. Records showed that staff of various ages, genders and ethnic backgrounds were employed; this would help them to meet residents diverse needs. Less than half of care staff had achieved a recognised qualification in care (NVQ) although other care staff were working towards the qualification or due to commence; Care Homes for Older People Page 22 of 32 Evidence: this would ensure that staff had the skills and knowledge to meet the needs of the residents in their care. The home did not have a formal training plan or clear records which made it difficult to determine the the skills and knowledge of staff currently working in the home. The registered manager said that all new staff commenced an induction that would be completed over three weeks and this training would give staff the basic skills and knowledge to fulfil their role; however of the three staff files looked at in detail only one had evidence of initial induction training and this was incomplete. The recruitment procedures provided senior staff with clear guidance. Three staff files were looked at in detail. It was clear that safe recruitment processes had not been followed as two of the three files did not have the required checks in place prior to employment; this could put residents at risk of being cared for by unsuitable people. Care Homes for Older People Page 23 of 32 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 home was safe and well managed and people were involved in decisions about how the home was run. Evidence: The registered manager is Jackie Cammish; she has the required qualifications and experience to run the home and has access to an external management team who provide her with advice and support. The registered manager sent us their annual quality assurance assessment (AQAA); this gave us a good picture of how the home was improving and where further improvements were needed. There were policies and procedures to support staff in all aspects of their work and these had been reviewed in line with current thinking and practice. Records were generally completed in detail although some gaps had been identified under specific outcome areas.The registered manager had developed systems that monitor staff practice and compliance with the procedures; further work was needed to Care Homes for Older People Page 24 of 32 Evidence: ensure gaps in practice and record keeping were identified. The staff team had an understanding of person centred planning although this was not always clear when planning care for residents (see standards 7 and 12); the registered manager advised that further training would be provided to support staff in this area. Two residents finance records were checked; records were clear and accurate and showed that finances were safeguarded by the systems and record keeping although it was recommended that any transactions were witnessed by a second person. The home had achieved the Investors in People award; this is a recognised quality award that monitors the development of staff and management systems within the home. People were consulted about whether their needs and expectations were being met; this gave them the opportunity to be involved in the day to day management of the home. Resident and relative surveys were sent out every six months to obtain their views; the results of the recent survey were not yet available. Resident forums had been introduced and people were given the opportunity to raise any issues and become involved in decisions about the running of the home; these were to be held four times a year. Regular staff meetings were held to keep staff up to date and informed of current practice; staff said they were able to discuss any issues or concerns. The provision of training that would help to keep people safe had improved. However there were still staff who had not received any induction or ongoing safety training; this had been identified at the inspection visit of December 2007 and remains outstanding as this could impact on peoples safety and well being. Systems and equipment were maintained and serviced to ensure they were safe to use. Care Homes for Older People Page 25 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 3 14(1)(d) Following their assessment the resident must receive written confirmation about whether the home can meet their needs or not. 31/08/2006 2 7 15(1) Each and every resident 31/08/2006 must have a plan of care that sets out their personal, health and social care needs. All staff must receive training 31/12/2006 on protection of vulnerable adults. (Previous timescale of 31/07/05 not met) There must be two written 31/08/2006 references for each employee. One of the references must be from the current or most recent employer. 3 18 13(6) 4 29 19 Care Homes for Older People Page 26 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Residents and or their representatives must be involved in the development and ongoing review of their care plan. This will ensure residents are involved in decisions about the care they receive and want. 12/01/2009 2 7 15 Residents care plans must 12/01/2009 set out in detail the action to be taken to ensure all aspects of the health, personal and social needs are met. This will ensure residents receive the care they need 3 8 13 The use of bed rails must be supported by a risk assessment and discussed with residents and their relatives. 12/01/2009 Care Homes for Older People Page 27 of 32 This will help to determine whether this form of restraint is suitable for the resident. 4 16 22 All complaints must be 12/01/2009 responded to according to procedure and a clear record made of the complaint, the investigation and any action taken. This will ensure any concerns or complaints are identified and responded to to help improve the service. 5 18 13 All staff must be provided with safeguarding training. To ensure staff have the skills and experience to recognise and respond to any abuse or neglect. 6 18 13 The safeguarding procedures 12/01/2009 must provide staff with clear and safe guidance to help them to recognise and respond to any signs or reports of abuse or neglect. This will ensure residents will be protected from harm. 7 29 19 Staff must only commence work in the home once the required checks have been returned. This will ensure residents are protected from unsuitable people. 8 30 19 New staff must receive 12/01/2009 induction training that meets skills for care specifications. 12/01/2009 12/01/2009 Care Homes for Older People Page 28 of 32 This will ensure new staff are equipped with the basic skills and knowledge to meet residents needs. 9 38 13 All staff must be provided with training in safe moving and handling and food hygiene. This will ensure people are not put at risk by unsafe practices. 12/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 There should be an up to date statement of purpose available that meets the requirements of standard 1 and schedule 1; this will provide people with the information they need. The service user guide should be reviewed to include a summary of the last inspection, a copy of the terms and conditions and service user views and also the contact information for the commission should be updated; this would help people to decide whether the home is suitable for them. The statement of purpose should be reviewed to include all aspects of standard one and schedule one; this would ensure people had accurate information about available services. Confirmation that residents needs could be met should be sent in writing prior to admission; this would reassure people that they would be looked after properly. The date on the pre assessment should be recorded; this would help to determine whether the assessment had been completed prior to admission. Residents preferences, likes, dislikes and routines should be recorded in the care plan; this ensures that the care delivered is person centred. Consideration should be given to providing staff with clear guidance on the level of intervention required once a low, Page 29 of 32 2 1 3 1 4 3 5 3 6 7 7 8 Care Homes for Older People medium or high risk has been identified in the nutritional, dependency and pressure risk assessments; this will ensure residents will receive the appropriate care for the level of risk. 8 8 Wound care treatment plans should be stored with the individual care plan or reference made in the care plan to indicate their whereabouts; this will ensure all staff are aware of the residents current care needs. There should be a recent copy of the British National Formulary (BNF) to provide up to date reference for staff. Consent should be obtained from those residents who prefer staff to take control of their medcines. Prescriptions should be checked by staff at the home to reduce the risk of mis handling and error. Transcribing or handwritten entries should be witnessed by a second person to reduce the risk of error. PRN or as needed medicines should be supported by clear protocols to assist staff with their decisions to administer or not. Procedures should be developed to support staff with the decision to administer PRN medicines, handwritten entries to medicine records, verbal changes, medicines taken away from the home, administration of homely remedies and covert administration. Information in care plans should include any decisions and preferences around death and dying. There should be a record of residents who participated in activities, excursions and entertainments and whether it was enjoyed; this will enable staff to plan suitable activities for all residents. There should be a record of residents routines prior to moving into the home, preferences, likes and dislikes; this would assist staff with the planning of care and the provision of suitable activities. The complaints procedures should be reviewed to include the correct contact information for the Commission for Social Care Inspection. Doors to residents private accomodation should be fitted with locks suited to residents capabilities and accessible to staff in emergencies and residents should be provided with keys unless a risk assessment determines otherwise. Work to replace or repair faulty double glazed units should be progressed. 9 10 11 12 13 9 9 9 9 9 14 9 15 16 11 12 17 12 18 16 19 24 20 25 Care Homes for Older People Page 30 of 32 21 27 The staffing rota should include the names, roles and hours worked of all staff; this helps to determine whether sufficient staff are provided to meet residents needs and to keep people safe in the event of a fire. 50 of staff should have an appropriate NVQ qualification; this will ensure staff have the skills and knowledge to meet residents needs. A training matrix or plan should be developed to clearly demonstrate staff skills and qualifications and to identify training and development that is needed. Consideration should be given to improving the Regulation 26 report format to include more information; this will demonstrate that all aspects of the management of the home is being monitored in detail. Audits to monitor staff compliance with procedures should be further developed to help management and senior staff to identify any issues or gaps in record keeping. The results of the residents and relatives survey should be analysed and made available to users and interested parties. Any financial transactions made on residents behalf should be witnessed by a second person; this will ensure residents finances are safeguarded and staff are protected. 22 28 23 30 24 33 25 33 26 33 27 35 Care Homes for Older People Page 31 of 32 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). 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