Care Home: Dalemead

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What the care home does well People are happy living at the home. Staff are happy and feel well supported. People are given good support and are cared for when they move to the home, during the time they live there and, whenever possible, to the end of their life. The staff work well with other professionals to give a high standard of care and support. The activities at Dalemead are excellent and people are supported to learn new things, develop skills, have a positive self image and have fun. People really like the food and are able to choose things they want to eat. The home is clean and well maintained. The Manager is respected by staff and people living at the home, he is supportive and works hard to continually improve the service. What has improved since the last inspection? The way in which people are supported is better, they are given more individual care and support. There has been improvements to record keeping and care plans. There have been improvements in the health of individuals living at the home. There have been improvements in the way medication is managed. There have been new activities, including visits from other organisations. There are new ways to monitor the quality and customer satisfaction. People living at the home have been consulted about what they think. What the care home could do better: The Manager has a clear plan for further improvements and he also listens to other people`s ideas and suggestions for change so that the service is continually developing. In most areas the home meets or exceeds National Minimum Standards. The Manager needs to make sure there are further improvements to the way medication is managedso that people are always kept safe and risks to their wellbeing are minimised. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dalemead 10-12 Riverdale Gardens East Twickenham Middlesex TW1 2DA     The quality rating for this care home is:   three star excellent 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: Sandy Patrick     Date: 0 8 0 1 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 33 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 33 Information about the care home Name of care home: Address: Dalemead 10-12 Riverdale Gardens East Twickenham Middlesex TW1 2DA 02088922161 02088916697 anwar.dalemead@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Anwar Phul care home 49 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 49 The maximum number of service users who can be accommodated is: 49 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Date of last inspection Brief description of the care home Dalemead is a privately run residential care home located in East Twickenham. The home is close to local shops, pubs, parks and other amenities. The home offers accommodation to 49 older people over the age of 65 who have dementia. The home was opened in 1942 and purchased by the current owner in 1989. The building consists of two Victorian properties linked together with a further extension. Accommodation is on three floors, all serviced by a passenger lift. There is a large and mature garden to the rear and a small car park at the front. The home is divided into four interconnecting units. All bedrooms have en suite facilities. The Registered Owner is also the Manager and has managed the home since 1978. The current scale of charges is £595 - £650 per week. Additional charges are made for hairdressing, private chiropody, toiletries, newspapers and magazines, escort duty and private transport. Care Homes for Older People Page 4 of 33 Brief description of the care home The Registered Person has produced a Service User Guide, which includes information on the aims and objectives of the service. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 3 stars. This means the people who use this service experience excellent quality outcomes. The inspection of the home included an unannounced visit on the 8 January 2009. We met with people who live at the home, staff, visitors and the Manager. We looked at records, the environment and how people were being cared for. We wrote to people living at the home, staff and other professionals and asked them to complete surveys about their experiences. 14 people who live at the home and their representatives, 13 members of staff and 6 professionals returned surveys to us. Care Homes for Older People Page 6 of 33 We asked the Manager to complete a quality self assessment. We looked at all the information we had received about the service since our last inspection. Some of the things people told us about Dalemead were: There is a very friendly atmosphere. I cannot fault the home. We have no concerns, we are very happy. I feel the care service offered at Dalemead is a very high standard. The staff listen to residents and their families and respond sensitively. Dalemead is a happy, homely place where they care for people, in most cases, for the rest of their lives. They continue to make changes to improve the way they care for people. Residents are treated as individuals and are celebrated for who they are. I am very proud to work at Dalemead. I feel it is a privilege to work for Dalemead, I think that the residents are extremely well cared for. They do their best to improve the lives to residents, there is good food, activities, visits from outside agencies and good staff. The level of care is fantastic and everyone is considered an equal. There is peace and harmony at Dalemead. They make people feel at home. There is a relaxed atmosphere and they welcome people. I would recommend Dalemead to anyone searching for a home. My relative grew to feel that she was a valued person and respected, she was very happy at Dalemead. Perfect, I have no complaints, I think it is marvelous. I am happy here in my home. What the care home does well: What has improved since the last inspection? What they could do better: The Manager has a clear plan for further improvements and he also listens to other peoples ideas and suggestions for change so that the service is continually developing. In most areas the home meets or exceeds National Minimum Standards. The Manager needs to make sure there are further improvements to the way medication is managed Care Homes for Older People Page 8 of 33 so that people are always kept safe and risks to their wellbeing are minimised. 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 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information about Dalemead and opportunities to visit there before they make a decision about moving into the home. The staff support people during their move and are sensitive to the fact some people find this a difficult time. Evidence: There is a guide to the home and a statement of purpose which are given to people who are thinking about moving there. These have been updated regularly. The Manager or senior staff visit people who are interested in moving to the home. They speak to them and their representatives so that they can assess their needs. The person is also invited to visit Dalemead and spend some time there. The information from these assessments is recorded and helps the staff plan the care and support they will give them. Recently some of the care staff have accompanied managers on these visits to hospital. We spoke to one of the care staff who had done this. They told us Care Homes for Older People Page 11 of 33 Evidence: that they had found it very useful as they had started to get to know someone before they moved to the home. They told us that the people moving to the home had been comforted by a familiar face. We saw one person and their family being shown around the home on the day of our visit. Since the last inspection the Manager has introduced short questionnaires which are given to people who look around the home. They ask them for their feedback on what they thought. These are designed to help look at how people are supported when they are thinking of moving there and whether there is any improvements Dalemead could make. Everyone has their needs reviewed after a few weeks to make sure these needs are being met and to make sure they are happy at Dalemead. Everyone who lives at the home has a contract outlining the terms and conditions of living there. Some of the things people told us about their move to Dalemead were, we are delighted our relative has made the transition to the home well and that they are approachable and adaptable to meet her needs, the management and staff were very good when mum moved in and they made her and us feel very welcome, the reassurance given to our relative in a strange new environment greatly assisted her in adjusting to the change in her life, people who showed us round were helpful and informative and I found it hard settling in but the staff were very patient with me and worked with me, it is difficult moving home but I am grateful for their help I feel at home now. The relatives of people who have passed away or moved away from the service are invited to complete surveys about their experiences and thoughts on the home. We saw that some people had written very positive comments about the service. We also saw that some people had written letters complimenting the staff and saying that their relatives were well cared for and happy at the home. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 the home are healthy and well cared for. There are records to help the staff know what they need to do to support each person. The staff work with other professionals to keep people healthy and to make sure they have their right medication. The staff are sensitive and kind when supporting people with personal needs. Evidence: Each person has a record (care plan) which helps the staff to understand about their individual needs and wishes. Since the last inspection these records have been improved and there is more information about the persons life before they moved to the home. These records are designed to focus on good outcomes for each person and what staff can do to make these happen. Everyone has a copy of their plan and copies are given to relatives. These plans are regularly reviewed and updated. We looked at a sample of care plans and assessments. We saw that the risks people faced had been recorded and action was taken to support Care Homes for Older People Page 13 of 33 Evidence: people who take risks. We saw that there were plans for people to make sure they could move around safely. Since the last inspection there has been a lot of work to support staff to think about individual people and their needs and wishes. The staff have been supported by clear and positive care plans. They have also had training and the senior staff encourage them to think about each person as they work with them. This is really positive and the quality of care and support people receive has improved. Each person has a key member of staff who makes sure they are getting the care they need. People are encouraged to display photographs in their rooms to help orientate them and also to help staff who care for them to have a better idea about their lives and their families. The deputy manager told us that she encourages staff to use these photographs to help initiate conversations and ask questions so that they get to know individuals better. Everyone is registered with local GPs and other health care professionals. The Manager said that he has a good relationship with the local community team and other professionals who support people who live at the home. The deputy manager told us about some of the different peoples health needs. From this conversation and looking at records we could see that some peoples health and nutrition had improved since they moved to the home. People are able to continue to see GPs and professionals they have used before moving to the home. One relative of a person living at Dalemead told us, my relative was supported to remain with the GP she had used for over 40 years. Some of the things other professionals told us about Dalemead were, there is good liaison with other health professionals and they always follow up test results, they treat everyone as equals and are warm and friendly, changes we recommend are acted upon immediately, carers are aware of preventative measures to keep people healthy, residents are always taken to individual rooms for appointments, people are spoken to with kindness, thoughtfulness and respect, staff are very mindful of clients privacy and dignity, care plans are well structured and cater for each persons needs, individual choices are always taken into account wherever possible, carers always appear non discriminatory and speak very highly of residents, the staff keep people healthy and work hard to give attention to detail, the staff are very good at caring for people who are confused, irritable, restless or refuse to accept care, the service has improved their communication with us and I have always found Dalemead to be a clean, well run residential home and care is taken to respect residents wishes and autonomy. Care Homes for Older People Page 14 of 33 Evidence: The pharmacist visits the home and offers training to all the staff responsible for administering medication. There is a medication procedure and all medication is stored securely. Since the last inspection there have been improvements to the way medication is stored and dispensed. We looked at a sample of medication storage and records and we observed people being administered medication. In general medication was well managed. However, some medication administration charts did not contain details about peoples allergies and should do. Some of the amounts of medication carried forward from one month to the next were not recorded. Where some people were prescribed a variable dose of a medication, the amount administered was not always recorded. There were no photographs accompanying medication records and we strongly recommend this to help staff identify people receiving medication. The majority of medication was appropriately labelled, however we saw one unlabelled medication that should have been labelled with the recipients name and date of opening. Peoples care needs are recorded in their plans. These state the importance of respecting individual choices and upholding dignity. We saw that the staff had a good understanding of these issues and they were kind, polite and sensitive when supporting people. Care support is recorded, as are all accidents and medical interventions. Some of the staff talked about their roles. They talked about the importance of respecting people and about positive touch, facial expressions and making sure people were happy. They showed us that they had a good understanding about how to care for people. A hairdresser visits the home each week. People told us that she offered a good service which was value for money. We saw some staff sitting with people caring for their nails and chatting. The staff told us that they had been trained in nail care. One visitor who was speaking about their relative at Dalemead said, the carers sit down and talk with her, they hold her hands and find out her wishes. Peoples individual wishes and needs regarding end of life care and death are recorded. People are supported to remain at the home wherever possible. The senior staff told us that they helped support people to grieve when there was a bereavement at the home. Families of many of the people who have passed away stay in contact and some continue to visit the home to offer support and friendship to other people. One person told us, the carers were extremely supportive to me around the time of my relatives Care Homes for Older People Page 15 of 33 Evidence: death. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to learn, develop skills, and have fun through activities and events which take place throughout their waking day. Visitors are welcome and are involved in caring for their relatives if they wish to. People enjoy a varied and nutritious diet. Evidence: Some of the things people told us were, activities organised for the service users are absolutely superb and cater for the specific individual needs of people, as well as the usual activities there is garden parties and cream teas during the summer and a Christmas party, my relative enjoys the activities which give her an enhanced feeling of self worth and well being, mum joins in a wide range of stimulating activities and Dalemead is a busy calendar of classes and events. Throughout our visit we saw people relaxing in the lounges and their rooms. There was a pleasant atmosphere and staff were kind, caring and supportive. We saw people taking part in different activities. There were fresh flowers around communal rooms and people were consulted about television and music choices. Care Homes for Older People Page 17 of 33 Evidence: There is a varied and full plan of activities, including events for the whole home, for small groups and individuals. There is a full time activities officer. She is enthusiastic, positive and knows each persons needs and interests really well. She is consistently thinking about new activities and things which people who live at the home might enjoy. She has recorded details about individual interests and hobbies and makes sure they are given the support and help to pursue these interests. She has worked with families to help create a detailed picture of peoples lives before they came to the home so that staff can know and understand them as the person they have been throughout their lives not just the person who now lives at the home. The continuous hard work and dedication of the activities officer is a really positive aspect to the home and people living at Dalemead are supported to stay active, have fun and enjoy their lives. The activities officer told us that her philosophy was that people should be supported to continue to learn and develop if they want to when they move to the home. The activities officer talked about some of the things she had supported individuals with. For example one person has a regular beauty therapy session, another person has a weekly shopping trip and she supports one person to rent DVDs. Visitors told us that they were made welcome and could visit at any time. We saw people spending time with their relatives. The activities officer has organised for children from a local nursery to visit regularly. They entertain people with songs and share drinks and snacks with everyone. Some people from the home have also visited the children in their nursery and at Christmas they went to see the children performing their nativity play. The activities officer said that this experience was really positive for everyone and gave an example of one person who had not talked for a long time, engaging and talking with the children who visited. Some visitors also bring pets to the home and people enjoy spending time with these. The activities officer organises for a local farm to visit the house regularly. This is a popular event, with rabbits, goats and people are encouraged to touch and hold them. There are regular special events and parties. Relatives, friends and relatives of people who have passed away are invited to these. The staff reported that they had a very good rapport with families. One visitor told us, there is a lovely family atmosphere and everyone talks to everyone, the families support each other. The community police visit the home each month and spend time with the people living there. The activities officer told us that this has been positive for everyone and Care Homes for Older People Page 18 of 33 Evidence: that people had told her that they felt safer. A local library visits the home. People can browse different books or put in requests. The activities officer has informed the librarian about different peoples interests and tastes so that books that might appeal to them can be offered to them. People who are able and want to are supported to go to local shops or out for a walk. The activities officer orders items that people who are unable to get out to the shops request so that they can buy the things that they want and chose. She said that she buys products which people have requested and makes sure individual favourite chocolate bars and toiletries are available for people. She also organises a regular clothes party, where people can chose new clothes if they wish from a local supplier. There are regular residents meetings and these are minuted. People are informed about changes and asked how they would like to spend their time and if there are any changes that they would like. At a recent residents meeting people asked for a visit from a reptile farm and this was organised. We saw photographs of people holding snakes and lizards. The activities officer said that everyone really enjoyed this activity. Some people have visited Kew Gardens and other places of interest. Kew Gardens staff are visiting the home and holding a slide show for everyone. A regular church service takes place for people who wish to join this. There are daily activities which include art and craft, nail care, hand massage, games and exercise and anyone can join in with these. Activities are well advertised on brightly coloured notice boards. Photographs around the home help people to see the activities which have taken place. There is a newsletter which keeps people up to date with events and changes. This is displayed on notice boards throughout the home. There are lots of resources for activities in the home, including craft materials, DVDs, flat screen televisions, magazines and books, garden bird feeders and the activities officer has purchased equipments and things that appeal to peoples specific interests and likes. The activities officer told us that the Manager is very supportive and will fund any equipment or resources she requires. The staff are encouraged to use these resources with people outside of the planned activity time. The activities officer told us that there are regular taste sessions where people are encouraged to try a new food which they have not tried before. These have included exotic fruits, different cheeses and wines. People are invited to comment on these and popular foods are added to the menu. Care Homes for Older People Page 19 of 33 Evidence: There is a varied menu which offers choices at each mealtime. The cook has worked at the home for many years and knows peoples individual tastes, likes and dislikes. The menu is regularly reviewed and people are able to contribute their ideas. We saw people enjoying their lunchtime meal when we visited. People told us that the meal was tasty. We saw that the staff serving the meal were kind and asked people about their enjoyment. People are able to have snacks throughout the day and the kitchenettes in different units of the home have bread, biscuits and facilities to make sandwiches, toast and hot drinks. We saw people being offered slices of fruit, biscuits, hot and cold drinks throughout our visit. Some of the things people told us about the food were, there is always good soup, there is always good food so that people do not miss out, catering meets individual needs and wishes, our relative eats well and comments that the food is nice, there is great variety and food is nicely presented, all meals are cooked freshly, the meals are delicious, extremely varied and appetisingly served, the ingredients are always fresh and of the highest standard, if there is something I am not keen on they give me an alternative and they know my likes and dislikes anyway and I love the meals at the home if I ask for a special request it is not a problem. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are procedures designed to protect people and to enable them to make complaints. The staff are aware of these and have been trained so that they can support people appropriately. Evidence: There is an appropriate complaints procedure and copies of this are given to people when they move to the home. Copies are displayed around the home. There is a record for all complaints and the action taken to investigate these. People told us that they knew how to make a complaint. There are procedures for protection of vulnerable adults and whistle blowing, including a copy of the local authority procedure. The staff we spoke to demonstrated an understanding of these. There is regular training for staff in protection of vulnerable adults and the Manager told us that he was going to provide some in house training. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, well maintained and attractive environment, which has undergone improvements. Further improvements are planned. Evidence: The building is divided into four units, each with a kitchenette, lounge, en suite bedrooms and bathroom and shower facilities. The home is nicely decorated throughout. The garden is well maintained and has areas for seating and relaxation. The building and garden are well maintained and there have been improvements to the environment. These include new furniture and flooring and redecoration in some areas. There are plans for further improvements. Everyone has their own bedroom and they are encouraged to personalise this and bring their own furniture and belongings. People are supported to choose a label to help them identify their room. Some people had photographs, others had pictures which were meaningful to them. For example, two people had the badge of their favourite football teams. People invited us to see some of their bedrooms and these were individual and personalised. Some of the bathrooms have been refurbished and two new shower rooms have been Care Homes for Older People Page 22 of 33 Evidence: created. We found that there was a slight step up to one of these shower rooms, which could be a hazard. The Manager should look at minimising the risks of people tripping. Some of the kitchenettes in the units had been improved and there was new flooring in some areas. We felt that further improvements were needed in other kitchenettes, where cupboard doors needed mending. The home was clean throughout on the day of our visit. The Manager has introduced systems to make sure all areas of the home are thoroughly cleaned. Some people smoke and are able to do so in their bedrooms. There are no communal smoking areas. We noticed that at times the smoke from bedrooms had drifted into communal areas. The Manager should think about ways this can be minimised or ventilation be improved so that all communal areas are smoke free zones. One person told us, the laundry is wonderful I cannot fault it. Another person said, the laundry service is good with fresh cloths daily. One visitor said, whenever we visit there is always someone cleaning and our relatives own room is in very good condition. Someone living at the home said, spills and accidents are dealt with immediately, my bedroom is very clean and is always fresh. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by well trained, supported and appropriately recruited staff. Evidence: Some of the things people told us about the staff were, the staff are all very positive about the home and very caring towards residents, sometimes I would like there to be more staff available in the lounges, the staff are always available and explain if they are delayed in any way, all the staff are very kind and they are very good. One member of staff told us, the staff team is really stable and we support each other. Each unit has an allocated team leader and a team of staff who support the people living there. At the time of our visit there were some staff vacancies, including a team leader post. The Manager was recruiting to these and had held some staff interviews. One of the team leaders has been promoted to deputy manager. We saw that the staff were kind, supportive and attentive to peoples needs. They appeared to have the skills and knowledge needed for their jobs. There are suitable procedures for recruiting new staff, including formal interviews and Care Homes for Older People Page 24 of 33 Evidence: checks on their suitability. We looked at a selection of staff files and saw evidence of thorough recruitment. The Manager should consider ways to involve the people who live at the home in staff recruitment. For example staff applicants could meet and share a drink with some of the people at the home. People could then give their opinions on what they thought of the applicants and staff on duty could observe their interactions. Staff are given a variety of training opportunities and the Manager and senior staff offer in house training in some areas. Some of the records that evidence staff training needed to be updated to make sure they accurately reflect all training needs, training achieved and when updates are due. Some of the staff have recently undertaken IT training and there are lap tops throughout the building so that they can update records whilst spending time with people living in the home. There are regular team meetings for all staff and we saw some of the minutes from these. We saw that staff were well informed and that they were given opportunities to contribute. There is a handover of information when there is a change of staff each day. The staff are supported to undertake NVQ training and over half the staff are qualified to NVQ Level 2 or above. Other staff were undertaking this at the time of the inspection. The deputy manager and one of the team leaders are undertaking a management qualification. Some of the staff told us that the training they had done was very useful at helping them in their roles. One person said, the Manager is very keen for me to go on training which will further my understanding of the job. The staff who we spoke to said that they were happy and well supported. They said that they had a range of training and regular meetings. They told us that they had the information they needed to do their jobs. Some of the things that they said were, the manager provides me with up to date literature and this keeps me informed about important issues in the care sector, I can always approach my team leader if I have any questions, I had a good induction, I am given regular refresher courses on all my training, we usually have good communications in the team and any problems are sorted out by the Manager or team leaders, since I started my job there have been a lot of improvements, the induction was very impressive and we have a lot of information and are provided with handouts from the CSCI and other organisations. Care Homes for Older People Page 25 of 33 Evidence: The Manager told us that he has identified that there needs to be improvements to the way people are supported at night. He said that he will be doing this through closer monitoring and clearer directions for night staff. We saw that this issue had been discussed at senior staff team meetings. A social work student was undertaking a placement at the home at the time of the inspection. The staff told us that they were thinking of ways to ask local schools to volunteer. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a service which is well managed. The management approach is flexible, open and adapts to changes. There are systems to monitor customer satisfaction and look at the things people living at the home would like to change or be improved. There are systems to help monitor health and safety. Evidence: The Owner is also the Manager. He is experienced and appropriately qualified. The Manager spoke positively about the staff, in particular the senior staff. He has delegated different duties and invited senior staff to join him for feedback at the end of the inspection visit. He holds regular senior team meetings and clearly values their input and ideas. The Manager works with other care providers and local groups to share good practice Care Homes for Older People Page 27 of 33 Evidence: and training. He has a good network of support and works well with other local services and health care professionals. Some of the things people said about the Manager were, the Manager is a really happy person and always having a little laugh, he is very forward thinking and he encourages us and wants to support us, he is the best manager I have ever had he is really supportive, the Manager is excellent, very approachable and great to work for, we always get support from the Manager, the Manager is approachable, accessible, reliable, consistent, caring and responsible, he always does his best for staff and he is keen to share his knowledge and also learn from others, the Manager never objects when people suggest changes and the owner and staff are always very helpful, dedicated and supportive. Two senior members of staff are volunteering for Skills for Care (a national authority that look at training standards and developing skills in social care). They visit schools and universities and talk to groups of students about social care and answer questions they may have. They spoke about this as a positive experience, developing their skills and helping to encourage young people to think about the work in the care sector. All staff have regular supervision meetings with their line manager. These are recorded. Some of the staff told us that these were useful. They said that they were able to look at their own skills and development and that they were able to talk through problems with their manager. One person said, I have supervision on a regular basis and I find this extremely useful it is very focused on my needs and development and carried out in an objective and non critical way. New surveys have been introduced so that people can write about their views and experiences of the home, including their initial visits and end of life care. There are also general surveys which people are asked to complete annually. These ask people about food, accommodation, staffing and activities. The Manager uses information from these to help look at how the service can change and improve. He has produced a summary of the results from the surveys. We saw that according to these results people were generally very satisfied with all aspects of the home. The Manager had recorded specific comments and suggestions and how he planned to address these. There are informal meetings and chats with people who live at the home to make sure they are getting the care they need. Some of the things that they have talked about are discussed further at residents meetings, if appropriate. Everyone has an annual review that is designed to make sure their needs are being met. The staff review care plans each month. The staff should make sure they consult people about their own care each month and should record this in their reviews. Care Homes for Older People Page 28 of 33 Evidence: In general, relatives are encouraged to look after and manage peoples finances. Small purchases and hairdressing services are recorded and included in monthly invoices. However, the Manager has agreed to hold small amounts of cash for some people. We saw that there were accurate records of this. Cash belonging to one person was stored in a medication cabinet in one part of the home. The records for this were included in another document. There should an independent record of this money and any expenditure and the money should be stored in a more appropriate place. The Manager has created a business plan which records the visions and values of the home. He has recorded aims for the coming year and achievements. Plans for the future include further improvements to the environment and staff training. There are regular recorded checks on health and safety. We saw evidence of fire checks, electrical testing, water temperature and food storage temperature checks. We saw that the environmental health officer had visited the home. We saw that the Manager had done that the things they had asked the home to do. We saw that the fire officer had visited the home and was happy with fire safety there. All staff have had training in fire safety, food hygiene and basic first aid. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 13 The Registered Person must make sure all medication is labelled with the persons name and date of opening (if applicable). We found some unlabelled first aid equipment which had been opened and used for a specific person. 06/02/2009 2 13 The Registered Person must make sure medication records record peoples allergies, record the total amount of medication held and record the amount of medication administered whenever a variable dose is prescribed. Some medication records did not show peoples allergies, some did not record the total amount of medication held and some did not record the amount of medication administered 06/02/2009 Care Homes for Older People Page 31 of 33 when a variable dose was prescribed 3 30 18 The Registered Person must make sure all staff training is recorded and records are kept up to date. Some of the training staff had attended was not recorded. Individual training records and the central record had not been updated. 31/03/2009 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 9 19 25 25 27 The Registered Person should make sure photographs of each person accommpany their medication records. The Manager should consider further refurbishment of the kitchenettes. The Manager should think about ways ventilation can be improved so that all communal areas are smoke free zones. The Manager should make sure the entrance to the shower room does not present a risk to people who might trip. The Manager should make sure the night staff are supported to work in the same person centred way the day staff do. The Manager should think about ways to involve people who live at the home in the recruitment of new staff. The care staff should consult people living at the home about their thoughts and feelings as part of the monthly review of care plans and they should record this. The Manager should make sure all money held on behalf of people living at the home is appropriately stored and recorded. 6 7 29 33 8 35 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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