Care Home: Broom Lane Nursing Home

Similar services:

• Abbey The
• Snydale Care Home
• Hawkhills
• Larchfield Manor
• Beeches The - North Yorkshire County Council
• Carentan House
• Ravensworth Lodge

What the care home does well People living in the home said that the care they were receiving was good. They made comments such as, "I like it here the staff are nice". "Everyone is very kind" "Its lovely here". "Some staff are really good, others aren`t so good". "They look after me really well and the food is good". Comments received from questionnaires and from talking to relatives were in the main positive and included, "I find the staff very helpful and kind to mother and myself". "The staff are caring and polite". "The home has a lovely atmosphere". "Some staff are better than others". "Very good care and understanding staff". Health professionals said, "Its a lovely home and unit to visit and work on". "The staff provide very good caring personalized care and are always well informed about people when they request a GP visit". People`s health care was monitored and access to health specialists was available. People and relatives said that staff were always respectful towards them. People said that they had a choice of food and that the quality of food served was "good"and "tasty". There was a complaints procedure and adult protection procedure in place, to promote peoples safety. People said that they felt safe living at the home. Training took place, to equip staff with the essential skills needed. Systems were checked and serviced to maintain a safe environment. What has improved since the last inspection? At the previous key and random inspections six requirements were issued. At this inspection four of the requirements had been fully actioned and the other two had been partly actioned. Finances had been made available to improve the decoration and maintenance of the home. New carpets, furniture and furnishings were in place. Further work was necessary to continue to improve the environment. The manager said that the provider had agreed to a "mini refurbishment", which was due to start in the near future. An alternative storage place for clothing had been found and the laundry had been thoroughly cleaned. This meant that the risk of fire and obstruction was reduced. People were seen being moved around in wheelchairs with footplate`s fitted, ensuring their safety. The boiler room door was kept locked. What the care home could do better: The service provided at Broom Lane is of a good standard and everyone involved with the home should be proud of this. People should be asked about what they like to do in their spare time. The activities programme should include peoples individual preferences. If people have participated in activities this should be recorded in their care plan. Staff responsible for the administration of medications should always sign to confirmthey have given medication, at the time of the administration. If medications are not given then a code should be recorded on the Medication Administration Record (MAR) sheet to confirm why the medication has not been given. Staff should respond promptly when the emergency call system is sounded. The manager should make sure that staffing levels are maintained at the level necessary to ensure that people are receiving consistent care and support. The staff who have not received training in adult safe guarding, should do so as soon as possible. So that peoples health, safety and welfare is not put at risk the door to the sluice rooms must be kept locked. We acknowledge that the provider and manager continue to evaluate and monitor the service and make any changes necessary to ensure that the home continues to provide the good service that is presently offered. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Broom Lane Nursing Home 174 Broom Lane Rotherham South Yorkshire S60 3NW     The quality rating for this care home is:   two star good 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: Sue Turner     Date: 0 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Broom Lane Nursing Home 174 Broom Lane Rotherham South Yorkshire S60 3NW 01709541333 01709700850 broom.lane@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Health Care (England) Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Name of registered manager (if applicable) Mrs Patricia Potter Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: To provide eight Intermediate Care beds in The Broom Unit is granted as a condition of registration. Date of last inspection Brief description of the care home Broom lane provides nursing and personal care for service users over the age of 65, it also has 8 beds for intermediate care. All the rooms are single with some being ensuite. The home is in two units Broom and Sitwell, which are connected by a corridor. Nursing care is provided in the Broom building. There are small garden areas to the front and rear of the home and adequate car parking facilities. The home has a statement of purpose and service users guide which are available to service users and perspective service users and their families these give information about Broom Lane and what service is provided. Care Homes for Older People Page 4 of 28 care home 61 Over 65 61 0 Brief description of the care home The fees at Broom Lane range from 353 pounds to 508 pounds with free nursing care fees in addition to this. Toiletries, hairdressing, chiropody and some transport costs for outings are extra. Care Homes for Older People Page 5 of 28 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: two star good 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was an unannounced key inspection carried out by Sue Turner, regulation inspector. This site visit took place between the hours of 7.30 am and 2.45 pm. The registered manager is Pat Potter who was present during the site visit. The manager was given verbal feedback during and at the end of the site visit. Care Homes for Older People Page 6 of 28 Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. Questionnaires, regarding the quality of the care and support provided, were sent to people living in the home, their relatives and any professionals involved in peoples care. We received four from people, three from relatives, two from health professionals and two from staff. Comments and feedback from these have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. Time was spent observing and interacting with staff and people. Seven staff, three relatives and twelve people living in the home were spoken to. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in November 2006 and the random inspection in June 2008. The progress made has been reported on under the relevant standard in this report. The inspector wishes to thank the people living in the home, staff, and relatives for their time, friendliness and co-operation throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The service provided at Broom Lane is of a good standard and everyone involved with the home should be proud of this. People should be asked about what they like to do in their spare time. The activities programme should include peoples individual preferences. If people have participated in activities this should be recorded in their care plan. Staff responsible for the administration of medications should always sign to confirm Care Homes for Older People Page 8 of 28 they have given medication, at the time of the administration. If medications are not given then a code should be recorded on the Medication Administration Record (MAR) sheet to confirm why the medication has not been given. Staff should respond promptly when the emergency call system is sounded. The manager should make sure that staffing levels are maintained at the level necessary to ensure that people are receiving consistent care and support. The staff who have not received training in adult safe guarding, should do so as soon as possible. So that peoples health, safety and welfare is not put at risk the door to the sluice rooms must be kept locked. We acknowledge that the provider and manager continue to evaluate and monitor the service and make any changes necessary to ensure that the home continues to provide the good service that is presently offered. 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 28 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 28 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 home provided sufficient information to inform people about their rights and choices. People were encouraged to visit the home, look around and meet other people staying there. The intermediate care unit helped to maximize peoples independence and where possible enabled them to return home. Evidence: The home had a Statement of Purpose (SOP) and Service User Guide (SUG). These were available for people living in the home and anyone who may be considering living in the home. The SOP needed to be updated to reflect some changes at the home. Before people stayed in the home they were assessed by a social worker. The manager also carried out a pre assessment by visiting people in their own home or hospital. This meant that everyone could be assured that the home could meet the persons needs. People were invited to visit the home, try out the meals and spend time meeting the staff and seeing the services available. Any information collated from the needs Care Homes for Older People Page 11 of 28 Evidence: assessment would then form the basis for the care plan. When staff were asked, are you given enough information about people to enable you to care for their individual needs, one staff said always and one said usually. The home had one unit that accomodated people who were receiving intermediate care. The unit had its own staff team and unit manager. Specialist facilities and equipment was provided for the unit. One health profesional said, The intermediate care unit manager and staff are very good and supportive. They always follow peoples individual plans of care set by the therapists. We saw that people were encouraged and enabled to be independent and improve their everyday living skills. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of health care professionals visited the home to support peoples care. Medication procedures did not fully protect peoples health and welfare. The health and personal care needs of people were met in a way that maintained their privacy and dignity. Evidence: Each person that lived in the home had an individualised plan of care. These were checked for three people. The AQAA said, Care plans have become more detailed and staff have tried to involve clients and there families more in the care plan process although not everyone wants to become involved. We spoke to some relatives that had been involved in care planning and others who had chosen not to be involved. We looked at the care plans for three people. Care plans contained information about peoples health and personal needs. Care plans seen were not written in a person centred way. They focused on the tasks necessary to care for the person. There was no information about what the person themself felt their needs were and how they would prefer these needs to be met. The manager said that staff had undertaken Care Homes for Older People Page 13 of 28 Evidence: training in person centred care, however this was not reflected in the way care plans were completed. Further work was necessary to ensure that each person had a care plan that reflected their individual needs and preferences. Care plans seen contained details of all health care contacts, appointments and treatments, and the home supported access to these to ensure health was maintained. Access to dentists, chiropodists and opticians was available. Care plans had been updated, however information that was no longer current or relavent remained on peoples files. This made it difficult to establish peoples present care needs and requirements. Staff completed daily records at the end of each shift. Those seen related to the care plans. People seen looked well cared for, were dressed appropriately and had received a good standard of personal care and support. People said, Staff are good and help me if I need it. I would rather be at home but this is OK. The staff are very good and help me with my continence. Staff are wonderful. Nurses administered medications on the nursing unit and senior carers administered on the residential unit. Senior carers said they had undertaken training in medication administration. Medicines were securely stored in locked trolleys. There were some gaps in staff signatures on the Medication Administration Records (MAR). The majority of the gaps were where staff had not recorded a code to explain why medication had not been given. Controlled Drugs (CD) were kept securely stored. Staff recorded CDs in a CD register. This was checked and found correct. During the site visit we observed that people were cared for in a friendly way. Staff were skillful in ensuring that people maintained their privacy and dignity when receiving personal care. Care Homes for Older People Page 14 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples recreational interests and needs were not fully met. Peoples health and welfare could be put at risk, due to the slow response of staff to the emergency call system. People were receiving a balanced diet in pleasant surroundings. Evidence: People said they were able to get up and go to bed when they chose, and were seen to walk freely around the home, if able. One relative spoken to said they were able to visit at any time and were made to feel very welcome. Staff took time to make sure friends and family were made to feel comfortable whilst visiting their loved one. Some people said they preferred to stay in their room at certain times of the day and that the staff respected their decision. During the site visit we observed that when people pressed the call system it could be 10 to 15 minutes before staff attended to them. We saw that staff didnt always go to the person and see if their was an emergency, but left the buzzer sounding until they had time to attend to their needs. We spoke to the manager about the need for staff to answer buzzers as promptly as possible, even if this was to inform people that they were busy and would be with them as soon as possible. On the day of the site visit we believe staffing numbers contributed to this delay. Further information about staffing levels is commented upon in the staffing Care Homes for Older People Page 15 of 28 Evidence: section of this report. One person surveyed said, There have been occasions when I have asked staff for help, but still kept waiting an hour later. One example was when I needed the toilet, which was very frustrating. An activities co ordinator worked each day, Monday to Friday. On the day of the visit some people were involved in a board game. People were asked are there activities arranged at the home that you can take part in. They said, We have bingo, quizzes and darts. I think there is a lack of activities and not much to do, no stimulation. I would like to go on trips, but were just left in our chairs.Relatives said, The activities could be better but it seems that there is difficulty in getting funds to do anything. I think there is a need for more activities and people to be taken out. They used to go out but havent for a couple of years. I dont know if this is down to funding. The manager said she was aware that the activities provided were not adequate and was addressing this with the activities coordinator. We observed breakfast and lunch being served in the dining rooms. Choices were available and staff were aware of peoples meal preferences. At breakfast people had a choice of cereals, grapefruit or porridge followed by bread or toast with preserves. People said that cooked breakfasts were available every day if requested. At lunchtime the dining room tables were set nicely with tablecloths, cutlery and matching crockery. Condiments were on the tables and a choice of hot or cold drinks was available. The dining rooms were quite small and had a pleasant relaxed ambiance. Staff, on the nursing unit said that they assisted eight people to eat. On the day of the site visit this meant that only one member of staff was in the dining room. People said, There is always a choice. The food isnt bad. It cant be that bad because Ive put on weight. One relative said, Mum has put on weight whilst shes been here and is looking better for it. The manager said that isome ssues about food and meals had been highlighted in the quality assurance surveys sent out to people. She was addressing these issues with the catering staff. Care Homes for Older People Page 16 of 28 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. In the main there were systems in place to protect people. However as there were some staff who had not received training in adult safe guarding this could result in people being put at risk of abuse. Evidence: People and their families had been provided with a copy of the homes complaints procedure, which was also on display in the entrance hall. This detailed who to speak to at the home or, if preferred, external to the home to make a complaint, should they wish to do so. The complaints procedure directed people to the manager to deal with any complaints. If the manager was unable to resolve complaints then people were directed to the provider of the service. The home kept a record of complaints, this detailed any action that had been taken and the outcome of the complaint. Since the last inspection the home had received twenty one complaints, two of these were referred to adult safe guarding. The AQAA stated, We take all complaints seriously and investigate them thoroughly. We learn by our mistakes and aim to prevent them reoccurring.We have an open door policy for residents and relatives and staff to discuss any concerns they may have. Seven people were asked Do you know how to make a complaint. Six people said yes and one said no. Since the last inspection there had been six referrals to the adult safe guarding team. Two have been resolved, the others are being investigated. When adult safe guarding Care Homes for Older People Page 17 of 28 Evidence: concerns were reported the manager had taken appropriate action to ensure that people were kept safe. The manager said that the majority of staff had completed training in adult safe guarding, but there remained some staff that had not completed the training. Staff spoken to were aware of their role and responsibilities in dealing with any alleged safeguarding incidents. The home had copies of and were working with the revised South Yorkshire protocols for adult safeguarding. People spoken to said they felt safe living in the home. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was maintained to an adequate standard. Procedures for the control of infection were in place which promoted peoples health and welfare. Evidence: The AQAA stated, TV aerials have been updated in all bedrooms to enhance picture quality. The home was clean and tidy. Lounge and dining areas were domestically furnished. Bedrooms were spacious and personalized. Since the last inspection refurbishment of the home had continued. Some carpets and furniture had been replaced and some bedrooms had been redecorated. Carpets in some lounge and corridors were stained and marked. The toilets and bathrooms were in need of updating and making more homely. The manager said that a mini refurbishment was planned. She was in discussions with the provider about the areas of the home that needed to be updated. Most areas of the home smelt fresh and clean. There were a small number of bedrooms that had unpleasant odours. Controls of infection procedures were in place. Staff were observed using protective aprons and gloves. The homes laundry was sited away from food preparation areas. Staff had undertaken training in infection control. Relatives said, I made a claim for a new carpet and one was fitted inside a month. Mother is on the residential side it is kept fresh, but I think her bedroom could be Care Homes for Older People Page 19 of 28 Evidence: cleaner. At odd times the bedroom smells strongly of urine. The home is clean but could do with something to give it freshness, for example pot pourri or air fresheners. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers were not always appropriate to meet the assessed needs of people. Recruitment information obtained for staff was sufficient to adequately protect the welfare of people. Staff had completed training. Evidence: Staff interviewed said that they enjoyed working at the home and got a lot of job satisfaction. The AQAA stated, We have a fairly stable work force. Many of the staff have worked at Broom Lane Care Home for over 2 years and recently long service awards were made to staff for service of 10 years and 15 years. On the day of the site visit staffing numbers were low. The nursing unit had one nurse and three carers, caring for twenty six people. People on the nursing unit were highly dependent, with eight people being cared for in bed. The residential unit had one senior carer and three carers, caring for twenty one people. On the intermediate unit there was one senior and one carer, supporting six people. Two carers were needed to escort people to hospital which reduced the number of staff on the intermediate and residential units. Staff were very open and honest about staffing levels. Those on the residential unit said they were managing well. Staff on the other two units said they were able to provide people with the care they needed, but had to rush, which they didnt think was fair to the residents. The manager said that numbers were low because many staff had left taking their annual leave until the end of the year, so Care Homes for Older People Page 21 of 28 Evidence: several people were off at one time. We talked to the manager about the importance of staff leave being managed so that staffing levels were not affected by this. We reitorated that rotas must be arranged so that the needs of people living in the home could be met at all times. Relatives said, Sometimes we feel we are putting on the carers which frustrates us and we feel upset. Staff listen but dont always have the time to do what we ask. Were always being told there isnt enough staff to do things. The manager had undertaken a review of staff training and had identified the shortfalls. Mandatory training had been booked and further training in specialized topics for example dementia was being delivered. The AQAA stated that Rotherham Council had provided some staff training. Two staff surveys were returned. When asked did your induction cover what you needed to know when you started the job, one staff said very well and the other said mostly. Staff also said they were receiving lots of training which was relevant to their role. Staff were able to talk about the various training courses that they had attended which included, Moving and Handling, Food Hygiene, First Aid and Fire. A number of care staff had completed the NVQ Level 2 in care and others had commenced the training. The number of staff trained met the required minimum of 50 per cent of the staff team trained to NVQ Level 2 in Care. Four records of employment were checked. These included all of the required information references, certificates of training, health checks and evidence of Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check. Application forms recorded peoples previous employment. Care Homes for Older People Page 22 of 28 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 had a management structure, that people and staff were aware of. In the main peoples health and safety was promoted. Evidence: The manager is a qualified nurse and had many years experience of caring for older people. Staff said that they didnt always find the manager easy to talk to. They said she was often busy and didnt have time to spend with them. Most staff preferred to speak to their unit managers about any concerns or difficulties they had. The deputy manager had recently stepped down from this role and reverted to being a nurse. We believe that a deputy manager in post would be beneficial and complement the management team. The home was visited on a regular basis by the area manager. She was nominated to carry out Regulation 26 visits. Following her visits a report was completed which highlighted any action that needed to be taken to improve the service. Staff said she was available for them to speak to should they wish to. Care Homes for Older People Page 23 of 28 Evidence: Relatives said they were asked their opinions of the home and the service provided. They said they received questionnaires from the manager which they completed and returned. Questionaires had been sent to people in October 2008. The manager said that a report that detailed the findings and told people what actions would be taken, following their comments had not been provided. The manager said she was due to complete this with the area manager in the next few weeks. Care Homes for Older People Page 24 of 28 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 25 of 28 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 The information in care plans must be up to date and relavent. So that staff are aware of peoples current needs and preferences. 30/03/2009 2 9 13 Mar sheets must be fully completed at the time of medication administration. To protect peoples health and welfare. 13/03/2009 3 12 16 People must be provided with a programme of activities, which suits their expectations, preferences and capacities. So that peoples well being is promoted and enhanced. 31/03/2009 4 14 12 Staff must respond to the emergency call system as soon as is practicable. So that peoples health, safety and welfare is not put at risk. 13/03/2009 Care Homes for Older People Page 26 of 28 5 18 18 All staff must be provided with training in adult safe guarding procedures. So that people are not put at risk of abuse. 30/03/2009 6 27 18 Staffing numbers must be 13/03/2009 appropriate to the assessed needs of people and the size of the home. So that people care and support needs are consistently met. 7 38 13 The sluice doors must be kept locked at all times. So that peoples health and safety is not put at risk. 13/03/2009 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 2 3 4 5 1 7 19 31 33 The Statement of Purpose should be reviewed and updated. Care plans should be written in a more person centred way. Refurbishment and redecoration of the home should continue so that the environment is of a high standard. There should be a deputy manager in post. A report that details the outcome of the quality assurance audit should be provided to people, soon after the audit has been completed. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!