Care Home: Ferndale

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What the care home does well The home had maintained good standards of care delivery and good working relations with the service users and their family members, staff and relevant professionals. This had been useful for appropriate care delivery and in meeting the service users assessed needs. One relative commented that "Ferndale always the needs of my mother in mind and acts accordingly, despite sometimes being understaffed, what all the staff do very well is help to keep to high standards". Staff were observed to interact well with all people using the service and respecting and dignifying their individual needs. A person who uses the service commented that "care staff always come to help me when they can" "I like my key worker and the care form the team leaders and manager". The service in general is very homely with personal touches having been made to make sure that the environment reflects their home as much as possible. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. Medication is well managed to ensure that people health and social care needs are being met at all times. Care planning is detailed in order for the delivery of care to the person using the service to be person centred at all times. One relative commented that, "there is always literature about the home which keeps me up to date. They always discuss any situations with me before any decisions are made about my mother". In December 2007 the service conducted its annual resident customer satisfaction questionnaire. The findings from this survey determined that 100% of the people who use the service rated the home either excellent / good for over all satisfaction. What has improved since the last inspection? The service continuously strives to make and continues to make improvements, this includes improvements in the environment for compliance with the fire authority, decoration, training, activities and supervision. Areas of the environment have been improved, including, ski mats for the evacuation of people who use the service in the event of a fire. What the care home could do better: The provision of activities is more challenging to provide as the service does not currently employ an activities coordinator. Staffing levels must be consistent to ensure that needs of the people who use the service are being met at all times. Medication route should be added to the medication administration records to ensure people receive their medication using the correct route of administration. Medication should be accurately booked in following the services policy and procedure for the receipt of medicines. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ferndale Easton Road Flitwick Bedfordshire MK45 1HB     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: Louise Bushell     Date: 2 9 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Ferndale Easton Road Flitwick Bedfordshire MK45 1HB 01525712650 01525714169 barnepen@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Penny Barnes Type of registration: Number of places registered: BUPA Care Homes (Bedfordshire) Ltd care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Ferndale is a purpose built care home that is registered to provide care for thirty frail people over the age of sixty-five who may also have dementia and / or physical disabilities. The communal accommodation of three lounges and a large dining room is located on the ground floor. All of the lounges overlook a well-stocked and maintained garden. Toilets and bathrooms are located for convenient access throughout the building. The home is located within walking distance of Flitwicks town centre and its amenities. 0 0 0 Over 65 30 30 30 Care Homes for Older People Page 4 of 29 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: Standards identified as key standards and highlighted through the report were inspected. In addition to the key standards a number of other standards were inspected to assess the services ability as part of case tracking people that use the service from the admission stage to placement stage. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, the annual quality assurance assessment, (AQAA), pre inspection planning, an unannounced inspection visit to the home, any information sent to us from the service and other professionals, collating information received in person from relatives and the people who use the service, and drawing together all of the evidence gathered. Care Homes for Older People Page 5 of 29 The service has received five complaints since the last inspection. The pre inspection planning was carried out over the period of a day and involved reviewing the service history, which details all contact and correspondence with the home and previous inspection reports. The last full inspection took place on the 28th January 2008. This unannounced inspection visit was carried out by one inspector and covered the morning and afternoon of a weekday. The inspection was carried out by case tracking, which involves selecting samples of residents records and tracking their care and experiences. Observations of the homes routines and care provided were made and views on the care provided were sought from people who use the service, visitors and staff. Additionally questionnaires were sent to a random selection of people to ascertain their views. Responses had been received from five staff, six people that use the service and seven relatives / representatives. In addition to this views and comments were gathered during the inspection. The management of medication was checked through reviewing prescribed medication for a sample of people as part of case tracking. A sample of staff files were reviewed to check the adequacy of the recruitment procedures in protecting people who use the service. Communal areas and a sample of bedrooms were viewed and observations were made of peoples general well being, daily routines and interactions between staff and people who use the service. Verbal feedback was given to the current registered manager and the prospective manager of the service. Fees for accommodation were between 462 and 476 weekly. The fee range is dependant on assessed needs and excludes personal toiletries, chiropody, hairdressing and additional personal items. What the care home does well: What has improved since the last inspection? What they could do better: The provision of activities is more challenging to provide as the service does not currently employ an activities coordinator. Staffing levels must be consistent to ensure that needs of the people who use the service are being met at all times. Medication route should be added to the medication administration records to ensure people receive their medication using the correct route of administration. Medication should be accurately booked in following the services policy and procedure for the receipt of medicines. Care Homes for Older People Page 7 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service had made appropriate arrangements for the assessment of needs of the people who use the service and they and were aware of the care and services they would receive from the home prior to their admission. Evidence: The service has developed a statement of purpose, which sets out the aims and objectives of the service, and includes a guide, which provides basic information about the service and the specialist care that is available. All documents were made available during the inspection process. The guide details what the prospective people using the service can expect and gives an account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. All people who use the service are given a copy of the guide. One relative commented Care Homes for Older People Page 10 of 29 Evidence: that, there is always literature about the home which keeps me up to date. They always discuss any situations with me before any decisions are made about my mother. Admissions are not made to the service until a full needs assessment has been undertaken. A senior person always completes the assessment prior to admission to the service. A number of pre assessments were seen and completed well. The service also completes a secondary assessment on admission to review any changes in need, this information is used to inform the personal plan. The assessment explored areas of diversity including preferences, religious and cultural needs, involvement from family, partners and advocates, race and disability. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. The service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process. The Annual Quality Assurance assessment (AQAA) states that The QUEST programme has been developed to ensure we provide continuously high levels of person centered care. The programme includes an extensive assessment, taking into account resident choice. The QUEST programme has encouraged positive feedback regarding assessment and Care Planning. Comprehensive written information in provided to all prospective clients, outlining the ethos of BUPA Care Services and the home, as well as vital information to help with the process of choosing a care home. In December 2007 the service conducted its annual resident customer satisfaction questionnaire. The findings from this survey determined that 100 of the people who use the service rated the home either excellent / good for over all satisfaction Care Homes for Older People Page 11 of 29 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 service has suitable care plans and arrangements in place for the receipt, storage, administration and disposal of medication, meeting all peoples medical, health and social care needs. Evidence: A total of two care plans were case tracked fully, it was established that people who use the service receive personal and health care support using a person centered approach. Personal health care needs including specialist health, nursing and dietary requirements are clearly recorded in each persons care plan. The care plan provides clear information and a comprehensive guide for staff to know how to support the person. The care plan is generated from the pre admission assessment and includes guidelines, risk assessments for the management of falls, manual handling assessments and self medication risk assessments and care plans. Where a short term need had been identified through the review of assessments a short term care plan is implemented to support the person through the management of the particular issue. The falls risk assessment had been reviewed, including the care plan review. It was Care Homes for Older People Page 12 of 29 Evidence: evidenced that a risk assessment for the use of a pressure mattress required reviewing. It was observed that personal support is responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. The service listens and responds to individual choices and decisions about who delivers their personal care. The care plan also details another additional personal preferences, this included food types, night time preferences, activities, religion, personal appearance, personal time and how the person would like to be addressed. A person who uses the service commented that care staff always come to help me when they can I like my key worker and the care form the team leaders and manager. The people who use the service have access to health care and remedial services. The health care needs of those residing at the service who are unable to leave the service are managed by visits from local health care services. The service is not registered as a nursing home and therefore has vital links with the district nursing team. From the information gathered it is clear that good relationships are held. Clear evidence was seen in the care plans of specialist health care support services visiting the service and in addition to the care plan there were detailed notes made by the specialist visiting the service for example the District Nursing team and General Practitioners. A number of comments were received directly from people that use the service, their relatives and friends. One person commented that, Ferndale always gives very good care and the support my mother needs as agreed to my mothers care plan. One relative commented that Ferndale always the needs of my mother in mind and acts accordingly, despite sometimes being understaffed, what all the staff do very well is help to keep to high standards. The service has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. The management of controlled drugs is effective with records being accurate and stock balances being correct. A total of two peoples medication was case tracked in order to ensure compliance. Fridge and room temperatures were being recorded where medication was stored. Dates of opening was recorded on the majority of the bottles and boxes observed. Ordering and returns documentation was up to date and accurate. The service works with individuals regarding any refusal to take medication. The people using the service are given the support they need to manage their medication. If individuals prefer or where they lack capacity, care staff can manage medication on their behalf. This is assessed and detailed in the care plan. It was evidenced that a number of medicines had not been correctly booked into the Medication Administration Care Homes for Older People Page 13 of 29 Evidence: Record (MAR), using the booking in method and the route in which to administer / take the medicine was not detailed on the MAR. The service has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. The service is using Boots as the provider of the medication. Staff have completed and passed an appropriate medication course. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. The AQAA determines that All residents are now assessed as a matter of course on their capability to self medicate when they are admitted, no matter what they have been doing previously. The majority of care plans tracked contained suitable and sensitive plans and arrangements for the management of end of life. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to be involved in meaningful activities of their choice if made available, reflecting were ever possible their personal tastes and preferences. Evidence: People who use the service have the opportunity to develop and maintain important personal and family relationships. Feedback from one relative on the day of the inspection confirmed that relatives / representatives are always welcome into the service. One relative stated that Ferndale is a very happy, efficient care home who carry out their duties to a very high standard. I have always been grateful indeed for taking care of my mother, they are such a friendly bunch of people. On the day of the inspection a number of visitors were seen in the building visiting their relatives / friend / partners. Another relative commented that I am always made very welcome here when I visit. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. This was indirectly observed through the practices of the staff on duty. A Care Homes for Older People Page 15 of 29 Evidence: number of people who use the service were seen to be very relaxed and calm within their own environment and engaging with staff in an equal manner. People using the service are involved in some meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. The care plan details life maps for each individual which supports the service in providing meaningful activities of their choice. There is also reference in the care plan to the preferences of each individual for activities and previous interests. There is currently a vacancy for an activities coordinator post at the service. The manager stated that they are trying to recruit to ensure adequate activities are provided. Two relative commented that more activities are needed and more outings would be good. Last year they drove around Woburn safari park, my mother got immense pleasure form that as I am unable to meet that need. In addition to these, comments were received from the people who use the service and a number of them stated that I dont go out any more, we used to go out quite a bit, and I do walk around the garden and feed the cat and water the plants though. We do a keep fit class sitting down and play bingo, but at the moment they are very short staffed. Staff have commented that there is a shortage of staff at the weekends leaving the people to on shift to work harder to over for the shortfalls. The manager confirmed that the service is aiming to further develop the provision and variety of activities being made available. The manager stated that the staff are facilitating activities in the interim. Activity records were available. The AQAA stated that We intend to involve relatives and families more in the activities, and particularly in the planning of outings from the home. This will help improve our community relations, our relative participation in care and its planning, and may ease the logistical restraints sometimes encountered. The resident customer satisfaction questionnaire issued by the service determines that 71 are happy with the number of activities and events in the service, whilst 21 believe the number of activities and events to be poor. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Menu’s were on display. The food provided appeared appetising and well presented. Comments received included; We always get a choice over the food we have, its nice. Snacks are available 24 hours a day and the kitchenette areas were seen to be stocked. The AQAA determines the following; We have developed our menus to allow Care Homes for Older People Page 16 of 29 Evidence: for resident choices and preferences. The menu master helps ensure every menu within the business is customer led and nutritionally balanced. The Nite Bite menu allows our residents to choose to eat when they feel like it, providing healthy choices at any time through the night. The resident customer satisfaction questionnaire distributed by the service determines that over all 93 of the people suing the service find the food at an excellent / good standard. The care staff are sensitive to the needs of those people who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a robust complaints procedure in place, good staff awareness and attitude towards safeguarding issues so people who use the service are safe and protected. Evidence: The service has an open culture that allows people who use the service to express their views and concerns in a safe and understanding environment. Complaints leaflets were on display at the service. People who use the service have commented that they are happy with the service provided, feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. A verbal complaints log is in place and records appeared to be effective. One person using the service commented I am quite happy here. It was evident that verbal complaints are also well managed, resolved quickly in the best interest of the person using the service. The service has a complaints procedure that is clearly written and easy to understand. It is available in a number of formats such as different languages on request. The complaints procedure is supplied to everyone living at the service and is displayed in a number of areas within the service. There is a detailed record of all complaints and Care Homes for Older People Page 18 of 29 Evidence: compliments made and received. The service has received five complaints since the last inspection. The AQAA determines that 80 of these were managed within the 28 days time scale. One referral was past to the Safeguarding of Vulnerable Adults Team. Feedback from a relative determined that if they have any concerns that the staff are always attentive. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received training in safeguarding and felt confident in reporting any issues as they occurred. Staff had a clear understanding of the Whistle-blowing policy and when the use of this may be put into practice. The service understands the procedures for safeguarding adults and attends meetings or provides information to external agencies when requested. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is pleasant, clean and comfortable, ensuring that the people who use the service are comfortable and relaxed within their environment. Evidence: The service provides a physical environment that is appropriate to the specific needs of the people who live there. The environment provides a homely feel with specialist aids and equipment to meet needs as required. The service is a pleasant place to live. The bedrooms and communal room provide a personal and homely feel. There is a rolling programme of redecoration in place. The layout of the building enables people to move freely. The people who use the service appear to like the environment, were relaxed, comfortable, and settled. The living areas all have access to the garden, which is secure, and people who use the service can use this space with support. The garden areas have flowers and tables and chairs, promoting independence and a homely feel. The people who use the service are encouraged to personalise their bedrooms. All the home’s fixtures and fittings meet the needs of individuals and can be changed if their needs change. The building design supports the needs of people with Dementia. The dining rooms are laid out to encourage communal dining with a calm relaxed atmosphere. The environment promotes the privacy, dignity and autonomy of Care Homes for Older People Page 20 of 29 Evidence: residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The service did not have automatic door closures on a number of the doors. The service is currently working in line with the fire authorities to ensure that full compliance is achieved by the end of 2008. BUPA employs a fire officer to ensure compliance and acts as a liaison between the fire authorities and the service. The home has an infection control policy. The service is clean, well lit and smells fresh. A number of people using the service commented that they liked living at the service. One person using the service commented that I like my room its now down stairs so I can get about easier. The manager stated that new fire safety equipment such as new ski mats had been purchased for the service to further support people evacuating the building in the event of a fire. The AQAA determines that there a now a refurbishment programme. We have had all communal corridors re decorated, and several bedrooms which are on a rolling programme for re decoration. We have installed a level access shower room to promote the personal and chosen individual care expressed by residents. We have moved the hairdressing salon from the ground floor main corridor to a brighter and larger room in a quieter area of the Home on the second floor. This has been embraced as a very positive change, since it makes the experience of visiting the hairdressers much more like it would be in the community. It has afforded our residents more peace and privacy while participating in this activity and the feedback has been extremely positive and encouraging. There was restricted access to high risk areas such as the main kitchen and the laundry areas to reduce the risk of cross infection. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The skill mix, numbers of staff and recruitment processes of the service are sufficient and robust, ensuring that the wellbeing of the people using the service is maintained at all times. Evidence: Feedback from the people who use the service shows that they have confidence in the staff who care for them. Staff Rotas were seen and displayed sufficient numbers of staff on duty to meet the needs of the people using the service. A manager and team leaders are usually on shift in addition to the care staff. This enables staffing levels to be maintained for the safety of all and that record keeping was completed and monitored as required. A number of staff commented that there is a shortage of care staff at the weekend leaving the care staff to work hard and to cover the people that are off sick and the off duty needs to be examined and more staff allocation is needed. The manager of the service confirmed that there is currently an issue with staffing allocation at the weekend, however that they are actively recruiting for part time staff to cover the weekends. The manager encourage and enable the team to complete training to develop their Care Homes for Older People Page 22 of 29 Evidence: individual skills and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role and are able to meet their needs. The AQAA determines that We have a good level of staff retention. We have a unified style and format for staff files. We have an improved skill-mix. All mandatory training is up to date. Some staff express an interest in areas of training which are not mandatory but in which they have a special interest. We aim to access these other areas of training. There is a recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Four staff files were audited. One staff file did not contain references. An immediate requirement was issued. Following the issuing of the immediate requirement to service found the references and compliance was achieved. A number of staff surveyed commented on the positive team culture. One staff member commented that the service is well run and organised staff giving 100 at all times. We communicate well and work well as a team and no matter what occurs our clients are given full care all of the time to the best of our ability. Once recruited staff receive induction and training. The induction process, known as personal best is a process where the staff member is trained and mentored through a complete programme. The programme is then signed at the end of each stage. The service has scheduled specific mandatory training for the year and is conducted by qualified trainers within the group. Following discussion with the staff and manager, it was determined that the analysis of individuals needs were being added to a central matrix and personal training plans. The completed Annual Quality Assurance document determines that the service is providing training to the staff ensuring that they can meet the needs of the people using the service. Staff confirmed that staff meetings occur and a number of comments received on the staff surveys determined that the staff feel fully involved and updated. The mix of staff is suitable to meet the cultural needs and mix of people that use the service. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the services ensures that the people who use the service are kept safe. Evidence: The Registered Manager has the required qualifications and experience and is competent to run the home. The managers have a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve the service. Feedback received on the day of the inspection from staff and as part of the feedback questionnaires received determines that the management are effective and approachable. With the care planning format and training, there is a focus on person centered thinking, with the people who use the service becoming increasingly more involved. The AQAA determines that the promotion of resident choice and awareness of residents own rights with special attention to involving the residents family (where Care Homes for Older People Page 24 of 29 Evidence: they so wish) is a high priority for all. The managers lead and support a stable staff team who have been recruited and trained to satisfactory levels. The manager is aware of the continued need to ensure that there are enough staff available at all times. The managers promotes equal opportunities, has good people skills and understands the importance of person centered care and effective outcomes for people who use the service. The service has sound policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures that staff follow the policies and procedures of the home. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. This includes the management of finances within the service, where systems were directly observed to be transparent and open, with detailed records being maintained at all times. The AQAA determines that the home received a blue rating from the internal Company Financial Audit process earlier this year. There was some evidence on staff records that staff have supervision but this is not always carried out on a one to one basis where staff have the opportunity to discuss their personal development. The manager confirmed that continued development and progress is being made with training and supervision and it was seen that progress had been made. Staff meetings take place regularly and minutes of the meetings are available. The home works to a clear health and safety policy. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. In house training is scheduled for safeguarding. Staff showed a sound working knowledge of action to take in such an event. Through discussions with the management team and it was determined that priority is given to ensure that all staff are in receipt of adequate training, including in house refresher courses and a full complete induction programme. Individual training plans are being developed and will be used, once complete to review the annual performance of staff in their appraisal. The AQAA determines that all polices and procedures have been received and that all health and Safety checks have occurred. Care Homes for Older People Page 25 of 29 Care Homes for Older People Page 26 of 29 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 27 of 29 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 12 16 Activities must be provided at a level suitable to meet the needs and wishes of the people who use the service. To ensure that the people who use the service are provided with stimulation and engagement. 30/10/2008 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 9 The route to take and administer medication should be noted on the Medication Administration Record and the medication booked in as per the services policy and procedure. Supervision should occur at least six times a year to ensure that staff are supported in their roles. 2 36 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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