Care Home: Manor II

What the care home does well The registered manager and her staff have worked hard to meet the areas of improvement identified at the last key inspection and subsequent random inspection. One resident told us "I have been here for a long time and am well looked after". Staff receive a range of training to assist them meet the needs and wishes of residents and staff turnover is low, which helps to provide continuity of care. The home is comfortable, well decorated, well furnished and has a large pleasant garden that residents enjoy using. What has improved since the last inspection? At the last key inspection twelve requirements were made and we were pleased to see that eleven of these had been complied with. One requirement for a temporary manager to be registered as such by the Commission was no longer applicable as the permanent registered manager has returned from maternity leave. The eleven requirements that had been met were in the following areas: improved records of what was important to residents before they had dementia, to better assist staff in meeting their needs and wishes now; improved risk assessments to help keep residents safe; improved storage facilities for some prescribed medication to meet new regulations that came into force in 2008; the home is working hard to improve the social and leisure activities available for residents to enjoy; ensuring that the home`s complaints policy is properly implemented at all times to better protect residents; four identified improvements to the home`s environment to assist in maximising residents` safety, dignity and comfort; talking to the placing authority of one resident to make sure that the person`s financial interests were being maximised and ensuring that risks to staff were being minimised when using the some steep stairs to access staff facilities in the home`s basement. A good practice recommendation was also made for staff to undertake training regarding the Mental Capacity Act, which had just been implemented at that time. At the random inspection undertaken in January 2009 an additional requirement was made regarding the electrical wiring in the home in order to maximise safety to all that use the home. Written evidence was received from the provider organisation, and confirmed at this inspection, that the required work to meet health and safety regulations was started promptly and is nearly complete. What the care home could do better: At this inspection one requirement is made relating to the completion of the work to the home`s electrical wiring identified at the previous random inspection. This is for the home to provide documentary evidence to the Commission that the work to the home`s wiring is certified as being completed to the required standard by a person competent to do so when it is finished. Four good practice recommendations are also made in the following areas: for key workers to maintain better written records of the work they undertake in this role to help share this information with other staff; for a broken dishwasher to be repaired or replaced to make better use of staff time; for staff to receive further training in newlegislation regarding the deprivation of liberty of vulnerable people, which comes into force in April 2009 and for more structured support for the registered manager from the responsible individual, who is her line manager. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Manor II 205-207 Hainault Road Leytonstone London E11 1EU     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: Peter Illes     Date: 1 6 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 32 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 32 Information about the care home Name of care home: Address: Manor II 205-207 Hainault Road Leytonstone London E11 1EU 02085390079 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) : manager.manor2@aermid.com Aermid Health Care Properties Ltd care home 17 Number of places (if applicable): Under 65 Over 65 17 dementia Additional conditions: 0 The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia - Code DE(E) The maximum number of service users who can be accommodated is: 17 Date of last inspection Brief description of the care home Manor II is a care home registered to provide care, support and accommodation for up to 17 older people with dementia type illnesses. The home is owned and operated by Aermid Health Care Properties Limited. Accommodation provided is in single rooms, and all have en suite facilities except two, which are an adjacent to bathrooms/ toilets. There is a main lounge/ dining room, a smaller lounge and conservatory on the ground floor, and a stair lift to the first floor that contains further bedrooms, shower and toilet facilities. The home has a large pleasant rear garden. The home is situated in Leytonstone with good transport facilities to local shops and amenities. A stated aim of the home is to provide a caring and homely atmosphere, which respects the individuality, dignity and right to privacy of each resident. On the day of the inspection the range of fees for the home was GBP550.00 per week. A copy of the Statement of Care Homes for Older People Page 4 of 32 0 8 0 1 2 0 0 9 Brief description of the care home Purpose, Service User Guide and last inspection report were displayed in the home and copies can also be obtained on request. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service took place on 1st May 2008. A subsequent random inspection took place on 8th January 2009 following an anonymous complaint received by the Commission. The outcomes for residents from both of these inspections are included in this report. This key inspection took approximately six hours and was undertaken by the lead inspector. However, terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The registered manager was available to assist throughout the inspection and eight residents were living in the home on the day. Two residents were in hospital, there were six vacancies and the provider organisation has currently Care Homes for Older People Page 6 of 32 decided to use one of the homes bedrooms as an office. The inspection activity included: meeting and speaking to all of the residents present although conversation was limited due to their communication needs; detailed discussion with the registered manager; independent discussion with three care staff; independent discussion by telephone with a social worker from L.B. of Waltham Forest and a reviewing officer from L.B. of Redbridge. Further information was obtained from a tour of the building, documentation kept in the home and from survey forms sent to us by residents (assisted by their relatives), staff and healthcare professionals. The home sends us an Annual Quality Assurance Assessment (AQAA) annually but we had not asked for one prior to this inspection. What the care home does well: What has improved since the last inspection? What they could do better: At this inspection one requirement is made relating to the completion of the work to the homes electrical wiring identified at the previous random inspection. This is for the home to provide documentary evidence to the Commission that the work to the homes wiring is certified as being completed to the required standard by a person competent to do so when it is finished. Four good practice recommendations are also made in the following areas: for key workers to maintain better written records of the work they undertake in this role to help share this information with other staff; for a broken dishwasher to be repaired or replaced to make better use of staff time; for staff to receive further training in new Care Homes for Older People Page 8 of 32 legislation regarding the deprivation of liberty of vulnerable people, which comes into force in April 2009 and for more structured support for the registered manager from the responsible individual, who is her line manager. 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of up to date information about the home to let people know what it can and cannot provide. Peoples needs are properly assessed when they are first admitted to the home to make sure their needs can be met. Once admitted their needs are regularly reviewed to ensure staff are aware of any changing needs and wishes. Evidence: The home has an up to date Statement of Purpose and Service User Guide. Copies of these were seen in the entrance hall of the home for the information of anyone living or working there and for visitors. In addition a copy of the homes last key inspection report; complaints procedure and the L.B. of Waltham Forests safeguarding adults document (information to help keep residents safe from abuse) were also available in the entrance hall. Care Homes for Older People Page 11 of 32 Evidence: No new residents had been admitted to the home since the last key inspection. The files of five of the current residents were inspected. These contained evidence of assessment information the home had received at the time of the persons admission. The files also showed evidence that the persons needs were being reviewed on a regular basis, including annual reviews by the placing authority where appropriate. We spoke independently by phone to a L.B. of Waltham Forest social worker who had recently undertaken a review of a resident at the home. He stated that he had no concerns at all about the resident or the home following that review. We also spoke independently by phone to a L.B. of Redbridge social worker who had also recently undertaken a review of a resident at the home. He stated that he was happy with the personal care and the activities provided at the home. At the last key inspection a requirement was made that the home must find out and record as much information as it could about what had been important to the person before the onset of their dementia. This was to assist staff in judging how to best meet the persons wishes and preferences, especially where the person was not now able to tell staff what these were. Evidence was seen that staff were working hard to comply with this requirement. Each persons file inspected contained information including about the persons likes, dislikes, interests and cultural needs. One persons file stated that they liked playing dominos, cards, gardening and chatting. Each person is allocated a key worker. One key worker was spoken to independently and they were familiar with their residents likes and dislikes and was able to describe how they worked with the person in a sensitive way. An example of this was how they were trying to keep the person interested in the homes garden. Although the key worker was able to describe the work they do and stated that they were involved in reviewing their persons care plan, there was no separate record of the individual key working that they undertook with that resident. A good practice recommendation is made that a monthly report of the work undertaken by the key worker for each resident is written. This can then contribute to the monthly review of the care plan and be available to assist the worker develop their skills further through the homes staff supervision process. The home does not provide intermediate care. Care Homes for Older People Page 12 of 32 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. People benefit from their needs and preferences being properly recorded and by staff being aware of how to address these. The home is working hard to meet the healthcare needs of residents. Satisfactory medication policies and procedures are in place to safeguard people living in the home. People are also treated with respect and dignity by staff, which they appreciate. Evidence: The care plans for five residents were inspected. These were of good quality and were up to date. The home has introduced a new format for peoples care plans since the last key inspection. The care plans have a range of different sections relating to that persons needs and preferences including physical, emotional and social needs and preferences. Although all the current residents are white European in origin the care plans seen had a section on peoples needs and preferences relating to their religion, culture and sexuality. The latter included whether the person had a preference with regard to the gender of the care staff that provide them with personal care. The plans were reviewed at least monthly and individual plans were also seen to have been Care Homes for Older People Page 13 of 32 Evidence: updated when the persons needs had changed. An example of this was that a persons care plan had been updated following an assessment by a dietician. At the last key inspection a requirement was made that care plans were informed by robust risk assessments and clear guidance for staff on how to minimise any identified risk. This requirement was being complied with and risk assessments seen at this inspection were up to date and identified a range of risks, including in relation to moving and handling. One resident had unfortunately returned from a hospital admission with the infection MRSA. This was clearly noted in their care plan and risk assessment with a range of guidance for staff including reinforcing the homes procedures on hand washing. We were pleased to see that the person no longer had the MRSA. Evidence was seen that the risk assessments were also being reviewed monthly. Evidence was seen that residents are registered with a G.P.and were supported to have their health needs met by appointments with a range of relevant health care professionals. These included appointments with their G.P., district nurse, optician, chiropodist, dentist and hospital out patient appointments. Two people had small pressure ulcers at the time of this inspection and evidence was seen that these were being properly treated by the district nurses. It was noted that those people that needed it had pressure relieving equipment, such as a specialist mattress. A district nurse that visited during the inspection was briefly spoken to independently. She stated that the staff attitude was OK although felt it would be helpful if the staff let the district nursing service know earlier, on occasion, if they felt that a persons skin was becoming vulnerable. This was fed back to the registered manager. The home sends out quality assurance questionnaires to healthcare professionals. A recently returned questionnaire from the G.P practice that most residents are registered with was seen. This indicated that the communication between the home and the practice had improved over the past year. However, one GP indicated in a questionnaire returned to us that some improvement was still needed although a second GP told us that no significant issues had been raised in the past 6 to 12 months. The home has a satisfactory medication policy and procedure and a copy was seen in the medication trolley. Medication and medication administration records (MAR) charts of two residents were sampled and indicated that residents are appropriately supported in the administration of medication. At the last inspection a requirement was made that controlled drugs, (CD), must be kept in a CD cupboard that met the updated regulations that had come into force at that time. This requirement had been complied with and a new CD cupboard was in place. One person was being prescribed controlled drugs at this inspection and these were being appropriately stored and recorded by two staff in a controlled drugs register. Care Homes for Older People Page 14 of 32 Evidence: All the residents seen were appropriately dressed, including with good quality slippers or other appropriate footwear of their choice. The home had a number of vacancies and staff were observed spending time chatting and interacting with residents on an individual basis, which the residents appeared to enjoy. Staff were also observed helping residents eat their lunch in an appropriately friendly and personal way. Care Homes for Older People Page 15 of 32 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. Work is in progress to provide people with an increasing choice of individual activities that they enjoy. Relatives and other visitors are made welcome at the home, which they and residents appreciate. People are supported to take as much control of their lives as they are able to maximise their independence. They are also provided with a range of healthy and nutritious meals that they enjoy. Evidence: At the last key inspection a requirement was made that the home must provide a range of personalised social and leisure activities for all residents and that a record of these are kept. This was to meet peoples individual needs and preferences in a meaningful way. At this inspection evidence was seen that staff are working hard to comply with this requirement. A list of activities was seen displayed including singing, a range of games and 1 to 1 sessions. Peoples files more fully described their interests and previous hobbies. The registered manager informed us that the provider organisation had advertised for an activities coordinator to work at this home and another nearby home that is also run by the provider organisation. However, we were told that no suitable applicants resulted from this process and that the post would be re-advertised. Care Homes for Older People Page 16 of 32 Evidence: During this inspection it was noted that staff spent significant amounts of time interacting with individual residents and in small groups, including using a reminiscence book and playing an indoor hoop game. It was also noted on files that the recording of activities that residents took part in on a daily basis were being recorded more effectively to evidence that more meaningful activities were taking place. One resident told us that they were happy in the home, enjoyed being in the garden and that the staff were wonderful; the relative of another resident told us that their person liked the sing-a-long sessions and staff spent individual time with them. A social worker from L.B. of Redbridge told us that his client enjoyed the activities including the chair exercises the singing and the outside entertainers that sometimes visited. During this inspection there were only eight residents present and the registered manager is aware that the home must have the resources, including staff time, to provide sufficient activities for all residents when the home is fully occupied. All the current residents are white European in origin although information, including on peoples cultural and religious needs, are obtained as part of the homes assessment process and are recorded on their files. The home has improved on this process over the past year, including new sections on peoples files including Getting to know you that includes spiritual and cultural needs and Choices, that include peoples preferences regarding food, and other likes and dislikes. The majority of residents have some contact with relatives and friends. One relative who visited during this inspection told us I am made very welcome whenever I visit, which is generally every other day, staff answer any queries I have and I think the care is good. The visitors book evidenced that relatives and friends visit the home frequently. Each residents file inspected had a section Communication with Families, which included a record of which events a relative wanted to be informed of. These included Doctors visits, falls and admission to hospital. Incident forms inspected indicated that these wishes were respected. The registered manager informed us that the home was not the appointee for any of the residents finances although did look after the personal allowances for residents. Evidence to support this can be found in the Management and Administration section of this report. The home employs a full time cook who unfortunately was on sick leave during this inspection and whose duties were being covered by other staff. The home has a five week menu that showed a range of nutritious meals with a choice for all main meals. Residents are asked each day which choice they would like with the assistance of a pictorial menu and an up to date record of this was seen. The lunch on the day of this Care Homes for Older People Page 17 of 32 Evidence: inspection was soup, shepherds pie or omelet and bread pudding. This was pleasantly presented and staff took time to assist those residents that needed one to one assistance with their meal. Feedback from the residents and relative spoken to was that people enjoyed the food at the home. We were told that the home can meet a range of needs and preferences regarding diet. One current resident is a vegetarian, three have diabetes and two require food supplements. We were informed that the home can also provide appropriate meals for people from different ethnic communities. It was noted that the homes dishwasher had been broken for some time and, although this had been reported, it had not been repaired or replaced. A good practice recommendation is made regarding this. Food was properly stored and a range of satisfactory health and safety records relating to the kitchen were seen. Care Homes for Older People Page 18 of 32 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 home has satisfactory procedures in place to deal with any complaints or concerns that may be raised. People are also protected by the homes safeguarding procedures and whistle blowing policy, which staff are aware of. Evidence: At the last key inspection a requirement was made that the homes complaints policy must be followed at all times and that the home ensures that an identified complaint at that time was properly dealt with. Records seen showed that this requirement had been complied with and the complaint in question resolved. In January 2009 the Commission received an anonymous complaint that the home was not properly heated and that their were not always enough staff on duty to meet the residents needs. A random inspection was undertaken to investigate this and no evidence was found to substantiate the complaint; more detail can be found in the Environment and Staffing sections of this report. No other complaints have been received by the Commission since the last inspection. At this inspection the home had a satisfactory complaints procedure, a copy of which was seen displayed in the entrance hall. The complaints book was inspected and the registered manager confirmed that no new complaints had been recorded by the home since the last inspection. Care Homes for Older People Page 19 of 32 Evidence: The home had an up to date copy of the L.B. of Waltham Forests safeguarding adults policy and procedure, a copy of this was also displayed in the entrance hall of the home. Records seen and staff spoken to evidenced that staff receive regular training in keeping people safe from abuse, the next refresher training for staff on this subject was planned for April 2009. Staff spoken to were able to satisfactorily describe the actions they would consider if an allegation or disclosure of abuse be made to them. No safeguarding allegations had been recorded at the home or made to the Commission since the last inspection. The home has a satisfactory whistle-blowing policy and the minutes of a recent staff meeting recorded that this was discussed to remind staff of the importance of this. Care Homes for Older People Page 20 of 32 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 home that is well decorated, well furnished and which meets their needs. The home was clean and tidy throughout, creating a pleasant environment for people accommodated, staff and visitors. Evidence: Accommodation provided is in single rooms, and all have en suite facilities except two, which are an adjacent to bathrooms/ toilets. There are four bedrooms, a main lounge/ dining room, a smaller lounge and a conservatory on the ground floor, and a stair lift to the first floor that contains twelve bedrooms, shower and toilet facilities. The home has a large pleasant rear garden, including a pond. At the last inspection requirements were made to: review where wheelchairs and the hoist are stored to minimise any possible health and safety hazards; to ensure that the garden is made more secure to better protect people with dementia who may try to leave the grounds; to ensure that the first floor shower was working properly to maximise the comfort and well being of residents and to ensure that people have access to a key to their bedroom and a lockable space in their bedroom unless the reason for not doing so is explained in their care plan. We were pleased to see that all of these requirements had been complied with. Care Homes for Older People Page 21 of 32 Evidence: During a tour of the building it was noted that the storage of wheelchairs and the hoist had been improved, which meant that corridors and the stair well were uncluttered; that a new fence had been erected to one boundary of the garden and another new fence placed round the garden pond and the first floor shower was working properly. It was also noted that keys to bedrooms and a lockable storage area in those rooms were available and, where these were not being used, the reason for this was recorded in the persons care plan. Feedback from a L.B. of Redbridge social worker, who had recently reviewed a resident at the home, included that the environment was good and met his clients needs. The building is well decorated, well furnished and judged to meet the needs of the current residents. In January 2009 an anonymous complaint was made to the Commission that included that the building was not being properly heated. As the weather was very cold at that time a random inspection was undertaken to investigate this. During that visit residents were seen to be warm and comfortable and the heating was working properly. A relative who was visiting the home at that time was spoken to independently. They told us that they visited the home most days and that the home was kept warm and comfortable despite the cold weather at that time. No evidence was found to substantiate the complaint. The home had suitable laundry facilities to meet the current residents needs with clear infection control policies and procedures in place. Records seen and staff spoken to evidenced that staff receive regular training in infection control. On the day of the inspection the home was found to be clean, tidy and free of unpleasant smells. Care Homes for Older People Page 22 of 32 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 current residents are supported to meet their needs by enough staff who have a range of skills, qualifications and competencies. The homes recruitment policies and procedures assist in protecting residents. Evidence: An up to date staff rota was seen that accurately reflected the staff on duty during this inspection. The rota showed two care staff on duty on the morning shifts, three care staff on duty on the afternoon shifts and two waking staff on duty at night, with the registered manager being in addition to this. We were told that the number of carers on the morning shifts could be increased to three although with only ten residents at present two care staff were judged by the registered persons to be sufficient to meet their needs. In addition the home employs a cook six days a week although the cook was on long term sick leave at this time; a domestic for six days a week and the home has the use of a handy person one day a week. This staffing level was judged by us to be sufficient to meet the needs of the current residents although the registered manager was reminded that this will need to be kept under review when more residents are admitted to the home. We were also informed that the registered manager from a nearby home run by the provider organisation is also available for support, especially when the registered manager is away on leave. Care Homes for Older People Page 23 of 32 Evidence: In January 2009 a random inspection was undertaken following an anonymous complaint that included that at times the home was not being properly staffed. The staff rota was checked and staffing levels were as above and judged to be satisfactory to meet the needs of the residents living at the home at that time. the complaint was not substantiated. In addition to the registered manager the home employs 1 head of care, 3 senior care staff and 11 care assistants. Of these care staff 1 is working towards the national vocational qualification (NVQ) level 4 in care; 1 has achieved NVQ level 3 in care; 11 have achieved NVQ level 2 in care, with four of these due to start working towards NVQ level 3 in care shortly, and 2 care staff are working towards NVQ level 2 in care. This meets the national minimum standard that at least 50 of care staff have achieved NVQ level 2 in care.Staff spoken to were enthusiastic about this qualification training and confirmed that they received good support for this from the home. We were told that no new permanent staff had been recruited since the last key inspection and at that time records seen indicated that the home was implementing a robust and safe recruitment procedure. The home had employed a temporary cook recently although this person had left soon after being recruited. The recruitment file for that person was inspected and showed that the process was satisfactory. The file contained all the relevant documentation including a protection of vulnerable adults (POVA First) clearance had been received before the person started along with proof of identity and two verified references. The registered manager keeps a staff training matrix to monitor and ensure that staff receive appropriate training and refresher training. The matrix showed evidence that staff had received a range of training including: fire safety; safeguarding adults; moving and handling; first aid; food hygiene; safe administration of medication; Mental Capacity Act and care of people with dementia. In addition individual training records are kept in staff files. The provider organisation had also provided a list of refresher training for the coming months, which was seen displayed in the home. Staff spoken to confirmed that they were kept up to date with refresher training and that they found this useful. At the last key inspection a good practice recommendation was made regarding staff training on the Mental Capacity Act and this had been acted upon. At this inspection a good practice recommendation is made that staff receive training in the Deprivation of Liberty Safeguards, an additional section of the Mental Capacity Act, which becomes effective in April 2009. Care Homes for Older People Page 24 of 32 Care Homes for Older People Page 25 of 32 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 well managed home. People living in the home, and relevant others, are consulted regarding the quality of the service provided. Peoples financial interests are safeguarded while living in the home. Staff benefit from regular supervision to assist them meet the needs of people living in the home and in their own development. The home promotes the health and safety of people that live, work and visit the home although further action is still required to evidence that the electrical wiring in the home does not pose a potential health and safety hazard. Evidence: At the last key inspection the registered manager was on maternity leave and a another manager from the provider organisation was providing full time cover at the home. A requirement was made at that inspection that the provider organisation registers the temporary manager with the Commission to confirm their skills and competencies. This requirement is no longer applicable as the registered manager has returned to work. The registered manager presented as being competent, experienced Care Homes for Older People Page 26 of 32 Evidence: and as having the skills to manage the home. Those staff spoken to stated that they felt well supported by her. The home has a number of ways that it monitors the quality of care provided. Residents views are sought, including through the key worker process although a good practice recommendation is made in this report to evidence this more robustly. Questionnaires are sent out to a range of stakeholders on a regular basis including relatives, staff and health and social care professionals. Questionnaires returned at the end of 2008 were sampled and showed a generally high level of satisfaction with the service provided. The registered manager stated that the questionnaires were analysed when returned and any issues raised addressed at the time. The home also holds relatives meetings approximately twice a year and minutes of the last meeting held in September 2008 were seen. Six relatives attended and the minutes suggested that they were satisfied with the service their person received. In addition, the responsible individual undertakes monthly unannounced visits to the home and records of these were sampled. At the last inspection a requirement was made that the home liaises with the placing authority of one resident, for whom the home was holding a large amount of cash in their personal allowance. This was to ensure that the persons financial best interests were being maximised. Evidence was seen that this requirement had been complied with. We were informed that the home did not act as appointee for any of the residents and only held personal allowances for them. Records of these were sampled and were clear and up to date. Money for individuals is held securely in separate envelopes, money held for one resident was checked against the record for that person and was found to be properly accounted for. The home holds regular staff meetings and the minutes of these were sampled. It was noted that at a recent meeting, attended by the responsible individual, staff were reminded of the importance of the homes whistle-blowing policy. All staff have formal supervision at least every two months and records sampled evidenced this. Staff spoken to stated that they found supervision helpful and that they could put their items on the agenda for the session. Staff also confirmed that they received a written record of the supervision session. When questioned, the registered manager said that she had regular contact with her line manager who is the responsible individual, including by him visiting the home, and felt that she felt supported by him. However, it was not clear to us that she received formal one to one sessions that were specifically about her support and development and a good practice recommendation is made regarding this. A random inspection was undertaken in January 2009 to investigate an anonymous Care Homes for Older People Page 27 of 32 Evidence: complaint and this is referred to in the Environment and Staffing sections of this report. Although there was no evidence to substantiate the complaint it was noted during that visit that the homes electrical installation certificate had expired and a requirement was made to address this at that time. As a result of this requirement it transpired that the home needed significant work undertaking to the wiring in the home. The provider organisation has taken prompt action to address this and has kept the Commission informed of progress. At this inspection the work was in the process of being completed. A new requirement is made that the registered persons forward a copy of the new electrical installation certificate to the Commission to evidence that the work has been satisfactorily completed and that the electrical installation at the home meets the required standard. A range of other satisfactory health and safety documentation was inspected and included: a gas safety certificate; a portable appliance certificate; evidence that the homes water supply had been checked to minimise the danger of legionella; evidence that the homes fire fighting equipment is regularly serviced; a fire risk assessment; a fire plan and records of a range of weekly health and safety checks undertaken by the home. At the last key inspection a requirement was made that a risk assessment was undertaken regarding staff using the steep staircase to the basement to minimise potential risks to staff when doing so. This requirement was seen to have been complied with. Care Homes for Older People Page 28 of 32 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 29 of 32 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 38 13 The registered persons must 16/04/2009 send a copy of a satisfactory electrical installation certificate to the Commission to evidence that the work currently being undertaken has been satisfactorily completed. This requirement is made to maximise the safety to everyone that uses the building. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The home should ask each key worker to write a monthly report on the work they have undertaken with their allocated resident(s). This report can then contribute to the monthly review of that residents care plan and be available to assist the worker develop their skills further through the homes staff supervision process. The home should repair or replace the broken dishwasher to allow more staff time to undertake other duties. Page 30 of 32 2 15 Care Homes for Older People 3 36 The provider organisation should provide regular, individual, structured and recorded supervision for the registered manager to assist support her and to further promote her own development. Care Homes for Older People Page 31 of 32 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). 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