Care Home: Northfield Manor Nursing And Residential Home

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What the care home does well People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. What has improved since the last inspection? The home has been fitted with a new nurse call system since our last visit in March 2007; so people can be confident that staff will respond to their calls for assistance. One person told us `I had to use the bell late at night, and the staff were there straight away and sorted the problem out`. Bedrooms now have soap and paper hand towel dispensors to improve infection control procedures, and staff have recieved training around this area of care to make sure any spread of infection risk to individuals is reduced. Robust practices around staff recruitment and training remain a high priority for the registered person and manager and work is ongoing to ensure staff are qualified and competent to fulfil their job roles. What the care home could do better: The way that staff record information in the care plans and medication records must get better to ensure that people are well looked after and any risks to their health are identified and acted on. We would like to thank everyone who completed a survey or spoke to us during this visit. Your comments are very important to us and ensure this report includes the views of people who use the service or work within it. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Northfield Manor Nursing And Residential Home Long Lane Driffield East Yorkshire YO25 5UT     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: Eileen Engelmann     Date: 1 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Northfield Manor Nursing And Residential Home Long Lane Driffield East Yorkshire YO25 5UT 01377257288 01377241253 info@northfieldmanor.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Silverfield Care Management Name of registered manager (if applicable) Mrs Melanie Louise Missin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: To admit one service under pensionable age. To admit one service user under 65 years of age for high dependency respite care. Date of last inspection Brief description of the care home Northfield Manor provides care (including nursing care) and accommodation for up to 45 elderly people. The home is situated on the outskirts of the market town of Driffield. Accommodation at the home is available in single or companion rooms which are decorated and furnished to a high standard. People using the service are able to use a choice of lounges or a conservatory to relax in and a wide range of activities are available. The grounds are well maintained and accessible to wheelchair users. Seating Care Homes for Older People Page 4 of 30 care home 45 Over 65 45 45 45 45 0 0 0 0 Brief description of the care home areas are provided and there are raised beds planted to appeal to those with sensory impairment. The current scale of charges for the home is 350.00 to 396.50 GBP per week for residential clients and nursing clients will pay their nursing band fees on top. There is a top up fee from 0 to 50 GBP per week depending on the room facilities chosen by the individual. There are optional additional charges for private chiropody, hairdressing, transport and escorts, newspapers/magazines, and a full list of the costs for these can be obtained from the manager. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. Information has been gathered from a number of different sources over the past 24 months since the service was last visited by the Commission for Social Care Inspection, this has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and peoples files, and records relating to the service. Informal Care Homes for Older People Page 6 of 30 chats with a number of people living in the home took place during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was good. We received 6 from staff (60 ) and 8 from people using the service (80 ). The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. Evidence: Three peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. Those people who fund their own placement are given written confirmation of any fee increases, at least a month before they are due to be implemented. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The home develops a care plan from the assessments, identifying the individuals Care Homes for Older People Page 10 of 30 Evidence: problems, needs and abilities using the information gathered from the person and their family. Those people living at the home who receive nursing care undergo an assessment by a registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. Discussion with the manager indicated she goes out to assess individuals who have expressed an interest in coming into the home, and each person is given information about the service and life in the home. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. Information from the peoples surveys showed that they were satisfied with the care they receive and have a good relationship with the staff. Information from the Annual Quality Assurance Assessment and discussion with the manager and people living in the home indicates that all of the people using the service are of White/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home is able to offer a limited choice of staff gender to people who express preferences about care delivery, as they employ 2 male care staff. The information about peoples preferences should be recorded onto the care plans. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, or they are booked onto training in 2009. The staff also have access to a range of more specialised training, which links to meeting the specific needs and conditions of people using the service. The home does not have any intermediate care beds and therefore standard six does not apply to this service Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is evidence in the care plans and medication records of gaps in information, which could potentially put people at risk. The home understands the need to comply with the administration, safekeeping and disposal of medication and the registered person is taking action to improve staff practices. Evidence: Information from this visit indicates that the people who spoke to us are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. We looked at the care of three people during this visit, two individuals were fairly new into the home and one has been there for some years. For the two people who have been in the longest time their care plans are adequate, the information in them gives basic details of the care they require and are updated monthly by the staff. The plans are not particularly person centred and do not have much information in them about Care Homes for Older People Page 12 of 30 Evidence: the wishes and choices of the individuals. We spoke to the manager about how these could be improved and also discussed how more equality and diversity information such as peoples preferences regarding staff gender for personal care should be included in the plans. Staff need to ensure that they are completing the daily hygiene sheets to show what care has been given, as in all three care plans there were large gaps in these records. The third care plan we looked at was for a person who has been in the home since February 2009. Their plan was not fully completed by the staff, and this is not acceptable practice. We spoke to the staff about the missing information and recommended that the manager completes a full audit of the care plans to ensure they are all up to date and informative. People said that they have good access to their GPs, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people using the service indicate they are satisfied with the level of medical support given to them. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. The nurses within the home carry out specialist tasks such as PEG tubes/feeding regimes and wound dressings. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses/beds and seat cushions. Checks of the medication show the home is using Boots the Chemist as their pharmacy supplier and their MDS system of medication is in use. At our last visit to the home in March 2007, we raised concerns around the inconsistencies of recording in the medication records. Checks on this visit show that staff continue to leave signature gaps, are not always counting in or signing in medication which arrives from the pharmacy mid-cycle and we observed a staff member signing the controlled drug book long after the medication had been given. This is not acceptable practice and time was spend discussing with the manager how she will ensure these poor practices are improved. Although medication audits are taking place, these are clearly ineffective and we recommended that the manager carry out weekly audits until staff practice improves. Care Homes for Older People Page 13 of 30 Evidence: We looked around the treatment room and found eye ointments in the medication fridge that were out of date or not labelled with the date they were opened. A number of these ointments do not need to be refridgerated and could cause some discomfort to people if they are not stored correctly; the manager assured us that she would sort this out immediately. We found one medication, sent from the hospital with a newly admitted person the day before our visit, that was out of date. The manager said she would speak to the hospital about this. The home has a number of people on temazepam tablets and although the medication was in a locked cabinet, it was not the controlled drug cabinet. We explained to the manager that the pharmaceutical legislation changed in 2008 and Temazepam became a Controlled Drug Schedule 3 (no register). This means it must be stored in a controlled drug cupboard that meets the legal requirements of the Misue of Drugs Regulations. Under these regulations temazepam does not legally require an entry in a controlled drugs register, but this is recommended good practice. We noted that the home does record temazepam in an appropriate register. Checks of the controlled drug stocks and the register showed that these are up to date and correct. Peoples comments show they are satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with choice and diversity in the meals and activities provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. Evidence: The home employs an activity co-ordinator who is responsible for carrying out the daily programme of leisure activities. This individual works a two week rota of Tuesday, Wednesday, Thursday, Friday and Tuesday, Wednesday, Saturday and Sunday. The programme of events is on display in the dining room and a file is kept of all activities undertaken and by whom. On the day of our visit the activity co-ordinator was on leave so we will look at her paperwork in more detail at our next visit. Information given to us in the Annual Quality Assurance Assessment (completed by the manager in February 2009) indicates that the home provides transport for outings and all people using the service are able to participate. There is a vegetable garden and fruit trees at the home and people are able to grow things and eat varied vegetables and food which they have produced. There is a pig bingo evening once a month to raise funds for entertainment and following a request from people using the Care Homes for Older People Page 15 of 30 Evidence: service there is now an in-house shop stocked with items they have requested. People told us in their surveys that there is always something for them to do in the home, and one person we spoke to said I enjoy playing bingo and dominoes with my friends. We talked to two people who are new into the home; they told us that they were settling in well and that the staff are very good, nothing is too much trouble. The manager said that there are monthly church of england services within the home, and people can also go to the local church services and religious celebrations as requested. The home provides special meals and cakes for birthdays and helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. There is some information and advice on advocacy and this is available in the service user guide. There are meetings where the viewpoints and opinions of those living in the home can be expressed and the management team will listen and take action were needed. Visitors said they are kept informed of any important issues affecting their friend/relative and felt that staff did a good job of supporting people to live the lives they choose. The manager told us that some staff have attended training on the Mental Capacity Act and current legislation in equality, diversity and disability matters, but the majority have not. The registered person should make sure that staff have sufficient knowledge about human rights legislation, so they understand individual rights within the care home and out in the community. Observation of the lunchtime meal showed the food was home made, and all the meals seen including the soft diets were presented in a satisfactory manner. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to people who need help with eating and drinking. People are pleased with the quality and quantity of the meals served, saying the food is good and there is always a choice given. Care Homes for Older People Page 16 of 30 Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples views are listened to and acted upon. Evidence: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. We checked the complaints book and saw that records are kept of any issues raised and the homes written response to the individuals concerned. Peoples survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said we would raise any concerns with the manager or staff. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of peoples money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults from abuse procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Care Homes for Older People Page 18 of 30 Evidence: The staff training matrix given to us on 13 March 2009 shows there is an ongoing training programme for staff to attend safeguarding of adults awareness training, and sessions were held in May 2008, July 2008, November 2008 and February 2009. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a comfortable and homely place to live. Evidence: We walked around the building and found it satisfactory and suitable to meet the needs of the people using the service. The home has an ongoing maintenance and refurbishment programme and the environment is clean, comfortable and homely. The home provides accommodation on three floors with a passenger lift or stairs to the upper levels. Since our last visit in March 2007 there has been a new nurse call system fitted throughout the home, and all bedrooms have been supplied with soap and paper towel dispensers as an infection control measure. The manager told us that there are plans to replace the corridor carpets on the ground floor over the next twelve months and also convert bathroom 4 into a shower room. We found that the upper floor corridors and stair carpets are worn and recommended that these should be considered in the replacement programme. In bathroom 1 we found the end panel of the bath was not in place and there are a number of broken tiles that need replacing, bathroom 5 is being used as storage space and this needs to Care Homes for Older People Page 20 of 30 Evidence: be cleared out as it could be a fire risk as appropriate fire detectors are not in place. We saw that the laundry store on the first floor had its fire detector dismantled and the door to the room did not close properly, the manager was asked to deal with these as soon as possible. We looked in a selection of bedrooms and noticed that room 30 does not have much storage space for clothing, and that the individual has not been provided with a chest of drawers. The registered person must make sure that people are given the option of having the minimum furnishings asked for by the Care Standards for Older People (standard 24.2), and where they choose not to have the furnishings this should be documented in their care plan. Not all bedrooms are supplied with a door lock or lockable storage space in the room, the registered person should ensure these are fitted when a person requests them or a need is identified through the risk assessment process. This should also be documented in their care plan. The manager also showed us a number of single bedrooms that have been created from what were originally double rooms. We discussed the need to ensure that where the conversion of the bedrooms involves structural work then the single room must meet with the room size standards of a new room (12 square metres of usable floor space, excluding ensuite facilities). The manager assured us that all the new rooms would meet this criteria. People living in the home have the use of a number of lounges, large and small, that offer individuals the choice of being with a number of others or sitting with just a handful of people. There are ramps into the home so disabled people have ease of access and there are well tended gardens, green houses and lawned areas, plus secluded patios with raised flower beds for people to sit out or work in during the better weather. Discussions during this visit indicate that people using the service are satisfied with the laundry service provided by the home. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. The staffing matrix supplied to us on 13 March 2009 indicates that infection control training took place in February 2009 and this will be an ongoing part of the training programme. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff induction, training and recruitment practices are good, resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. Evidence: We spoke to three people who use the service and they were all satisfied with the care they receive and said that they did not have to wait too long for staff to come when they needed assistance. Individuals told us that staff are friendly, helpful and supportive. They are willing to talk to you or listen if you have any problems and nothing is too much bother. Six staff who completed our surveys said that communication amongst themselves usually worked well and five said their induction process and training was good. Six staff expressed the view that the numbers on duty were sufficient to meet the needs of the people in the home; staff commented that I feel the people using the service are treated as individuals, and their independence respected and as with any nursing home we would all like to have more staff, but on the whole we have a good level of staffing. The manager told us that at the time of our visit there were 33 people in residence (14 Care Homes for Older People Page 22 of 30 Evidence: with nursing needs and 19 with residential needs); this was due to five recent admissions. The manager said that she was aware of the need to increase staffing levels to meet the increase of people and would be starting a recruitment drive as soon as possible. The staffing rota given to us during our visit showed that the following staffing levels were in use for the week commencing 9 March 2009 Early shift - One nurse plus four care staff and another covering breakfast (3 hours) Late shift - One nurse plus three care staff and another working 4pm to 8pm Night shift - One nurse and two care staff Information from the annual quality assurance assessment and discussion with the manager, about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the people using the service, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the minimum hours asked for in the recommended guidelines. 75 of care staff at the home have an NVQ 2 or above in care and the home has a mandatory staff training programme in place. The home has its own staff trainer and discussion with this individual indicates that the majority of the staff are up to date with mandatory training or are booked onto refresher training for 2009. Nurses are supported in maintaining their own professional portfolio of practice in order to keep their Personal Identification Number (PIN) from the Nursing and Midwifery Council (NMC) up to date. The information in the staff training matrix is basic and does not include all the training completed by the staff. The staff trainer should consider including the roles of the staff who attended training, all training sessions attended and the dates of when training was last completed. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. Evidence: The manager of the service is a level one nurse with an active PIN number on the Nursing and Midwifery Council (NMC) register. She has achieved her registered managers award and attends regular training sessions to keep her skills and knowledge base up to date. The home has achieved the Local Councils Quality Assurance Award (QDS parts I and II). Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager and senior staff complete in-house audits of the home and its service on a monthly basis, Care Homes for Older People Page 24 of 30 Evidence: and the registered person does spot checks and completes the regulation 26 visits. Feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires, and the manager has produced a development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Checks of the finance systems within the home found that handwritten records are kept for peoples personal allowances; the administrator on a daily basis up dates these. Information from the Annual Quality Assurance Assessment indicates the majority of people have their families looking after their financial affairs, and checks of the system show their relatives top up the persons individual allowance account on a regular basis. People who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. At our last visit in March 2007 we found that the home did not have an electrical wiring certificate for the home, checks at this visit found this has still not been done. We did not observe anything untoward regarding the electrics within the building, however we would recommend that the registered person checks with their fire insurance company that their policy is still valid without the electrical wiring certificate being in place. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13(2) The registered manager 14/03/2007 must ensure that all prescribed medications are signed for and if not required then this is documented (Outstanding requirement) Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 17 The registered person must make sure that records are kept of all medicines recieved, administered and leaving the home, or disposed of, to ensure that there is no mishandling. So people can be confident that their health and wellbeing is being looked after and they are protected from harm. 30/06/2009 2 24 16 The registered person must make sure that people are given the option of having the minimum room furnishings asked for by standard 24.2, and where they choose not to have the furnishings this should be documented in their care plans So people can be confident that they will be provided with sufficient furnishings to 01/09/2009 Care Homes for Older People Page 27 of 30 enable them to feel at home and store their belongings. 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 The manager should consider how the care plans can be developed further to become more person centred and include equality and diversity information such as the wishes of each person regarding staff gender for giving personal care. The manager should audit the care plans on a weekly basis to ensure that staff are completing them in full and information within them is up to date and informative. The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), there are two staff signing the entry to indicate they have both witnessed that the information on the sheet (name of medication, strength and administration methods) is correct. The manager should carry out weekly medication audits to ensure that staff are completing the records in a satisfactory manner and following the homes policies and procedures. The registered person should make sure that staff have sufficient knowledge about equality, diversity, disability matters and human rights legislation, so they understand individual rights within the care home and out in the community. The registered person should make sure that bathrooms are fit for purpose and cleared of all stored items, the laundry store should have a working fire detector and a door that closes. The registered person should consider replacing all the corridor and stair carpets as part of the refurbishment plan for the home. The registered person should make sure that people are provided with bedroom door locks and lockable storage space, when a person requests these or if a need is identified through the risk assessment process. This should also be documented in their care plan. 2 7 3 9 4 9 5 14 6 19 7 19 8 24 Care Homes for Older People Page 28 of 30 9 30 The information in the staff training matrix is basic and does not include all the training completed by the staff. The staff trainer should consider including the roles of the staff who attended training, all training sessions attended and the dates of when training was last completed. The registered person should check with their fire insurance company that their policy is still valid, as the home does not have an up to date electrical wiring certificate. 10 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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