Care Home: Christian Head

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What the care home does well People living in the home that we talked with spoke highly of the care and support they received from the manager and care staff and how hard they worked on their behalf. One person told us "Everyone has been so good and kind" and another said " I am really settled here, the staff are very good". The home provides a comfortable, homely and informal environment for people and we could see that there was a good rapport between the staff and people living there and that staff knew them well. The home is kept generally clean and tidy and many people have chosen to personalise their own bedrooms to make them more homely using their own pictures, ornaments and items of furniture. Although this home does not employ an activities coordinator it works hard to ensure a good level of organised activities and opportunities for people to have meaningful recreational activities. People are encouraged to make their own choices and to remain as independent as they can, including with their medications. People also commented that the food in the home was good, even those on special diets. The home works closely with other social and health care agencies and refers residents to specialist services when needed. There is a well trained staff team who clearly put a lot of effort into their work and robust recruitment procedures help safeguard resident`s interests and safety. What has improved since the last inspection? Since the last inspection the Statement of Purpose has been updated to ensure the information is current and is now available in large print for people who want this. The staff in the home have been working with people living there to implement new `Person Centered` care plans and life stories. These plans focus more closely on the needs, expectations and goals of the people living there. In line with this residents, relatives and staff have been more involved in developing activities people want and in fund raising. The home now has its own fund raising committee. The range of activities has been increased and the home has a volunteer to help with activities who plans to visit one day a week. The service has continued to develop its training programme and has provided training for staff in safe medication handling to promote resident safety. In an effort to improve hand overs between supervisors changes have been agreed on the rota so there is more time for this. To improve staff identification for people the manager has provided all staff with personal identity badges stating their name and role. The manager has made improvements to the complaints and compliments recording setting up more detailed and better organised filing system so records are better kept. The manager has improved quality assurance by more regular audits and the home now has an additional computer in the managers office making access easier. A range of improvements have been made to the environment to improve it for the people living there including bathing and shower facilities. A number of furniture items, new carpets and soft furnishings have been replaced and some bedrooms redecorated. People living there have been consulted about what colours and items they want when rooms are redecorated. Externally the appearance of the home has been improved through repainting and the repair of the perimeter fence. The gardens are now beingmaintained under contract. What the care home could do better: The service undertakes pre admission assessments with people before they come to live in the home but senior staff need to be sure that when they do assessments they sign and date this. Some assessments had not been signed and dated so it was not possible to say when they had been done or who had gathered the information that initial care plans were based on. Overall the care planning records were up to date to reflect people`s changing needs however staff should take care to make sure they update any changes in nutritional needs in full and complete screening promptly. This way any changes requiring specialist advice can be accessed quickly. Medication records we looked at were accurate and up to date but the home does not have appropriate safe storage for drugs liable to misuse called `controlled drugs`. New regulations require all care homes to have appropriate safe storage for these medicines. The legislation specifies the quality, construction and method of fixing and locking the cabinets. As the home was storing such medicines it must have the appropriate safe storage required by legislation. This will ensure it is kept safely and reduce the risk of mishandling. The management and care team work hard to keep staffing levels at safe levels within the staff resources they have available to them but at times of the day levels fluctuate especially when staff change shifts. Staff may have to work alone on units when staff are short which puts addition pressure on them. This is also a concern when resident needs indicate they require 2 people to assist them. We strongly recommended that the manager reviews the way staff are deployed throughout the day and night and adjusts staffing levels in line with resident`s individual needs and levels of dependency. This will help to make sure needs are always met promptly and safely rather that around what staff are available. Although residents felt their needs were being met the additional pressure on staff is affecting staff morale. Training programmes and records indicate staff training is given a high priority but records indicate that care staff do not routinely have food hygiene training although they do serve meals and prepare some light meals. We recommended staff have basic training to ensure consistent safe practice in this and when done is recorded. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Christian Head Silver Street Kirkby Stephen Cumbria CA17 4HA     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: Marian Whittam     Date: 0 8 1 2 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. 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 31 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 31 Information about the care home Name of care home: Address: Christian Head Silver Street Kirkby Stephen Cumbria CA17 4HA 01768371429 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Christian.Head@cumbriacc.gov.uk Cumbria Care Name of registered manager (if applicable) Miss Joanne McDermott Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The home is registered for a maximum of 33 service users to include: - up to 33 service users in the category of OP (Old age not falling within any other category) - up to 10 service users in the category of DE(E) (Dementia over 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults. Two service users may share a bedroom of at least 16 sqm usable floor space only if they have made a positive choice to do so, and when one of the shared spaces becomes vacant the remaining service user has the opportunity to choose not to share, by moving to a different room if necessary. Date of last inspection 0 0 Over 65 10 33 care home 33 Care Homes for Older People Page 4 of 31 Brief description of the care home Christian Head is a residential care home registered with the Commission for Social Care Inspection to provide care and accommodation for up to thirty-three people, some of whom may have dementia. Accommodation for residents is provided in four living units, one of which specialises in providing care for people with dementia. The home is owned by Cumbria County Council and is carried on by Cumbria Care, a business unit of the County Council. The home is located next to the fire station, close to the centre of Kirkby Stephen. Christian Head is close to local shops and services including doctors surgeries, banks and churches. There is car parking available at the front of the building. Accommodation for residents is provided over two floors in single bedrooms with a passenger lift between floors. Three bedrooms have ensuite facilities and there are appropriate toilet and bathing facilities close to all the accommodation provided for residents. The service provides information for prospective users of the service in its service user guide and statement of purpose. These are available in the home along with the last inspection report. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. This site visit took place on 8th December 2008 forms part of a key inspection. We (The Commission for Social care Inspection, CSCI) were in the home for six and a half hours. the last inspection omn this service was completed on 13th February 2007. Information about the service was gathered in different ways. An Annual Quality Assurance Assessment (AQAA) was completed by the manager of the home. This was returned to us in good time before the inspection and contained the information we asked for. This is a self assessment and a dataset that is completed annually by all Providers about their service and how they believe they are meeting Care Homes for Older People Page 6 of 31 outcomes for people using their service. It also gives statistical information about the individual service and patterns in social care. We looked at the homes service history and any complaints we had received and what other agencies and people had told us about the service. We sent out surveys to people who use the service, people who work there and professionals who come into contact with the service. This was to get their views and opinions of the service. We spent time during the visit talking to people living in the home and asking them about life there and their views on the service provided. We also talked to staff working about their experiences there and people visiting. We spent time observing what went on during the day and staff practices and approaches. We looked at care planning documents and assessments and asked people about their care to help us assess if the level of care provided in the home was meeting their needs and expectations. We made a tour of the premises to inspect the environment, cleanliness and the improvements that had been made. We also looked at recruitment records, records of complaints, training files and a selection of other records required by regulations. We assessed the handling of medicines through the inspection of relevant documents, meeting with people living there, the manager and staff and looking at storage facilities. Fees charged range from three hundred and twenty six pounds to four hundred and thirty four pounds. What the care home does well: What has improved since the last inspection? Since the last inspection the Statement of Purpose has been updated to ensure the information is current and is now available in large print for people who want this. The staff in the home have been working with people living there to implement new Person Centered care plans and life stories. These plans focus more closely on the needs, expectations and goals of the people living there. In line with this residents, relatives and staff have been more involved in developing activities people want and in fund raising. The home now has its own fund raising committee. The range of activities has been increased and the home has a volunteer to help with activities who plans to visit one day a week. The service has continued to develop its training programme and has provided training for staff in safe medication handling to promote resident safety. In an effort to improve hand overs between supervisors changes have been agreed on the rota so there is more time for this. To improve staff identification for people the manager has provided all staff with personal identity badges stating their name and role. The manager has made improvements to the complaints and compliments recording setting up more detailed and better organised filing system so records are better kept. The manager has improved quality assurance by more regular audits and the home now has an additional computer in the managers office making access easier. A range of improvements have been made to the environment to improve it for the people living there including bathing and shower facilities. A number of furniture items, new carpets and soft furnishings have been replaced and some bedrooms redecorated. People living there have been consulted about what colours and items they want when rooms are redecorated. Externally the appearance of the home has been improved through repainting and the repair of the perimeter fence. The gardens are now being Care Homes for Older People Page 8 of 31 maintained under contract. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of moving into the home receive information to help them to make a decision and the staff have sufficient information to understand the persons needs when they come in. Evidence: The home has a statement of purpose and service user guide on display that are available in large print if required by prospective residents. There is also a copy of the last inspection report and general information on activities in the home, support agencies and fees on display. The results of customer satisfaction surveys are also in the information available so prospective residents can see the views of those already using the service. People told us that they had sufficient information before they came into the home and that they had terms and conditions of residency so they were aware of their rights and responsibilities. Survey responses also supported this. Care Homes for Older People Page 11 of 31 Evidence: We looked at individuals care plans and their pre admission assessments and these showed that the manager or a supervisor had done an assessment with the person as well as receiving a copy of the social services management plan on the persons referral to the service. This helps to make sure that the service will be able to meet a persons individual needs when they come to live there and allows the service to plan for the admission. There is a four week trial period on admission followed by a review process to try to further ensure that the home suits the person and can meet their needs. People are also able to visit the home, spend time there and speak to staff and other residents if they want to. Two of the people we spoke with had used respite visits to get to know the home before they decided they wanted to come in to live there permanently. One person told us, I always said that when I needed to come into a home it would be here. The information taken at assessment was sufficient to begin developing a plan of care with that person. Some pre admission assessments had not been signed and dated when done and we recommended that staff always did this to show who had undertaken the pre admission assessment with the person and when. The home does not provide intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Christian Head receive the care and support that they need in a way that meets their expectations and protects their privacy and dignity. Evidence: We looked in detail at the care plans of three people living in the home and at care plans generally for residents. We found that these had been developed from the initial assessments and using the new more person centered documentation and care planning approaches had been further developed with the residents themselves. Care plans had sections about the person themselves, what they wanted to do for themselves, what they liked to do and how they wanted staff to support them, including their emotional needs and most cherished things. The plans we looked at made preferences clear, for example on wishes to self medicate, personal appearance and the times they wanted to take baths. One person preferred to have a shower twice a week rather than baths and confirmed they were able to do so and that a shower room had been altered to a walk in one for them so they could do this. They said being able to do this is marvelous, really great. The care plans were easy to follow and set Care Homes for Older People Page 13 of 31 Evidence: out assessed individual health, social and personal care needs and these had been reviewed at least monthly. Changes in condition and evaluations following monitoring of conditions and behaviours had generally been updated in the individual plans. This was evident in the care plans we looked at in detail and where reassessment and monitoring indicated the appropriate referrals had been made to specialised nursing and medical services. However one person who had lost weight had not have their nutritional screening completed and staff should always make sure this is kept up to date so action can be taken when the risk changes. If they wanted to, and were able to, people could sign their reviews to acknowledge their agreement. Comments from relatives also suggested a good standard of care for people living there. One relative commented, I would like it to go on record how much I appreciate the care they give my relative. We looked at medication practices, storage and recording. Overall record keeping was of a good standard with individual records of the medications received and returned and a total of stock held being found to be accurate. The quantities of medication received were agreed on the medication administration record (MAR) sheets. There were protocols in place for the administration of as required medicines for staff to follow to make sure people only had these medicines when they needed them. We saw further good practice in that alterations to any prescribed medication having been checked by another and that variable doses were recorded so it was clear what medicines people had been given. However, the home held some medicines liable to misuse, called controlled drugs, but did not have a regulation controlled drugs cabinet for storage. New regulations now require all care homes to have storage for controlled drugs that meets relevant legislation. As the home was storing a controlled drug for use by a person living there they must provide a regulation controlled drugs cabinet that complies with legislation. The regulations specify the quality, construction, the method of fixing and locking of the cabinet. We found that the home supported people to be responsible for their own medication where possible, within a risk assessment framework, and this promoted their independence and choice. We spoke with one person who did this who valued being able to keep control of this for themselves. They confirmed they had their own key for their room and safe storage for their medication. The persons GP had discussed this with them to ensure they understood about their medicines and care staff observed and reviewed for any problems. We spoke with groups of people living in the home, as they sat in the lounges, about their care as well as individually in their own bedrooms and the comments about their care were all positive. One person told us that The staff are very good, I cannot Care Homes for Older People Page 14 of 31 Evidence: complain about the attention I get. Another person told us I feel safe here, its wonderful. We could see that staff had a good rapport with the people they supported and spoke with and approached them in a friendly and informal way. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Christian Head receive the support they need to live their chosen lifestyles and to take part in activities that suit them. Evidence: Individuals care plans recorded their social interests, personal preferences and backgrounds as well as hobbies and interests. The home has a volunteer who helps out with activities and a fund raising committee has been organised with staff, residents and families to help provide funding for recreational activities. The people we talked with told us they were supported to follow their interests and maintain their outside contacts and friendships. One person told us they enjoyed having meals out and valued being supported to continue doing this after coming into the home permanently. They were going to the Christmas lunch organised by the home at a local pub and out to supper with friends that evening. Some people we talked to were taking part in developing their life stories with staff whilst some had decided they did not want to and this decision was respected. We spoke with two people who had their own mobility scooters and electric wheelchairs so they could still be mobile and go out. One person used it most days to go into the town. One person told us, They have my scooter charged up and ready for me when I want it .One person had been given a Care Homes for Older People Page 16 of 31 Evidence: larger room when it became available to allow them to make full use of their own mobility aids and wheelchair. They had also just had their room redecorated and had chosen the paper and carpets in their favourite colour of blue. We talked with people who had been on a holiday organised by the home in Blackpool and all had enjoyed this. One person told us It was smashing, I will be going again, Ive always liked Blackpool and another said The holiday was very good I really enjoyed it. It must have taken a lot of organising but it made a real change. Another holiday in Blackpool was being arranged for this year. It was evident talking to people about their social lives, looking at care plans and the activities on offer that the staff and manager support people to be independent and live the lives they want, doing things that have meaning for them inside the home and outside. One person told us how they had been able to achieve their wish to be able to attend a family wedding with support from staff. There are activities programmes on the units with details of the organised activities. During the Christmas season different local groups were visiting to provide seasonal entertainment including the local male voice choir, carols from the local Brownie group and their regular musical entertainers. During the visit staff were putting up Christmas decorations with residents being involved in this. There was Christmas Bingo and a raffle organised and a Pantomime in the home for residents who wanted to attend. People also told us that entertainers visit regularly all year and they had trips out in the Summer. Some people had gone out for lunch at a Carvery in the Summer and that had been enjoyed by those who took part. People told us they went into town with carers to the shops and have coffee and that staff took time to chat with them when they could and have games of dominoes and board games and they had made mince pies in the lounge. One person told us they appreciated doing these things as they did not go out much now. Other people told us about impromptu activities staff did talking about past times and quizzes. People confirmed they were able to follow their own faiths and beliefs and the home has regular weekly multi denominational church services and communion if people wish to attend. The Roman Catholic priest also visits people and one person told us they went into town to attend church. People told us they enjoyed the meals in the home and surveys also supported this view. We looked at the four weekly menus in use and these showed a variety of food and a choice at mealtimes. Food we saw being served during the visit was well presented and varied. People are able to have a cooked breakfast if they let staff know in advance. Records are kept of what food has been served and to who and if alternatives were provided to the menu choices. Care Homes for Older People Page 17 of 31 Evidence: One person was on a reducing diet after assessment by the dietician and this regime was outlined in the care plan along with records of weight. This person told us even though it was a diet the food was very good and they had lost weight. Another person told us The food is very good, I am putting on weight now. A group of people we talked to sitting in the lounge commented that the food was very good and that there was plenty of choice, snacks and cups of tea. We observed that staff assisted people with food and drinks or prompted them to make sure they got them. Care plans indicated if people had any particular dietary needs or difficulties. The home received a 5 star rating from the environmental health department at their last visit. We spent time with people in the lounge having their afternoon tea and they told us they enjoyed the home made mince pies and shortcake being served. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Christian Head are protected by effective complaints and safeguarding procedures that staff and residents are aware of. Evidence: The home has an accessible complaints procedure and a system for recording and investigating complaints. The procedure is available in large print and audio tape if people need this. There have been three complaints logged in the last 12 months and these were all responded to and resolved and recorded on file with outcomes. People living there told us they knew who to speak to if they were unhappy although one person did comment that I cant say a bad word at all about the staff and I have never needed to make a complaint but I would tell the manager and I am sure she would sort it out, I am quite happy. The manager has made inprovements in the recording of complaints and better organisation of records to improve the effectiveness of the system in use. Information is made available on contacting advocacy organisations and support services including Age Concern and Citizens Advice Bureau if people want this and on how to contact us if people wanted to. There have not been any referrals made under safeguarding adults procedures. The service has these procedures in place to protect vulnerable adults and whistle blowing procedures for staff to report bad practice. The service uses multi agency guidance on safeguarding procedures and these and the Department of Health guidance No Care Homes for Older People Page 19 of 31 Evidence: Secrets are available within the home. We talked with four staff and from what they told us they knew how to respond to any suspicions of abuse and had received training on this to make sure they were aware of what to look for and what to do. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Christian Head live in suitably adapted, clean, comfortable and homely surroundings with the equipment they need to promote mobility and independence. Evidence: Christian Head is being maintained to a consistently good standard and has a programme of redecoration and refurbishment based on its annual condition survey. The home is divided into four units and is over two floors with a passenger lift so people can get about the home. Each unit has its own lounge and kitchen area and there are accessible toilets and bathrooms with assisted baths. One shower room has been extended so that it better meets peoples mobility needs. One of the residents used this walk in shower twice a week and said it had made life much easier for them. Three of the bedrooms have en suite facilities and all others have wash basins for people to use. People we spoke with said that their rooms were kept clean and tidy and that they had been involved in the recent refurbishment and redecoration of their bedrooms through choosing colours and paper. Comments were made to us such as, Its very clean here, its a nice place and they look after us really well. The bedrooms we saw had been personalised by the people living in them to reflect their own tastes and with their personal items to make them more homely. Some people had equipment in their Care Homes for Older People Page 21 of 31 Evidence: rooms to meet their needs such as adjustable nursing beds, chairs to assist them to stand and commodes. The home was warm and well lit and there were accessible call bells in areas used by the people living there so they could summon help if they wanted it. People we talked with said that staff came quickly if they rang the bell. There was emergency lighting and equipment in the home and records showed these were being regularly tested and inspected to make sure they were in good working order. The home has policies and procedures covering infection control and records and conversations with staff indicate they have had training on this and understand the principles. We saw staff following correct practice using gloves and aprons and safe waste handling when appropriate. The laundry facilities were small but were tidy and had easily cleanable walls and floor. The laundry and sluice areas are away from areas used by residents and sluices are kept locked. There are systems in place and records kept of water temperature testing and shower head cleaning to promote residents safety. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Christian Head receive care and support from a well trained staff team who have gone through a thorough recruitment process to safeguard their interests but fluctuating staffing levels may affect the staffs ability to carry out person centered care for some people at times. Evidence: We looked at staff files and these showed the service was following good recruitment procedures to safeguard the interests of people living there. Criminal Record Bureau (CRB) checks, Protection of Vulnerable Adults (POVA) checks and references are being done before staff work with people living there and this includes volunteers. The staff we spoke to had a good understanding of their roles and the needs of the people living there. Staff have their own individual professional development files with records of their training and the service sets annual objectives for personal development with an annual training plan to help make sure staff receive the training they need to care for the people living there. Staff told us in conversation, and in their surveys, that they felt that they had been given training relevant to their role and had the right experience and knowledge to meet the different needs of people in the home and records supported this training. Over fifty percent of care staff have completed the Care Homes for Older People Page 23 of 31 Evidence: NVQ level 2 training in care to promote the skills they need to support people living there. Records indicate that staff have regular formal supervision from the supervisory staff and staff we spoke with did overall feel the management team supported them. However staff and residents did comment on the levels of staff at times available to meet those needs. Comments received indicated that there are times when staff are stretched to give the care they want according to individuals needs. A feeling was expressed to us that this can lead to stress and tension as sometimes service users need 2 people at a time when there is only one person on a unit, so staff morale is low. Other comments included, Service users needs are changing, more time is needed to do the job properly. Residents comments, whilst praising staff for their hard work and attending to their needs, did also note, They could do with more staff so the others dont have to run around so much and They (staff) are very good but very busy. One person observed They are short staffed at the moment, its very hard for them with people off sick as well. We looked at staffing rotas and found that these were frequently altered and that supervisory staff spent a lot of time on finding staff to cover shifts with staff doing extra shifts and agency staff being used. There were times when there was only one carer on a unit, often at shift changes, although care plans indicated some people living there required 2 carers to support them. Speaking to people living there and examining their care plans there was no evidence to indicate the personal care being given was not meeting their personal care needs or expectations, however they may need to wait a short time for support and attention and for two carers to be available to help them. It was evident from speaking to people living and working there and from individual care plans and training records that the service does recognise the importance of individualised person centered support but the fluctuations in staffing levels may restrict their ability to deliver consistent person centered care in practice and have a negative effect on staff morale. Staff we talked with liked their work and worked hard as a team to maintain the level of care people wanted but this relies a lot on the good will of staff rather than long term organisational planning. The acting manager is aware of the barriers to improvement presented by its current staffing issues. Although the management team and staff team tries to make best use of the staff resources available to them and look for ways to address this we strongly recommend that the acting manager review the way units are staffed at all times. Given the layout of the home and the levels of dependency of some people living there the manager needs to review how staff are deployed throughout the day and night so that the ratio of carers to residents is based on peoples needs rather than staff numbers and a one size fits all approach. Care Homes for Older People Page 24 of 31 Evidence: Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is being well run and a high level of consultation with people living there means that they are able to contribute to the way the home is run in their best interests. Evidence: The home has regular resident and staff meetings. We looked at the agenda and minutes of the residents meeting, held the month before the visit ,where people discussed such things as the homes newsletter, peoples views on the refurbishment, ideas for Christmas activities and fund raising activities. Residents told us that they saw the acting manager most days and could raise any matters they wanted to discuss at any time. The home also uses satisfaction surveys and residents meetings to help measure its effectiveness in meeting its objectives and is doing regular audits. The last survey is in the Statement of Purpose so people can see the views expressed. This years survey, although complete, has yet to be collated and published. We looked at this and found that overall people had made positive comments about the service and Care Homes for Older People Page 26 of 31 Evidence: the areas they had wanted changing were being addressed. Talking to, and observing, people living there, their visitors and the staff we found there was an open and friendly atmosphere in the home with visitors feeling welcome and people living there feeling they were listened to. One relative commented, The staff are very caring, not just of my relatives needs but also mine. The home has an experienced registered manager who is currently dividing their time between this and another Cumbria Care Home. This is an interim measure during the absence of the other homes manager and cannot go on indefinitely as this might in the long term affect the development of this home. The supervisor, who is presently acting manager, confirmed that this was a temporary measure due to end shortly. People we talked to in the home praised the registered manager and one said She is really, really good but is at another home at the moment, although Diane (acting manager) has made a real good job of standing in. We all help each other here, I set the tables and put the bowls out for cereals. Speaking to the acting manager and supervisors it was clear they had a good awareness of the needs of residents and were well organised with effective management systems that were well established. Records and information we asked for were well kept, up to date and this made it easy to find the information and records we needed. The home has systems in place to safeguard residents monies and transactions are recorded. Records and servicing contracts indicate that the home has systems, training and established practices to promote the health and safety of people living there. Records show that the servicing and maintenance of equipment, including emergency equipment is being done as needed to make sure they are all in good order. Records indicate and staff confirm that they have been given appropriate mandatory training, including fire training in line with their safe working procedures. However we found that only catering staff and one carer had recorded training in food hygiene. As staff on units prepare light meals and serve main meals and snacks we recommend that all care staff receive this training and that it is recorded when done. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The service must provide a 31/03/2009 controlled drugs cabinet that meets the requirements of the Misuse of Drugs ( Safe Custody)regulations when they keep and store controlled drugs for any resident. Controlled drugs have additional safety precautions and legal requirements regarding their safe storage as they are liable to misuse and addiction. 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 3 Staff undertaking pre admission assessments with people should make sure that they always sign and date these so it is clear who did the assessment and when it was done with people. Nutritional screening should be kept up to date and changed following review so action can be taken quickly as Page 29 of 31 2 7 Care Homes for Older People the risk changes. 3 27 We strongly recommend that the manager reviews the deployment of staff in the home so they can monitor and adjust staffing to resident ratios in line with peoples changing needs and levels of dependency rather than around staff numbers available and different shift times being worked. We recommend that the manager makes sure all staff handling, preparing and serving food in the home have food hygiene training to promote the health and safety of people living there. 4 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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