Care Home: Grace Manor Care Centre

What the care home does well Healthcare needs are well met with input from a range of healthcare professionals as required. Residents benefit from a range of activities and the opportunity to spend one-to-one time with the activities co-ordinator. The meals provided in this home are good and offer choice; variety and cater for special dietary needs. Complaints are listened to and acted upon with residents and visitors feeling confident about voicing any concerns they may have. The recruitment procedures safeguard the people living in home. Residents can be confident that they are cared for staff who have a good understanding of their needs. Residents and visitors spoke highly of the staff. Comments included: "The staff are very helpful and always listen to any comments and act upon them" "The staff are very kind and very welcoming". "Everyone, including the manager, is very approachable". "The staff at Grace Manor are always energetic and friendly and do everything to make my mother happy, safe and comfortable". Staff were observed to be kind and patient with residents. What has improved since the last inspection? For the purposes of staffing the home is set out in three units, this is to promote the continuity of care and maintain stability for people living in the home. This has been a positive move with staff confirming that it has helped them to get to know the residents better and have an improved understanding of their needs. A refurbishment programme has started and this is improving the ambience in the home. Areas that have been completed are light and airy. Four of the returned surveys all made positive comments about this. Auditing of care practices and health and safety issues have improved with a new system having been introduced, which enables the manager to monitor the quality of care provided in the home. Three requirements made at our last visit relating to bath hoists, fire safety and quality assurance had all been met. What the care home could do better: Feedback from relatives, staff, residents and surveys received identified that there are times when staffing levels appear to be low and people felt there were insufficient staff to meet individual needs. The rotas indicate that there are different numbers of staffon duty at times and this needs to be kept under review. The development of the staff training programme needs to continue so all staff benefit from receiving the appropriate training. Some of the assessments would benefit from giving clear guidance on supporting people with an identified risk. Medication practices are generally sound, but would benefit from improved auditing trails so that the home can be fully confident that they have complete records as to how much medication they have in stock. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grace Manor Care Centre 348 Grange Road Gillingham Kent ME7 2UD     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: Anne Butts     Date: 1 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: Grace Manor Care Centre 348 Grange Road Gillingham Kent ME7 2UD 08444725170 08444120630 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) : Grace Manor Care Ltd care home 60 Number of places (if applicable): Under 65 Over 65 0 48 dementia old age, not falling within any other category Additional conditions: 12 0 The maximum number of service users to be accommodated is 60. The registered person may provide the following category/ies of service only: Care home with nursing - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Dementia (DE). Date of last inspection Brief description of the care home Grace Manor is a Nursing Home for Older People. The home caters for 60 people with various nursing needs. The main part of the home was an old Manor House and the decor etc. is in keeping with the period of the home. The new addition affords service users en-suite rooms and there is plenty of day space to choose from. There is a courtyard garden at the centre of the home, which is a suntrap in the summer, which service users enjoy and benefit from. The home itself is set in generally wellmaintained grounds and overlooks the river Medway. The nearest town is Gillingham, which has a main line railway station and high street stores. There is some parking to the front of the building. Care Homes for Older People Page 4 of 30 Brief description of the care home The fees are from £520.00 to £813.75 per week. Care Homes for Older People Page 5 of 30 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This was a key unannounced inspection carried out by one inspector, who spent two days in the home. We (the Commission for Social Care Inspection) spent time touring the building, talking to people living in the home, staff and visitors, observing mealtimes and activities and reviewing a selection of resident and staff files and other relevant documents. Prior to our visit the service returned an Annual Quality Assurance Assessment (AQAA). This gave us additional information about how the service operates. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were Care Homes for Older People Page 6 of 30 spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable us to make an informed decision about each outcome area. Further information can be found on the CSCI website with regards to the on KLORAs and AQAAs. The registered provider has appointed a person to run the home on a day to day basis in the position of manager. They are not yet registered with the commission, but will be referred to as the manager within this report. The manager is currently making application to become the registered manager. The manager and the area manager were present on both days. At all times they were helpful and demonstrated a pro-active approach to the running of the home. The last key inspection was carried out on 3 April 2007 and an annual service review was carried out on 28 February 2008. What the care home does well: What has improved since the last inspection? What they could do better: Feedback from relatives, staff, residents and surveys received identified that there are times when staffing levels appear to be low and people felt there were insufficient staff to meet individual needs. The rotas indicate that there are different numbers of staff Care Homes for Older People Page 8 of 30 on duty at times and this needs to be kept under review. The development of the staff training programme needs to continue so all staff benefit from receiving the appropriate training. Some of the assessments would benefit from giving clear guidance on supporting people with an identified risk. Medication practices are generally sound, but would benefit from improved auditing trails so that the home can be fully confident that they have complete records as to how much medication they have in stock. 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 30 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 30 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. Procedures and assessment tools are in place to ensure that prospective residents needs are assessed prior to admission. Evidence: There is a Statement of Purpose and Service Users Guide in place; these are documents that tell prospective and current residents about what the home has to offer. These were on show in the entrance area to the home. The Annual Quality Assurance Assessment (AQAA) states that the home also produces easy to read brochures. Prior to moving in people are supported with a full assessment of need to make sure that the home will be able to meet their needs. Where possible a full joint assessment from appropriate healthcare professionals is also obtained for the individual person. We looked at the preadmission assessment for one of the newest residents. This Care Homes for Older People Page 11 of 30 Evidence: showed full admission details with an assessment of need. The home had also sought information relating to past medical history, and on arrival nursing observations are carried out. This is so the home is fully is able to support the individual person. Where people have a diagnosis of dementia the assessment process also takes this into account. Where possible people and / or their relatives have the opportunity to visit the home prior to moving in. One relative said I visited at least a couple times prior to my mother moving in. Staff were very welcoming. Intermediate care is not provided but the home will accept people to stay on a short term respite basis. Care Homes for Older People Page 12 of 30 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. Residents benefit from care plans which are aimed at supporting them in meeting individual needs. However some clearer guidance within the supporting risk assessments would further promote the support provided to people. Health needs are met and residents have full access to all professional health care services as required. Evidence: The Annual Quality Assurance Assessment (AQAA) states that people have their own individual care plan. We saw that these were in place. We looked at four care plans. The home is currently using two formats of care planning and we looked at examples of both. The area manager said that a new care planning system has been purchased which will replace the current systems. This will improve the continuity of the systems in the home. Care plans contained information and gave guidance for staff on how to support the Care Homes for Older People Page 13 of 30 Evidence: people living in the home. Care plans contained details of all aspects of care needs and identified high dependency needs such as nutrition, skin integrity, risk of falls and communication. Care plans are reviewed monthly. There are risk assessments in place to support the care plans and the majority of this information is fed into the care plans. There were occasions where an assessment had identified a risk but there was no outcome on how to monitor or reduce that risk. For example one resident had made a choice to stop using an inhaler and although the assessment identified this, there was no further guidance on the monitoring and ongoing support for this. Also where people had a diagnosis of epilepsy or diabetes the assessment process identified this but was not clear on trigger factors on the individual management. When completing risk assessments the home must ensure that all factors are taken into consideration and outcomes for support fully recorded. Care plans and risk assessments identified where people can manage areas of their own care. For example washing their own hands and face. People have the opportunity to manage their own medication if appropriately assessed. A member of staff did tell us how one person manages a specific part of their medication, but this was not in the care plan. As with the risk assessments this information needs to be incorporated. The new manager has introduced records for staff to maintain in order to make sure that peoples personal and health care needs are fully met. We looked at a selection of these and saw that they were completed appropriately. The lead nurse in each unit area reviews these regularly and reports to the manager. As this is a large home, however, when people are sitting in the lounge area these records are accompanying them. This did mean that some personal information was on clear display and did not promote the individuals privacy and dignity. We discussed this with the manager and area manager. They immediately ordered new folders, which did not allow for the information to be on display and maintained the privacy of the person. Older people, especially those with nursing needs, are prone to the thinning of the skin. The home makes sure on admission that they assess the individual and continue to support people with maintaining their skin integrity. Specialist equipment is in place and for people who need to stay in bed; staff support them to regularly move their position. One person did tell us that she was unhappy with how the home managed her relatives skin care and was currently discussing this with the manager. Other visitors said that they felt that their relatives healthcare needs were well met. All of the residents are registered with a local GP and have full access to specialist medical, nursing, dental and chiropody services as needed. Care Homes for Older People Page 14 of 30 Evidence: Each unit arranges the medication for the residents living in that area. We looked at the medication for one of the units on the day of our visit. The nurse in charge stated that the procedures were the same for all the units. There were no gaps found in the Medication Administration Record (MAR) sheets and a spot check on two medications showed that the correct amounts remained. There were sample signatures of staff who are allocated to administer medication and the nurse said she had received training in this area. We saw that the audit trail for medication was not as robust as it could be and that some of the recording procedures did not meet with the Royal Pharmaceutical Guidelines. There was not a copy available in the medication room and the nurse in charge was unsure where it was located. We discussed this at the time of our visit and are recommending that the home looks at their auditing management and ensures that there is a copy of the Royal Pharmaceutical Guidelines available. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to make choices, enabling them to have some control over their daily lives. A range of activities are available for people to participate in. The meals provided in this home are good and offer choice; variety and cater for special dietary needs. Evidence: The home has an activities co-ordinator who oversees the day-to-day activities for residents. There are a variety of different activities on offer, both for groups to participate in and for individual one to one activities. People can choose what they would like to do. We visited over the course of two days and on the first day we observed a birthday party which had been arranged for one resident. This included a singer with residents joining in. A buffet style birthday meal was arranged of that afternoon. On the second day bell-ringers visited the home to give a demonstration. Other organised activities on offer include bingo, board games, arts and crafts, armchair exercises. Outside organisations also visit for musical events. Last summer the home held a successful Care Homes for Older People Page 16 of 30 Evidence: medieval event with a falconry display, jesters and a hog roast. There are further plans for more events for this year. The home has organised an Easter raffle with a variety of prizes available. The activities co-ordinator also spends time with people on a one-to-one basis. He visits people who are unable to get out of bed to spend time with them. A returned survey said; My mother is not to keen to socialise and he arranged for carol singers to visit her in her room another survey said The activities co-ordinator spends time with my relative talking and looking through photographs. The AQAA states that the home has improved its knowledge of peoples life history and this is so that they can offer a more diverse range of entertainment and activities which will suit everyone. People are supported in making positive choices in their daily living. the home had recently carried out a survey asking people if they were given their preferred choices including were they able to get up at their preferred time and able to choose their own clothes. We saw evidence of the results and there were positive responses from people. Residents we spoke to also confirmed that they were able to make choices about their daily living. Visitors spoken to at the time of the inspection said that they were always made welcome. They are offered a cup of tea and can stay for a meal with their relative if they wish. Both residents and relatives confirmed that there is an open door policy and people can visit at any reasonable time. Feedback from residents and relatives indicated that meals are good. There is a choice of meals each day and one resident said that she is always asked what she would like. She also said that if there is nothing on the menu she wants, then the home will make an alternative meal for her. The food looked appetising and well presented. Where people are on special diets or need their food prepared to a different consistency this was catered for. The home was also in the process of producing new pictorial menu cards for display. Staff were seen to assist those residents who require feeding in a caring and sensitive manner. Care Homes for Older People Page 17 of 30 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. Complaints and adult protection procedures within the home serve to safeguard residents. Evidence: There is a complaints procedure in place and this identifies action that will be taken by the home should they receive a complaint. We saw evidence that both written and verbal complaints are taken seriously and investigated. The Annual Quality Assurance Assessment (AQAA) stated that there had been 21 complaints received in the last 12 months and that 15 of these had been upheld. This shows that the home takes complaints seriously. We spoke to five relatives on the day of our visit about complaints. Four people said that they did not have any complaints and felt confident about approaching the manager if they did. One person, however, did not have confidence that the service had always took action when they made a complaint. This person said that they knew who to complain to but stated that I dont feel that complaining does any good. The manager was aware of the situation and was continuing to work towards addressing the concerns. Residents also confirmed that they knew who to speak to and were happy to say if they had any concerns. We sent out surveys and five were returned, these also expressed confidence in the service addressing any issues. One stated; Our concerns have always been addressed and not re-opened. Care Homes for Older People Page 18 of 30 Evidence: There have been six safeguarding vulnerable adult investigations in the last 12 months, four of which have been raised by the home - demonstrating that they take pro-active action in safeguarding the people living in the home. We spoke to a care manager at Medway Council who confirmed that they had worked closely with the home to address any issues and that any safeguarding investigations had been closed. The majority of staff have been trained in safeguarding vulnerable adults, as with other areas of training there are still some staff who need to undertake this and the registered provider is reminded of their responsibilities to ensure that this happens. There are policies and procedures in place for the safeguarding of vulnerable adults. We spoke to staff working in the home and they were able to demonstrate the course of action they would take in relation to safeguarding people living in the home. Care Homes for Older People Page 19 of 30 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 home provides a comfortable, homely and clean environment. The ongoing refurbishment will further benefit residents. Evidence: Grace Manor is a large care home set in its own gardens. There are two parts to the building, the original house and a newer extension at the rear. It is a Grade 2 listed building and as such parts of the building retain many of the original features. There are extensive gardens and a courtyard in the centre of the home that can be used by residents. The manager told us that there are plans to establish a sensory garden. On our visit we took a general tour of the building and visited some of the bedrooms and the communal areas. Bedrooms we looked at were all clean and tidy and showed evidence of people being able to bring in their personal possessions. There are a number of lounge and dining areas around the home and people are free to choose where they prefer to sit. The home is currently undergoing a refurbishment programme. At the time of our visit the entrance hall had been completed and a lounge area was in the process of being Care Homes for Older People Page 20 of 30 Evidence: redecorated. The Annual Quality Assurance Assessment (AQAA) stated that a number of bedrooms had been re-decorated and new furniture is being purchased. Areas of the home, which had been newly decorated, were light and airy. A new hairdressing room was currently being completed. The manager told us that it was being refurbished so it would give the effect of a proper hairdressing salon. There are also plans to set up a sensory room in the dementia unit. The home has a range of specialist equipment to use in order to support residents in a safe manner. This mobile includes hoists; pressure relieving and preventative equipment and specialist beds. There are sluices in place. There are sufficient bathrooms and toilets in the home and some of the rooms are ensuite. We saw that two of the separate toilets in the older part of the building only had a bolt on the inside with no over-ride lock. This meant that someone could be at risk of getting locked in. We told the manager about this and before the end of our visit the bolts had been removed. The manager told us that the day before our visit the Environmental Health officer had been to the home to look at the kitchen. The manager told us that this had been a positive visit and that they were given a good report. We looked briefly at the kitchen and saw that it was clean, well equipped and well organised. We spoke to a member of the kitchen staff who demonstrated a good awareness of the importance of maintaining cleanliness and safe working practices in the kitchen. The AQAA stated that the laundry and domestic services have been re-organised in the last 12 months. Cleaning schedules have been put into place and domestic staff confirmed that they had received training in Control of Substances Hazardous to Health (CoSHH). We sent out surveys to residents and one of the questions asks if the home is clean and fresh. We had five surveys returned and they all confirmed that it was. Care Homes for Older People Page 21 of 30 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 recruitment procedures safeguard the people living in home. Residents can be confident that they are cared for staff who have a good understanding of their needs and the improved training plans will further enhance this. Staffing levels need to be kept under review. Evidence: The home employs registered nurses, care staff and additional dedicated ancillary staff for administration, domestic tasks, laundry, cooking and maintenance so as to support the residents. Nursing and care staff are allocated onto individual units in order to maintain continuity of care. Each unit has a registered nurse who will lead the individual shift; they are supported by a team of carers. We spoke to relatives and people living in the home. Feedback from people indicated that they found the staff helpful and caring. All the relatives we spoke to did say, however, that they felt that there was not always enough staff on duty. One relative told us It is sometimes very difficult to find someone to speak to. Another relative said Staffing levels do not always seem very high and I feel there is less staff here now. We were also told by another visitor that Care Homes for Older People Page 22 of 30 Evidence: their relative had told them that they often had to wait for somebody to answer their call bell if they rang it during the night. Members of staff we spoke to also confirmed that there were times when they felt that there was not enough staff available. Five of the six surveys returned also referred to staff shortages. We looked at the rotas, which staff had worked in February and at the beginning of March. These showed that there was some inequality in the staffing levels on different days and nights. For example in one unit there were mornings when four members of staff were rostered as having been on duty and other days indicated that there were only three members of staff on duty. The night duty rotas also showed that there were times when there was less staff on duty. We spoke to the manager and area manager about the staffing levels, they told us that staffing levels had not changed but there had been an increase in occupancy. It is the registered providers responsibility to ensure that staffing levels meet the needs of the people living in the home. We are strongly recommending that the registered provider makes sure that staffing levels are kept under review in order to ensure that there are sufficient members of staff on duty at all times to meet the needs of the people living in the home and the increasing number of occupancy. All the relatives we spoke to and a care professional said that there had been a high number of agency staff working in the home. The Annual Quality Assurance Assessment (AQAA) also showed that agency staff had been used. We were told by the care professional that the home is aware of the high use of agency and are addressing this. The AQAA states that currently eight members of staff have achieved their National Vocational Qualification (NVQ) in care at level two or above. The training records in the home show that there are also nine members of staff who are currently studying for this qualification. The personal files of four members of staff were examined. As part of the homes vetting procedures references are sought and obtained. A POVAFirst and a Criminal Records Bureau (CRB) check are obtained. Records showed that all staff complete an application form and are interviewed by two people, with records maintained. The manager was able to clearly describe the recruitment procedures and demonstrated a full awareness of the importance of a robust procedure. The AQAA states that staff undergo an induction which meets with the Skills for Care induction standards. Staff we spoke to all confirmed that they underwent a period of induction. Care Homes for Older People Page 23 of 30 Evidence: We looked at training records for staff. These showed that there are gaps in areas of training. For example not all staff had benefited from up to date training in the mandatory areas of care. The manager was aware of the shortfalls and was able to show that training sessions have been arranged and booked so this could be addressed. Nurses employed in the home are supported in maintaining their professional skills in activities relating to the nursing care they provide. One unit in the home is dedicated for people who have a diagnosis of dementia and a number of staff have received training in this area. The home has also recently employed a new nurse for this unit who has a background in dementia care. The home has recognised the importance of new legislation such as the Mental Capacity Act (MCA) and the Deprivation of Liberty (DoL) Act. Staff have received training in relation to the MCA and the manager said that training is planned for the DoL. Care Homes for Older People Page 24 of 30 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. People benefit from living in a home that has a clear development plan and showed commitment to supporting people with their care and support needs. Evidence: Since our last visit in April 2007, there has been a change in management. There has been a period of instability within the home, but a new manager has been appointed by the registered provider to run the home. She is not yet registered with us (the commission) but she has made application. Both the manager and the area manager were present throughout the inspection. Grace Manor can provide a care service for up to 60 people, at the time of our visit there were 43 people in residence. The manager told us that the home has been allocated into three geographical areas. This is for the purpose of promoting the smooth running of the home, ensuring clear lines of accountability and continuity of care with regards to the staffing structure. Care Homes for Older People Page 25 of 30 Evidence: The manager is responsible for the overall management of the home and there is additional support with a clinical manager and registered nurses. The manager has been in post for four months and has taken steps to improve quality assurance processes. An in-depth audit of working practices has been conducted and new systems introduced in order to improve the smooth running of the home. She is given regular reports and any issues arising from these are addressed. It is important that the people living in the home have a say about the way it is run and how they are supported. A quality questionnaire has been introduced and people have been asked about their care. The questions are looking at how people are supported in making their own choices for example can they get up at their preferred time and can they choose their own clothes. The answers have been collated and the manager said that any negative responses would be investigated so that action can be taken. This demonstrates that the management of the home is taking pro-active action to make sure people have the opportunity to have their say. There are plans to introduce a residents forum and also to have more relatives meetings and this, again, will give people the opportunity to have their say about how they feel the home is managed. There is a supervision programme in place and all staff we spoke to confirmed that they received regular supervision. The clinical manager carries out supervision for the nurses. The manager said that she also receives good support from the area manager. Residents families are encouraged to handle the monies of residents who are unable to manage them themselves. The home only deals with small amounts of personal monies on behalf of people. The AAA confirmed that the administration officer monitors this and that records are maintained. The AQAA identified that all the relevant health and safety checks as required by legislation were in place. Specialist equipment such as hoists are serviced regularly and we saw evidence of this on the day. There are auditing procedures in place for health and safety, medication and care planning. It also states that there is an action plan in place for maintaining infection control procedures. A requirement made at the last visit relating to fire risk assessments in the Coach House had been met. There are fire procedures in place and doors are fitted with safety mechanisms. Care Homes for Older People Page 26 of 30 Evidence: A member of the senior management team visits on a monthly basis in accordance with regulation 26, which is a monitoring visit to make sure that the home is being run in the best interests of the people living there. From evidence we saw throughout our visit it was apparent that the manager is running the home in an open and transparent manner and is working hard to make improvements. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 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 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 7 When completing risk assessments the home must ensure that all factors are taken into consideration and outcomes for support fully recorded. That the home ensures there is a copy of the most up to date Royal Pharmaceutical Guidelines available and that they ensure that their auditing processes for medication are robust. The registered provider must ensure that staffing levels are kept under review in order to make sure that there are sufficient members of staff on duty at all times to meet the needs of the people living in the home. That the registered provider ensures that the staff training and development programme continues so that all staff have received up to date training. 2 9 3 27 4 30 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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