Care Home: Osborne House Residential Home

What the care home does well The manager, Mr MacKrill continues to invest in staff training, providing a staff team with a clear and workable understanding of the diverse needs of people with Dementia. The approach to care in the home is Person Centred and considers the individual rather than a set of tasks that need to be completed. Staff were trained to recognise and respect that people in the home may at times be experiencing life in their own reality, which may not reflect other people`s perspectives of the situation at the time. Staff had also been given guidance on supporting people in maintaining and developing personal relationships within a supportive and caring environment. The provision of appropriate activities continued to be an important part of people`s lives in the home, and this outcome area was awarded an excellent rating. Activities were specifically aimed at meeting people`s individual likes and preferences, recognising skills obtained in people`s working/home lives. This was supported by reminiscence therapy and staff training in creative activities for people with dementia. People spoken to said they were happy living in Osborne House. One person said they were enjoying the wild animal discussion, whilst another commented on the tennis on TV. One relative said that they were more than happy with the level of care provided and especially the settled and relaxed atmosphere in the home. What has improved since the last inspection? Since the last inspection, the manager has almost completed a total refurbishment of the upper floor. When completed this will provide four large rooms with ensuite facilities. Relatives have commented on improved staffing levels, which staff confirmed was being followed. This meant that people in the home got the chance to join in outdoor activities such as going for a walk or sitting at the front of the home looking at the view and watching builders complete their work. The deputy manager had reviewed the conten of written care plans, so that they included guidance on what the expected outcomes and goals were for people living in the home. These were also agreed with either the resident or a relative if they were unable to make the decision. The care plans also included life and social histories. This enabled staff to recognise the possible meaning behind the actions of people when they were not acting as expected within the context of a situation. A Quality Assurance process had been developed but responses had not been received at the time of our visit. We agreed to look at this at the next inspection. Staff had completed specific training in areas such as managing challenging behaviours, safeguarding adults and nutritional screening. This was evident in care plans, where monthly weights were recorded, including the persons BMI (Body Mass Indicator), which meant staff would know whether a person was over or under weight. What the care home could do better: Following this inspection, we made two requirements and six best practice recommendations.We discussed the areas of improvement required with the manager and deputy manager. Assessments carried out prior to the person returning to the home from hospital must be more in depth. This means they neeed to be similar to the preadmission assessments carried out before a person moves into the home. This would ensure that the home could still meet the person`s needs. We discussed the need for the manager to be more proactive in referring people on to nursing care when their needs had increased whilst living in the residential setting. Failing to refer people on for nursing care, meant that the home found themselves in a position of not being able to meet the nursing needs of the people living in the home. The deputy manager had informed us that she was in the process of providing a service user guide, we noted that nobody living in the home had a service user guide and this needed to be provided in a suitable format for people to understand. We observed the medication round and noted that the breakfast round took a long time to complete, meaning the time lapse between medication given at breakfast time and required again at lunchtime would be too close. We recommended that the manager looks at ways of ensuring that the correct time lapse between medication is maintained. The example we suggested was to indicate the time the medication was given. We also noted that stock levels of medication had run out for three residents, meaning that they had missed a dose of prescribed medication. We recommended that the manager needs to be aware that stocks are running low so that an order is put in soon enough to prevent people missing a dose.. Concern had been raised about the Yale locks on bedroom doors for one specific person whose needs had changed and was unable to get out of bed to unlock the door. Yale locks are provided for people in the home, and some people are able to make an informed choice about whether they wish to lock the door or not. However, we recommended that the use of locks on residents doors needed to be risk assessed and reviewed to reflect changing needs. When walking around the home, we noted that there were some areas such as picture frames, picture rails and high corners that required dusting, we did appreciate that with building work being carried out in the home maintaining low dust levels was difficult. However, we pointed out some areas where there were cobwebs that needed to be dealt with. We also noted an odour in one area of the home, following discussion with the manager staff identified the cause of this odour. We recommended that the manager provided the appropriate products for reducing unpleasant odours in carpets. When we looked at recruitment processes, we noted that all required checks were being carried out. However, we recommended that when a prospective member of staff produces references that are addressed as, `to whom it may concern` or bring them to the interview, the manager needs to confirm the content of these references with the person they were from. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Osborne House Residential Home 16 Bay Road Clevedon North Somerset BS21 7BT     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: Juanita Glass     Date: 2 4 0 6 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 29 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Osborne House Residential Home 16 Bay Road Clevedon North Somerset BS21 7BT 01275872600 01275872600 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Osborne House (Ladye Bay) Limited care home 26 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: May accommodate one named person under 65 with Dementia care needs. Home will revert when named person leaves. May admit one named person aged 59 years and over. This condition lapses when the person leaves or becomes 65. May provide residential personal care for up to 26 persons, aged over 65 years, with Dementia. The two additional bedrooms are not to be used until minimum standards have been achieved and checked by the inspector. Date of last inspection Brief description of the care home Osborne House is registered with the Care Quality Commission to provide a personal care service for up to 26 persons with dementia. Care Homes for Older People Page 4 of 29 Over 65 0 1 1 5 1 0 2 0 0 8 Brief description of the care home The home is a pleasant period building with panoramic views over the Bristol Channel. It has three floors and twenty-two bedrooms, two of which are shared. At present the home can take up to 24 persons. Following completion of extensive refurbishment of the upper floor four en-suite rooms will become available. There is a call system throughout the home. There is a conservatory with views across the channel to Wales, dining room and two good-sized lounges. One lounge is set aside for activities and can always be seen with posters and pictures promoting reminiscence therapy. The other lounge has a widescreen TV. There are ample assisted baths, communal showers and toilet facilities and access to all floors via a lift. Osborne House aims to provide person centred care on an individual basis to people with Dementia whilst recognising their right to continue to make choices in a safe environment. They do not take people with nursing needs. Current fees can be obtained on request. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over three days and a total of ten hours were spent in the home. To gather enough evidence to support our judgments for this inspection, We The Commission asked the service provider to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gives us some numerical information about the service, and how they intend to maintain or improve outcomes for people using their service. Once we had received this information we carried out a visit to the home and spoke to people living there, the staff and relatives. Whilst in the home we also looked at documents maintained for the day-to-day running of the service. These included care Care Homes for Older People Page 6 of 29 plans, staff recruitment, training and supervision. Also records relevant to the administration of medication, the service records and health and safety. What the care home does well: What has improved since the last inspection? What they could do better: Following this inspection, we made two requirements and six best practice recommendations. Care Homes for Older People Page 8 of 29 We discussed the areas of improvement required with the manager and deputy manager. Assessments carried out prior to the person returning to the home from hospital must be more in depth. This means they neeed to be similar to the preadmission assessments carried out before a person moves into the home. This would ensure that the home could still meet the persons needs. We discussed the need for the manager to be more proactive in referring people on to nursing care when their needs had increased whilst living in the residential setting. Failing to refer people on for nursing care, meant that the home found themselves in a position of not being able to meet the nursing needs of the people living in the home. The deputy manager had informed us that she was in the process of providing a service user guide, we noted that nobody living in the home had a service user guide and this needed to be provided in a suitable format for people to understand. We observed the medication round and noted that the breakfast round took a long time to complete, meaning the time lapse between medication given at breakfast time and required again at lunchtime would be too close. We recommended that the manager looks at ways of ensuring that the correct time lapse between medication is maintained. The example we suggested was to indicate the time the medication was given. We also noted that stock levels of medication had run out for three residents, meaning that they had missed a dose of prescribed medication. We recommended that the manager needs to be aware that stocks are running low so that an order is put in soon enough to prevent people missing a dose.. Concern had been raised about the Yale locks on bedroom doors for one specific person whose needs had changed and was unable to get out of bed to unlock the door. Yale locks are provided for people in the home, and some people are able to make an informed choice about whether they wish to lock the door or not. However, we recommended that the use of locks on residents doors needed to be risk assessed and reviewed to reflect changing needs. When walking around the home, we noted that there were some areas such as picture frames, picture rails and high corners that required dusting, we did appreciate that with building work being carried out in the home maintaining low dust levels was difficult. However, we pointed out some areas where there were cobwebs that needed to be dealt with. We also noted an odour in one area of the home, following discussion with the manager staff identified the cause of this odour. We recommended that the manager provided the appropriate products for reducing unpleasant odours in carpets. When we looked at recruitment processes, we noted that all required checks were being carried out. However, we recommended that when a prospective member of staff produces references that are addressed as, to whom it may concern or bring them to the interview, the manager needs to confirm the content of these references with the person they were from. Care Homes for Older People Page 9 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from enough information to make an informed decision about moving into the home. However people did not have a service user guide in a suitable format. Prospective residents receive a full needs assessment and the home confirms they can meet their needs before they move into the home. However the assessment following a hospital admission was not as comprehensive. Evidence: We asked for a copy of the homes Statement of Purpose, this was readily available however was undergoing a review with updates being added. The contents reflected the service provided by the home. We also asked for a copy of the service user guide, the deputy manager explained that a copy was not available. She confirmed that she was currently designing a service user guide that would be available with words and pictures. This meant that people with a cognitive impairment may find it easier to understand enabling them to make a well informed choice of home. People living in the home also did not have a copy of a service user guide. Care Homes for Older People Page 12 of 29 Evidence: Three care plans were reviewed they all contained preadmission assessments, we also saw one care plan for a person returning from hospital their assessment was not as comprehensive as the initial assessment. This meant that the home was unable to meet their nursing needs. We discussed the assessment carried out when a person returns from hospital. This assessment needs to be in as much depth and detail as the initial assessment and the person is only returned to the home if they can meet their needs. The manager confirmed all new residents would receive a full preadmission assessment and they would only take them if they were sure they could meet their needs. The preadmission assessment forms the basis of the full care plan, which is then agreed with the resident or a relative if the resident is unable to express an opinion. People wishing to move into the home are offered the chance to visit and spend some time there when they can talk to staff and residents about their experiences. People living in the home did not comment on the experience of looking for a placement. One relative spoken to said staff had helped make the decision an easy one. Care Homes for Older People Page 13 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a Person Centred approach to care, which respects their right to maintain personal choice and dignity. Reviews of care needed to take into account peoples increasing needs such as the need for nursing care. People were protected by a robust medication Policy and Administration, however staff needed to be more aware of times between doses and maintaining good stock balance. Evidence: We looked at four care plans chosen at random. They were all written in a way that reflected the personal needs of the person rather than a group of tasks that needed completing. They also included the likes, dislikes and a history of the persons life before they moved into the home. The deputy manager showed us the new layout of how they would be writing future care plans. A few had already been completed. They gave staff clearer guidance about what the intended outcomes or goals were for the person as an individual. Staff spoken to were clear about the way they looked after people living in the home. They were aware of the care plans and where they could find out personal likes and dislikes of the people in their care. People who were able to Care Homes for Older People Page 14 of 29 Evidence: talk about the care they received said the staff were very caring, they knew what they wanted and treated them with respect. One person said they were very happy and was observed to go out for a walk with staff when they requested it. Another person said they were very happy and liked living at Osborne House. One relative said the care provided was really good and they had seen a definite improvement following an increase in staffing levels. Another relative said that they were kept well informed and were involved with the decision-making, they said they were very happy with the way their relative was looked after. We watched the way staff spoke to people living in the home they were polite and respectful treating everyone as an individual. We also discussed the level of care being provided for one person who had returned from hospital. The home was receiving support from community nursing services, however it was evident that home was not able to meet their nursing needs. The manager agreed that although their care had been kept under review the persons condition had deteriorated to such a point that they required higher levels of nursing care than the staff at Osborne House could provide. We discussed the need for the manager and deputy manager to carry out more in-depth assessments of people returning from hospital as discussed in the previous outcome area. We also discussed the need for them to be more proactive in referring people who required more care than the home could provide. The deputy manager said that they had been encouraging and supporting people in making end of life decisions, indicating their preferences for care at this stage of their life. Care plans also showed that people living at Osborne House continued to have access to healthcare specialists such as the dentist, the optician, the chiropodist and the diabetic nurse. Staff in the home helped people attend appointments either at the doctors surgery or hospital outpatient clinics. We looked at the way in which staff managed the receipt, storage and administration of medication. We observed one member of staff administering the morning medication, they followed the correct procedures however the medication round was slow and took longer than expected, resulting in people receiving medication later in the morning. This may have had a knock-on effect for the timing of medication throughout the rest of the day. We suggested to the manager that if medication was being given later in the morning the time needed to be recorded so that there was the correct timelapse between the two doses. We also noted that some medication had run out of stock and not been ordered in time to prevent a person missing a dose. We spoke to the manager about this as stock levels need to be maintained so that people do not miss doses of prescribed medication. All staff handling medication had received training, and the deputy manager assesses staff competence to administer medication to people living in the home. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home continue to benefit from appropriate and Person Centred activities to reflect their personal interests and past occupations. They are encouraged to maintain personal friendships and develop new relationships whilst maintaining contact with their families and friends. People living in Osborne House also benefit from a balanced and nutritional diet. Evidence: Activities at Osborne House continued to be organised to reflect the interests of past occupations of people living in the home. This allows for relationships to be built based on a persons biography and life experiences. The manager and staff had attended training in Creating Activity Therapy. A monthly theme is regularly chosen for the reminiscence therapy. When the months theme is completed there is a celebration of the subject covered such as a party. People spoken to showed an interest in the themed reminiscence activity, there were books posters and pictures of activities people enjoyed taking part in. People were observed to be taking part in a discussion about wild animals whilst looking at pictures of them in their natural habitat, another person was watching tennis and said theyd been watching the match but had forgotten the score. Another person sat in their room was surrounded by their personal effects, they said that they were very happy Care Homes for Older People Page 16 of 29 Evidence: but would like a TV in their room. We relayed this request to the manager and they agreed to provide a TV as soon as they could. Residents also take part in personal activities this enables one person to maintain a daily scrapbook, whilst another is assisted to go out for a walk when they wish. We saw staff responding when they were asked and one person went for a short walk several times through the day. Other people went outside to look at the view or watch the builders working. The manager confirmed that they were always looking for ways in which to improve activities in the home. At the previous inspection the manager stated they had looked into the possibility of starting an allotment group however building work had delayed progress in this area. An emphasis is also made of peoples past occupations and staff are constantly looking at ways of including previous life experiences in activities and in the day to day processes of running the home. People were also encouraged to continue to follow their chosen religion if they wished, and staff were also aware of the need to enable people to form relationships within a risk assessed and safe environment. A four weekly menu, which included choices was available. People made their choice at mealtimes rather than being expected to remember a choice made earlier in the day. People spoken to said theyd always had a good meal and lunch was observed to be a relaxed and unhurried social occasion. People who did not like the hustle and bustle of eating with others also had the choice of eating in a quiet area or in their own room. The menus looked at showed a choice of nutritionally well-balanced meals with fresh fruit and vegetables available. Snacks were also available on request and we saw people requesting drinks and snacks throughout the day. They were always listened to and their requests fulfilled. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Osborne House were protected by very clear policies and procedures that made it possible for them to feel they could raise issues and concerns with the manager and staff. Policies and procedures also included very clear guidelines protecting vulnerable people from abuse and neglect including a whistleblowing policy. Evidence: Osborne House had a very clear complaints policy and procedure, which was easy to read. It showed a clear timeline and action to be taken if someone wished to raise a concern or complaint. A copy was clearly displayed, and could be provided in large print if necessary. People we spoke to said they knew who to approach, one person stated they could always talk to the manager, one relative said they were kept well informed and felt they could go to the manager if they needed to. Most people spoken to did not comment on how to raise a complaint. The manager keeps a full record of all concerns, complaints and compliments they receive. Most of the staff working in the home had attended training in safeguarding vulnerable adults, whilst new staff would cover abuse issues and whistleblowing in their induction process. Staff spoken to were all aware of the homes policies and procedures for raising complaints and whistle blowing. They also knew what procedures to follow and who to contact if they suspected that a person living in the home was at risk of harm Care Homes for Older People Page 18 of 29 Evidence: or abuse. Since the last inspection staff were more aware of the need to check a persons identity before allowing them into the home. However on the second day of our visit a health care professional expressed concerns that a new member of staff had admitted them to the home without checking their identity. The manager stated that they would remind staff about the importance of protecting people from possible harm. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Osborne House benefit from a comfortably furnished and homely atmosphere. Staff need to be aware of maintaining cleanliness and preventing unpleasant odours in the home. People are encouraged to personalise their room so they reflect their interests and family. Evidence: Osborne House was comfortably furnished with specific emphasis being placed on the need to enhance certain areas to help people with cognitive impairments such as dementia to navigate their way around the home. This enabled people to maintain their independence for as long as possible. We saw the use of red surroundings around toilet doors to enable people to find them easily and large clear signage. People were seen to be using all the communal areas throughout the day. One area was used as the activities room and contained reminiscence therapy aids this continued to be a very popular room. The second lounge had a widescreen TV and the conservatory overlooked the channel with views to Wales. During our tour of the premises we noted that some areas of the homes were in need of cleaning with obvious dust on pictures, picture rails and cobwebs in corners. We did appreciate however that it was difficult to maintain low levels of dust when there were building works carrying on in the home. One relative commented that they felt the home needed a dedicated cleaner concentrating on just cleaning, freeing up care staff to care just for residents. We also noted that some areas of the home were looking Care Homes for Older People Page 20 of 29 Evidence: tired and in need of decoration, however the manager was aware of these areas and a plan of redecoration and refurbishment was in place, which would start following the completion of the rebuild of the upper floor. We discussed the use at Yale locks on bedroom doors, some people continued to have the capacity to decide whether they locked their doors or not. The use of Yale locks needed to be clearly risk assessed so that as peoples needs changed locks could be disabled so that people did not inadvertently end up locking themselves in their room. The manager confirmed that they were taking advice on door locks that were suitable to use with people with dementia. We identified one specific area in the home that had an unpleasant odour. Following discussions with the manager staff identified the cause and reviewed the care plan for one specific person. However the manager needs to ensure that staff have the appropriate carpet treatment to prevent unpleasant odours being present in the home. Staff demonstrated a clear understanding of infection control guidelines and were observed using personal protective clothing and gloves when necessary. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Osborne House benefit from staff who have received appropriate training to enable them to understand the diverse needs of those suffering from Dementia. Staffing levels have improved in the home and recruitment policies and procedures are followed protecting people from harm. Evidence: The manager continued to emphasise the need for staff working in the home to be able to meet the needs of people with dementia. This was evident in the amount of training regarding understanding the needs of people with dementia that staff, including the manager and deputy manager had attended. All staff were encouraged to attend training in Dementia Care and Creative Therapy. Staff also worked through the Yesterday, Today and Tomorrow course run by the Alzheimers Society. We noted that since the last inspection training also included safeguarding adults, managing challenging behaviour and specific areas relevant to peoples physical needs including nutrition. Staff were also encouraged to commence the NVQ 2 In Care training. Staffing levels had improved since the last inspection. One relative said they had seen a marked improvement in staffing levels within the home, which meant peoples individual needs were being met. One member of staff also confirmed that staffing levels were more representative of peoples needs. Care Homes for Older People Page 22 of 29 Evidence: Staff personnel files showed that people were protected by a robust recruitment procedure, which the manager and deputy manager followed. All recently employed staff had a POVA 1st, CRB and two references in place before they commenced work. They then worked alongside regular staff until the initial stage of their induction had been completed. However we did discuss with the manager the need to obtain confirmation of references addressed as, To Whom It May Concern or bought in by prospective staff at interview. The homes policies and procedures on recruitment of staff included an equal opportunities statement. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Osborne House benefit from a manager with knowledge of the diverse needs of people with Dementia. The manager maintains an open and inclusive atmosphere in the home. Peoples opinions are sought on a daily basis and a Quality Assurance process has been put in place. People are protected by robust health and safety policies and procedures in the home. Evidence: Mr MacKrill had continued to update his knowledge of Person Centred Care for people with Dementia and was involved with developing a therapeutic environment for people living in Osborne House. The deputy manager had also completed the Diploma in Dementia Care Matters, meaning that there was a consistent approach to the provision of Person Centred Care and support within the home. Relatives spoken to said they felt the home was run in an open and approachable way, they said they were included in decisions and involved in agreeing care plans. Residents spoken to said they knew who the manager was and they could talk to him when they wanted to. We observed the manager chatting amicably with residents and during our visit the Care Homes for Older People Page 24 of 29 Evidence: office door was open and people wandered in to speak to the manager as and when they wished. Peoples opinions were sought on a daily basis and an Annual Quality Assurance process had been developed since the last inspection, however consolidated responses had not been produced. Progress in this area will be looked at at the next inspection. Relatives confirmed that they saw and agreed care plans when they could comment on the care and support provided by the manager and staff, they said they felt their opinions were respectfully considered. A random check of residents finances held in the home on their behalf showed that receipts are kept for all transactions and a clear balance was evident. Records relating to servicing of equipment in the home were reviewed. All records were up-to-date and available for inspection. The implementation of health and safety within the home was satisfactory. All residents had personal risk assessments. Generic risk assessments were in place and reviewed regularly. A review of the fire log showed all tests, training and drills were being carried out to the Avon and Somerset Fire Brigade guidelines. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The responsible person must 28/08/2009 ensure a full assessment of needs is carried out and that they only admit a person to the home if they can meet their needs. This refers specifically to the readmission of people following a stay in hospital. 2 8 15 The responsible person must 28/08/2009 ensure that the changing needs of people are kept under constant review so that they can be referred for nursing care when their needs cannot be met by the home. This refers to the specific needs of people developing nursing needs whilst in a residential setting. Care Homes for Older People Page 27 of 29 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 1 The responsible person needs to ensure that the service user guide is made available in a suitable format for all people living in the home. The responsible person needs to look at ways of ensuring that the correct time gap between morning and lunchtime medications is maintained. The responsible person needs to identify when medication stock is running low so that people do not miss a dose of prescribed medication. The Responsible Person needs to ensure that the provision of locks on bedroom doors is clearly risk assessed and reviewed so that the persons changing needs are taken into consideration. The Responsible Person needs to identify areas of the home that require high cleaning as well as areas that need carpet treatment to prevent unpleasant odours. The responsible person needs to confirm the content of references that are addressed To Whom it May Concern, or references bought to interview by prospective staff. 2 9 3 9 4 24 5 26 6 29 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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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