Care Home: Nethercrest Residential Care Home

Similar services:

• Maple Lodge
• Heathlands
• Aston Court Nursing Home
• Breme
• Ravenhurst
• Bank House
• Inspirations
• Ashcroft Hollow Nursing Home

What the care home does well We found that the home provides a range of information for visitors and prospective residents that is easily accessible and the home does have a robust assessment in use to ensure it can decide as to whether it can meet peoples needs prior to admission. The staff we had direct contact with we saw to be helpful, friendly and respectful and many residents and relatives told us that they are very pleased with the staff at the home. We saw that the home is good at initiating contact with community services. We also found and were told that the standard of the food available was good and people enjoyed their meals. There are parts of the home that lend themselves well to encouraging independence and privacy (these the flats on the first floor), this the view of those living in these. We also saw that the home is kept clean and found the majority of the home to be odour free and fresh. We found the manager to be very responsive to any matters raised and keen to improve the service. What has improved since the last inspection? There are a number of areas where the home has improved since the last inspection, the most obvious been the redecoration of a number of areas of the home; this improving the general ambiance. The home now has a recently registered manager who has shown during the course of the inspection process her willingness to take on board issues raised and address them. We have noted that there has been a quick response to our concerns such as to underarm lifting (although this we only saw one instance of this) and some issues that we identified on our second visit in respect of medication management, these nearly all resolved at the point the pharmacy inspector visited the home. Whilst we have heard from some people that they are concerned as to staffing levels and response times, we saw evidence that the home is responding to these issues and is currently reviewing staff deployment and instigating some changes. The overall quality rating for the home reflects the willingness of the manager to action improvement as well as the very positive comments we have received from the majority of the people we spoke to. What the care home could do better: Whilst we have seen on going improvements there are still a number of areas where the home could be better. We have received positive comments from the majority of the people we spoke to as to the staff team, although there are still some issues with a small minority (based on comments received, and our observation of staff) where staff need to be more aware of their responses to residents and the way their actions are perceived. The manager has expressed a commitment to stamping out any poor practice and her response to the inspection team, and her management practice do confirm this. Other areas for improvement include the need to consider the space available within some areas of the home (namely the dining and main lounge area), better documentation in respect of residents property and money in safekeeping, ensuring all care plans are up to date and reflect changes in peoples needs, and ensuring potential limitations on individuals are better documented. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nethercrest Residential Care Home Brewster Street Netherton Dudley West Midlands DY2 0PH     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: Jonathan Potts     Date: 1 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 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 34 Information about the care home Name of care home: Address: Nethercrest Residential Care Home Brewster Street Netherton Dudley West Midlands DY2 0PH 01384234463 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mimosa Healthcare Group Limited care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users that may be accommodated is: 43 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 categories: Old age, not falling within any other category (OP) 43 Date of last inspection Brief description of the care home Nethercrest Care Home is privately owned by Mimosa Healthcare Group Ltd. The home provides residential care and accommodation, on a shared site with its sister home Nethercrest Nursing Home. First registered in June 1991 the home provides personal care for up to 43 residents in single rooms on the ground floor and flat-lets on the first floor. The flat-lets offer bedroom, lounge area, including snack making facilities and bathroom/toilet en-suite. The home, situated close to the centre of Netherton and having easy access to Dudley and Merry Hill shopping centre, is well sited for access to public transport. The exterior of the building facing the road was built to simulate the residential homes in the area, with cosmetic doors fitted to enhance this impression. Care Homes for Older People Page 4 of 34 Over 65 43 0 Brief description of the care home The main entrance to the home is off the shared car park. The home provides accommodation for mainly older people, some with a physical disability. Aids and adaptations have been provided to assist and maximise service users independence. The homes manager and deputy supervise a number of senior care and care assitants as well as in house support staff that carry out the catering, cleaning and laundry. The manager is also supported by an on site administrator. There is a handyperson shared with the adjacent Nursing Home. The homes fees range between £353 to £480 per week, this as seen to be stated in the homes welcome pack we saw in bedrooms. Care Homes for Older People Page 5 of 34 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: We carried out the inspection of the home over a period of approximately one month with three visits carried out during this period. The inspection team included an expert by experience (who spent time talking to people at the home to discuss their views and personal experiences of the service) and a pharmacy inspector (who assessed the homes management of medication) as well as the homes link inspector. We used evidence from information about the home we have received since the last key inspection, comments cards returned to us and completed by residents, relatives, friends and staff as well as tracking the care provided to a number of residents, this involving observation of the care provided, discussion with residents, relatives and examination of care and management records. We also toured the building on a number of occasions. Care Homes for Older People Page 6 of 34 Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Whilst we have seen on going improvements there are still a number of areas where the home could be better. We have received positive comments from the majority of the people we spoke to as to the staff team, although there are still some issues with a small minority (based on comments received, and our observation of staff) where staff need to be more aware of their responses to residents and the way their actions are perceived. The manager has expressed a commitment to stamping out any poor practice and her response to the inspection team, and her management practice do confirm this. Other areas for improvement include the need to consider the space available within some areas of the home (namely the dining and main lounge area), better documentation in respect of residents property and money in safekeeping, ensuring all care plans are up to date and reflect changes in peoples needs, and ensuring potential limitations on individuals are better documented. Care Homes for Older People Page 8 of 34 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 34 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 34 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 has a good range of information available to individuals who are considering using the service and this allows them to make an informed decision as to whether Nethercrest is the right home for them. The home has a robust assessment process in place to identify the needs of individuals and as to whether the service is able to meet their needs. Evidence: We saw that the home has a range of information available to prospective residents in the form of a welcome guide that sets out clear information about the service containing such as what aims and objectives it sets out to achieve, the accommodation available, qualifications and experience of staff and how to make a complaint. This welcome guide is readily available and we saw that there were copies in the bedrooms we entered. There are also copies of our reports available in the reception area of the home as well as other useful information about the service and such as where to get Care Homes for Older People Page 11 of 34 Evidence: assistance with care costs and how to access advocacy. We received conflicting comments from residents as to whether they had received a contract only 2 out of the 6 that responding to questionnaires saying that they had. We did however see copies of contracts in all the residents documentation that we examined, this indicating that they were possibly not aware of the contract they had with the home. Out of 6 residents that responded to our questionnaires all of them told us that they had received sufficient information prior to admission to decide as to whether the home was suitable to them. When we looked at recent admissions to the home we saw that they have a trial period followed by a formal review so they are able to discuss their satisfaction with the home, and as to whether their needs are met. We discussed the homes admissions processes with the manager and she described how this involved her visiting prospective residents in their current environment to carry out an assessment of need. The assessments we saw were present in all the case files we examined and we saw that they covered a wide range of potential needs, as expected by National Minimum Standards (NMS). We saw that these are supported by the home obtaining copies of the social workers assessment (where residents are not self funding) with sufficient information available for the home to make a decision as to whether they can met the individuals needs and devise an initial care plan. Relatives and significant others maybe involved in an individuals assessment. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that individuals receive are generally based on their assessed individual needs as reflected in care plans, although updating of these plans could be more robust. The majority of staff show respect for individuals dignity and privacy, with management promoting the consistency of care. Medication management is to a good standard. Evidence: When examining four residents case files we saw that they all contained care plans that detailed individuals needs in respect of health and personal care as well as some personal and social preferences. From discussion with residents, staff, management and observation of what was happening in the home during the time of our visits we found that these plans are generally accurate and reflect the personal requirements of the individuals they relate to, although there was not always signatures on the plans to reflect this agreement. We saw one documented agreement that a relative would be made aware of changes, although there was no evidence to show this had been actioned. We did, to a lesser extent find some evidence of inaccuracies that clearly Care Homes for Older People Page 13 of 34 Evidence: related to a lack of updates, as verbal explanation by staff or individuals clarified that current needs did not always reflect what was recorded. Whilst we saw that the manager carries out regular audits of care plans we did note that some errors are highlighted more than once and were still present at the time we looked at them, underlining that any follow up on this auditing exercise does need to be more robust. Risk assessments in respect of health care and general well being we saw had been well documented although their are some instances where the regular weighing of residents in response to nutritional risk is not as regular as should be the case, and as informed by said risk assessments. The majority of residents we spoke to told us that they receive good care, this also reflected by the views of their relatives with comments such as The care is very good, Im very happy and they do look after me. Further to this we received comment from relatives stating that all the staff I have come into contact with are all kind to the residents and nothing is too much trouble and The overall care and each individual is treated as such. We also saw positive practices and interactions between the staff and residents with some carers talking residents through what they were doing when transferring them and also spending additional time to ask individuals what their choices were. It was clear that certain staff are positively noted by residents for how well they interact with them but there were limited instances where we saw some questionable practices, including one with a staff member talking over a resident, one where they referred to them in the third person in their presence, and one occasion of underarm lifting. There was some limited comment from respondents to questionnaires pre dating our visits to the home that underlined that the practices of some staff should be better. These issues were raised with the manager who in turn has raised these issues with staff and made it clear to us that such practices would be challenged if seen.The manager was clearly aware that such practices undermine the good, and positive work the majority of staff aim to achieve, and it is to be noted that whilst we saw these examples of poor practice on the first visit to the home, we saw no repetition on the two later visits which gives credence to the actions of the manager to eradicate such practices. The lack of such a response would clearly have had the potential to impact on the quality of the service. Based on the records we saw the home is pro active in encouraging access to community health services although when we saw clear evidence of referral there has been a delay in response from outside professionals, presumably due to the limited availability of some resources. Out of six residents that responded to questionnaires five said they receive the medical support they need, only one saying they did not. We heard from residents that in many instances their privacy is respected and they are able to go to their rooms when they wish, staff knock doors prior to entry, and we saw Care Homes for Older People Page 14 of 34 Evidence: interactions with residents by staff that were clearly mindful of their dignity (when assisting with toileting for example). We were told by some individuals that they have been offered bedroom door keys as well. The pharmacist inspection took place on 10th November 2008. Four residents medication was looked at together with their medication charts and care plans. One senior care assistant was spoken with and one resident. A medication round was observed and all feedback was given to the manager at the end of the inspection. The medicine management was good. Staff had worked hard to improve the handling of medication. Audits indicated that the majority of medicines had been administered as prescribed and staff had accurately recorded what they had done. The medicine charts were looked at before the preparation of the medication and the residents were treated with respect whilst being offered their medication. The medicine chart was then signed to record the transaction. Medicines prescribed on a when required basis had supporting protocols detailing their use for staff to follow to ensure they are administered as the doctor intended them to be and not routinely. Care staff check the medicines and charts received into the home but fail to use the scanned copy of the original prescription. All checks should involve this to ensure that there are no dispensing errors and if there are these are recognized before administration. The care assistant spoken with had a limited knowledge of what the medication she administered was for. She would not be able to fully support the residents clinical needs without such knowledge. This had been recognized by the manager and further training had already been arranged. Concern was raised that one resident had been prescribed anti psychotics used to control aggressive behavior but no doctors visits had been recorded, so it was unclear why two anti psychotics had been prescribed together with a third sedating medication. Residents are encouraged to self administer their own medication and risk assessments are undertaken before they are allowed to take control of them. No compliance checks had been done or documented to confirm that the resident does safely take their own medicines as prescribed. This was to be addressed after the inspection. Care Homes for Older People Page 15 of 34 Evidence: Care plans did not always support the clinical needs of the residents. For example, one resident required a blood test to check a drug level every three months as directed by a consultants letter, but no care plan had been written to ensure this occurred or blood tests requested from the doctors. Whilst it is the responsibility of the doctor to ensure this happens care staff must also ensure that the consultants wishes are adhered to. All controlled drug balances were correct and storage complied with current regulations. One resident spoken with said that she loved living in the home and the staff were very good Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are usually able to make choices about their lifestyle although this maybe limited by their mental capacity. Social opportunities and activities in many cases meet individuals expectations although may need targeting for more dependent residents. The home provides residents with a good choice of diet that they enjoy. Evidence: We saw evidence in individual records of consultation with residents as to their preferences with the home building on this through use of group meetings where people are asked as to their views on the service, what they like, what they want and what could be improved. We heard residents views, the majority expressing satisfaction with their lifestyle at the home with comments such as its the nicest place I have ever been in , I love it here and excellent home for me. Some of the comments from relatives supported this view although there was reference to a need for improvement in regard to activities and stimulation. Out of the six residents that responded to questionnaires only one said activities are always available, two saying there was never any. There was also comment from a relative that there should be more input into the residents instead of just sitting there looking at each other. The homes own quality monitoring does not however reflect this view and discussion with Care Homes for Older People Page 17 of 34 Evidence: some individuals in the home confirms that they are happy in respect of what is available to them, with reference to trips out, and been able to do what they wished, when they wished. Meetings with residents clearly shows that there has been discussion with them as to their preferred activity which includes bingo, trips, draughts, going to the pub, entertainment, dominoes,arts and crafts. Whilst we saw that some individuals were involved in individual pursuits on the days of our visits, it was difficult to assess the input for more dependent residents as there was limited daily recording of individual or group activity, and at the time there was no displayed activity schedule to confirm what the home planned with the exception of notices advertising events involving visiting entertainers. This recording needs to be improved so as to allow better auditing of the levels of stimulation for all residents, especially those that are more dependent and not so able to follow their chosen pursuits. We noted that there is inconsistent documentation of individuals religion, which would make it difficult to cater for any spiritual needs in some cases. We are aware that there are visits from a vicar from a local church to see residents however. The home does have an activity organizer who residents told us does ask them what they like, and what they wish to do, although they have a limited number of hours and it was suggested that having the time to plan daily activities based on residents views that other staff could implement would be appropriate. We were given the impression that the activity organizer is not valued by some staff as their status is not the same as that of a care assistant. The provision of stimulation to residents should be seen as critical in promotion of individuals emotional health and an important element in provision of good care. The home has information on its visiting policy available and the majority of relatives told us that the home does encourage their involvement and keep them up to date with any important changes. We heard comments to the effect that well aware we can ring the home at any time and carers would call us if there was a problem of any type. Are 100 certain this would be the case. We received many positive comments from residents in respect of the food provided by the home such as very good meals, Food is good and again can have food other than at meals times and good variety of foods. We spoke to the cook who showed us menu choice sheets which are taken round by herself or the staff and are completed after residents are offered a choice of two meals, three at tea time. We also saw records held by the cook in respect of residents dietary needs that reflected information in case files this so as she is kept in the loop . The cook told us she consults with residents on a regular basis to ask they what they think of the meals, this building on the consultation through residents meetings. We sampled a meal and Care Homes for Older People Page 18 of 34 Evidence: found it nicely cooked with vegetables moist and firm and potatoes creamy. The meal was also hot as opposed to lukewarm. Dining tables are attractively laid out and condiments are available although the lack of space available in the main dining room was perceived to be an issue as we saw it was difficult for residents and staff to get by occupied tables on occasions, this presenting the potential for accidents. We saw that assistance was provided with meals in a subtle but appropriate way, with the exception of one staff member who was feeding two residents at the same time, this a matter than was taken up with staff by the manager following our first visit to the home. It was pleasing to see that we saw staff offering drinks to residents on a regular basis outside of meal times, as well as fresh fruit. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service tell us they are usually able to express their concerns and have access to a robust, and generally effective complaints procedure. The home is improving the way in which it protects people from abuse. Evidence: We saw the home has an accessible complaints procedure that is available in many areas of the home as well as bedrooms. Residents told us that staff listen and act upon what they say, this also confirmed by some of the residents we spoke to during the course of our visits. The majority of relatives also told us they knew how to make a complaint, some also saying they had an appropriate response to concerns raised. The home has received a number of complaints this year and whilst we saw evidence of a robust response in some instances there have been cases where some people have been dissatisfied with the homes response. In these instances the complainants have known who to contact and outcomes from this inspection have evidenced that many of the issues raised in complaints earlier in the year have been addressed. The records of complaints kept by the home include a number that have been raised verbally and these are well documented, with outcomes also fully recorded. Based what we have seen during the course of our visits the service has learned from any issues of complaint received, and has responded robustly to these, as well as other matters raised during the course of our visits such as underarm lifting which has resulted in the manager raising this issue with all staff and purchasing more lifting belts. Care Homes for Older People Page 20 of 34 Evidence: We did advise the manager than the addition of CSCIs national helpline number and revision in the homes complaints procedure in respect of the statement as to our role as an investigator of all complaints (which is inaccurate) would be beneficial. We saw the homes policies and procedures for safeguarding adults which are supplemented by the local authorities safeguard and protect procedures. Guidance on the process for reporting safeguarding issues is assisted by a simple one page flow chart available to staff in the home. There are also clear whistle blowing procedures in place. There has been one matter since the last inspection in respect of safeguarding that the manager reported directly to social services and ourselves and attendance and assistance with the safeguarding process has been readily provided by the management when issues have arisen. This has assisted with the management of referrals and resolution of safeguarding matters. We saw that staff are provided with training in recognizing abuse and discussion with the manager and deputy clearly evidenced that they have a clear grasp of their responsibilities and what to do in the event of any safeguarding concerns.We saw that use of equipment that restrains individuals is considered through a risk assessment approach although the use of clearer recording in respect of potential limitations could sometimes be better, this where there are issues in respect of mental capacity. Care Homes for Older People Page 21 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment although the lack of space in the main living areas can be problematic. Evidence: Sited near the centre of Netherton the home is well positioned to allow access from public transport and is within a short walking distance of the local shopping centre. The home is designed so as to replicate a number of terraced houses from the main street, this so that it does not resemble an institution but a number of private dwellings. The home also comprises of a number of self contained flats on the first floor, these having their own snack making facilities and bathrooms. We have been told that these facilities allow privacy and independence by some of those that reside within them, with access available to others in communal areas if wished. we saw that there has been on going works to improve the ambiance of the home with redecoration of many rooms and areas, this so the home presents as light and comfortable. We saw that many residents have personalized their bedrooms and flats so as to reflect their personalities. There have been a number of issues with some of the lifts between floor levels over the last year, this resulting in the home having to call in engineers a number of times, although at the time of the inspection these we saw are working. There has also been the occasional issue with toilets not working, although again work Care Homes for Older People Page 22 of 34 Evidence: has been carried out to address these issues. We saw that there is regular servicing of equipment this to ensure that they are safe for use, with risk assessments in place in respect of the maintenance and safety of the environment. The home employs a handy person to complete minor repairs and maintenance. Whilst the post holder had just left the home was recruiting to this post. We did however note that some areas are limited in terms of the space available, this notably the main dining and living area. We saw that the main dining area was crowded during lunchtimes and access for residents and staff was limited, with us observing one occasion when a member of staff inadvertently squashed a residents hand when moving between tables. We also saw that when residents use such as footstools or stretch their legs out in areas of the main lounge this can inhibit easy access past them. Whilst it is seen as positive by some residents that the entrance leads into the main living area, as they can see who is coming and going, this does mean that there is more traffic that inadvertently encroaches on available space. We saw that the home was clean and tidy and at no point did we note any unpleasant odours beyond a couple of bedrooms that held a slight mustiness.There have been some outbreaks of infection over the last year, these reported to the health protection agency. we saw that the staff have access to suitable protective wear and that there is clear guidance on hand washing as well as facilities to do so. The home has policies on infection control and numerous staff have received training in this area Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are overall well trained, skilled and in sufficient numbers to support the people who use the service, although deployment of staff has at times been problematic. Recruitment practice is generally robust and is underwritten by robust procedures. Evidence: Based on comments made to us by residents and relatives they are generally satisfied with the care that is provided by staff although we did have some conflicting views as to the quality of the service; this reflected by the following comments: Without exception the skills and experience we have seen with both (resident X) and other residents are exceptional and By the carers having more time for the people they care for instead of just treating it like something they have to do. We have been told that people sometimes have to wait a short time for staff support, this an issue that arose in some of the complaints received by us earlier in the year. Response times to calls for assistance we saw have been raised as a issue in staff meetings and the manager is actively pursuing ways in which the home can improve staff deployment, including the revision of staffing levels at differing times of day, this in response to the feedback she has received. Staff questionnaires told us that staff think there is a need for more staff, this despite Care Homes for Older People Page 24 of 34 Evidence: the hours available on paper reflecting the number and dependency of residents. The manager did however consider deployment of staff as an area that needs on going monitoring and also highlighted the fact that sickness levels have on occasions caused problems especially when very short notice is received. This has resulted in the manager having to cover care shifts on occasions, detracting from the time she has in the management role. The manager in discussion was fully aware of the potential implications this had on outcomes for residents, and to alleviate this three bank staff have been employed to assist with maintaining staffing levels. Whilst acknowledging difficulties over the last year in terms of staffing it is pleasing to see that the manager has recognized and is responding to these issues, to hopefully improve the homes ability to provide a responsive care team. From site of the homes training plan, copies of training certificates in staff files and discussion with staff we saw that there is a recognition by the home of the importance of staff training. The levels of vocational qualification amongst the staff team has improved significantly since the last inspection and where there are gaps in training provision these are mostly identified, and in many cases training input booked to cover these gaps/updates as was evidenced to us by the manager. The home has provided 5 staff with guidance in obsessive compulsive disorders in response to a persons needs, this needing to be cascaded to the wider staff team, perhaps through clear guidance in the care plan, team meetings etc .We also noted that numerous staff would benefit from a refresher in fire training. Consideration of providing staff with input in person centered care that fits in with national developments in accordance with the personalization agenda would be helpful, especially in allowing staff to examine their values and attitudes. We saw a mixture of interactions with residents, the majority of these positive, as was reflected by those we spoke to with comments such as the staff are wonderful and that they feel part of a family sharing an open relationship with staff. We did however witness one incident that illustrated a less than satisfactory response from a member of staff in the way she spoke to a resident, this a matter that has been taken up by the manager We saw that the home has a good recruitment procedure that clearly shows what steps are to be taken and we looked at a number of staff files of recently recruited staff that evidenced that this is followed in practice. The staff induction process was also seen to reflect nationally recognized standards. We did advise the manager to ensure copies of training certificates are taken when shown to her at their interview and that any new staff taken on with out a full enhanced disclosure are subject to a documented risk assessment of the actions the home takes (such as supervision logs, working with an identified and experienced staff member etc). Care Homes for Older People Page 25 of 34 Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is responsive to the needs of the service and the people that use it and is committed to improving the outcomes for residents through development of quality assurance systems that involve customer feedback. Evidence: The manager, who was registered as such late last year, has the required experience and is completing the expected qualifications. Discussion with the manager throughout the inspection evidenced that she has a clear perception of areas where the home needs to improve and has demonstrated through her response to our feedback that she is receptive to constructive criticism and has tried hard to address issues raised during the course of the visits, this to the extent that some concerns on the first day of our visit to the home have been addressed to our satisfaction at the point we completed the inspection. We saw that staffing issues have involved discussion with staff in meetings, purchase of additional equipment and steps to change the way staff Care Homes for Older People Page 27 of 34 Evidence: are deployed.The manager is now supported by a recently employed deputy manager with additional administrative support on site. We saw that the home has various systems for ensuring feedback is obtained as to the homes performance, this including meetings with staff, residents and relatives as well as questionnaires to canvas peoples views (the summary of these we saw as reflecting a positive view of the service). The manager submitted an annual quality assurance assessment to us earlier this year, and we noted that some of the areas for improvement identified within this have now been actioned, this supporting our view that the service is responsive to feedback. As we stated elsewhere in this report the manager has responded to issues raised at the point we first visited and improved some areas of practice, most notably medication management. Some areas that were the subject of complaint earlier this year have also been found to be of a good standard, notably meal provision. We saw that senior management are also carrying out regular visits to the home and monitoring the quality of the service, with a senior manager we spoke to clearly very supportive of the homes manager and expressing every confidence in their ability to manage and improve the service. We looked at a number of residents records relating to monies in safekeeping, and whilst these were generally in good order, we did see that some entries were only verified by one signature (these not the more recent entries however) and tracking some receipts was difficult due to a lack of referencing. We also noted that inventories of residents property are not always completed, this important so as to ensure it is clear what property they bring into the home in the advent of items going missing. The service was seen to have generally sound policies and procedures that are monitored by the company and updated based on practice across a number of homes. These policies and procedures are translated and reinforced to staff through meetings, supervisions, (which are themed month by month) and on going training in mandatory areas of practice. We did however not the the staff are due an update in fire safety training. The home we saw to have a good record of addressing health and safety requirements, with regular environmental audits carried out on a quarterly basis, these in addition to infection control audits. There have been some issues that have arisen that the home has kept us informed of such as the difficulties with some of the walk on lifts (now resolved). Any areas of immediate concern that have been raised on the initial visit by us to the home have been addressed by the manager, who has shown a willingness to work with us and take on board constructive criticism. On area of note where the home has performed well in respect of food hygiene, with a four star rating awarded for food hygiene practices. Care Homes for Older People Page 28 of 34 Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 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 7 15 All care plans must be up to date and reflect the current practice of staff in caring for residents. This is so that the information in plans is accurate and reflects current care intervention. 31/01/2009 2 9 15 All the care plans must be 31/12/2008 reviewed to ensure that they fully support the clinical needs of the service users. This is so that care plans are clear as to the input needed in respect of clinical need. 3 35 17 The registered manager 31/12/2008 must ensure that inventories of residents property are always completed This is to ensure that all parties are aware of the property that a person has brought into the home. Care Homes for Older People Page 31 of 34 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 Where the home carries out audits of care plans the outcomes of these should be followed up to ensure that any identified issues are addressed. Where there is agreement that a residnet or relative wishes to be advised of cahnges to a care plan the manager should ensure that this is maintained and evdienced. Whever possible residnets or tehir representatives should sign to indicate their agreement with the plan of care. Residents weights should be monitored consistently on a regular basisi and in accordance with the otcomes of any nutrtional risk assessment. It is advised that the prescriptions are checked before they are dispensed and used to check the dispensed medication and charts received into the home for accuracy. It is advised that compliance checks are undertaken and fully documented to demonstrate that service users wishing to self administer their own medication do so safely as the doctor prescribed. The registered manager should ensure that stimulation for more dependent residents is always available and provides for their specific needs. The recording of activities provided on a daily basis should be improved, and a weekly activities plan for group activity made available so as to assit with the homes assessment of its performnace in this area. The registered manager should ensure that it is clear as to the religion of each individual and what this entails for the home in meeting their spiritual needs. Assessments relating to a persons mental capacity should be considered so as to establish their ability to make decisions and when a limitation maybe valid. It should also be clear that when a decision is made on behalf of a person that they do not have capacity in accordance with the Mental Capacity Act. The registered manager should risk assess any issues presented by the available space in the main living area of the home against dependency levels of the current resident group, and how the impact of limited space can be lessened or negated. The registered persons should ensure that staff deployment is kept under review so as to ensure there are sufficient staff available at all times so as to meet the health and Page 32 of 34 2 7 3 8 4 9 5 9 6 12 7 12 8 14 9 19 10 27 Care Homes for Older People welfare of service users. 11 29 The registered manager should ensure that the steps she takes to protect residents when employing staff without a full enhanced disclosure are documented in a risk assessment. The receipts kept by the home to verify the expenditure of residents monies should be referenced to allow easier auditing. Staff should be given updates on fire training. 12 35 13 38 Care Homes for Older People Page 33 of 34 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!