Care Home: Paulmay Dementia Care

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What the care home does well `I have severe dementia as well as being unable to walk or move by myself. The staff are very attentive and move me into my bed for an afternoon nap. Whenever there is cause for concern the doctor is always sent for. The staff at the home have been here for several years so they all know the residents very well and care for each of us individually. Mr & Mrs Gurry are very nice people ( and the deputy is wonderful). All the staff are very caring.` This was the feedback from a relative writing on behalf of a resident and sums up many of the very positive aspects of the care provided at the home. The home provides a very warm and stimulating environment to people with varying degrees of dementia. As a result residents over time feel more secure at the home and this can be reflected in a reduction in the level of challenging behaviours presented by some individuals. The small size of the home means that a very personal family-like atmospere is created where each resident is seen as an individual in their own right. The home is particularly good at keeping residents as healthy as possible, and liaises closely with health professionals as and when needed. Relatives commented on the open and welcoming atmosphere in the home which meant that they too felt at home and relaxed whilst visiting. There is an experienced and committed team of staff who work hard to meet the needs and wishes of residents. There is a strong management team in place with considerable experience and expertise in supporting older people with dementia. All who work at the home are to be congratulated on the high standard of care provided. What has improved since the last inspection? The last key inspection took place in Juy 2007. All of the areas identified at that inspection for improvement had been dealt with. In addition the owners have continued to invest in new furniture, equipment and ongoing decoration of the home. Staff training has resulted in all staff achieving the NVQ Level 2 in caring for older people. Best practice methods, such as auditing the quality of the service using a personcentred approach to dementia care, have been introduced. As a result the home has significantly improved the standard of service provided. What the care home could do better: Three requirements have been made. The home must ensure there are satisfactory access arrangements for wheelchair users to the front and rear of the building. The home must also have an assessment made of the premises by a qualified professional to advise on how the building can be made as accessible and functional as possible to residents, especially those with significant mobility difficulties and other physical disabilities. The handbasin and radiator in the downstairs toilet must have thermostatic valves fitted so that the temperature of the hot water and the surface of the radiatior are always at a safe level. Seven recommendations are made to improve care practice further in the home. It is recommended that a simplified pictorial version of the Statement of Purpose and theService User Guide is made so that important information about the home is in as accessible a format as possible for potential residents. The registered persons should ensure that there is an annual audit of the medication arrangements in the home to ensure they are working as effectively as possible. The management team should also in their business plan for the home identify how choice can be increased for residents who wish to have a single room. The manager should investigate how best to maintain the posture and comfort of residents by the provision of suitable cushions, and the heights and types of seating used throughout the home. It is recommended as an extra precaution to safeguard residents` monies that two staff signatures are needed on records of their income and expenditure. The manager should also obtain an up to date assessment of fire safety arrangements in the home to ensure that the home`s fire safety plan takes account of the decreasing mobility and increasing frailty of residents, as well as any changes to existing fire doors. At the conclusion of the inspection the manager and owner indicated that they are keen to follow up all areas identified for improvement and recommendations made and that they are committed to a process of continuously raising standards within the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Paulmay Dementia Care 17 Dukes Avenue Finchley London N3 2DE     The quality rating for this care home is:   three star excellent 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: Brian Bowie     Date: 2 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 29 Information about the care home Name of care home: Address: Paulmay Dementia Care 17 Dukes Avenue Finchley London N3 2DE 02083463642 02083493424 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Marjorie L Gurry,Mr Kevin Gurry care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Paulmay is a large double fronted Edwardian semi-detached house situated in a quiet residential area of Finchley in North London. The home is registered to provide care for eight older people who have some form of dementia. The home has one single and one double room on the ground floor. There are three single rooms and one double room on the first floor. The home has a stair lift to the first floor. There is a large lounge/dining area on the ground floor leading to the well-maintained garden. The stated aim of the home is to provide professional and skilled care to residents. This is within a friendly, family atmosphere where freedom, choice and dignity are maintained. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. The current scales of charges range from 498-550 pounds per week. 0 0 Over 65 8 8 Care Homes for Older People Page 4 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: three star excellent 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 inspection took place over two days and was unannounced. This inspection was a key inspection and all the key standards were inspected. The inspection took eleven hours to complete. The inspection began at teatime so that the early evening routines in the home could be observed. The manager was interviewed and assisted with the inspection. All eight people resident in the home at the time of the inspection were seen and most residents spoken to. Time was spent with residents in order to get their thoughts and understand their experience of living at Paulmay Dementia Care. Some residents have difficulty communicating verbally. Throughout the inspection the way in which staff communicated with and supported residents was observed, as well as how residents got on with staff. We also interviewed staff to get their views and comments on the home, as well as speaking to a relative and a professional, both of whom have Care Homes for Older People Page 5 of 29 regular contact with the home. We were also helped with the inspection by an Expert by Experience. This is an individual who has had some experience of using services or has a relative who has received a care service. Relatives and care professionals involved with the home provided written feedback on what they thought about the home. We received surveys from 4 relatives, 8 members of staff, and a health professional. A wide range of records, including care plans, staff files and health and safety documents, were also looked at. The homes Annual Quality Assurance Assessment also provided considerable detail about the running of Paulmay Dementia Care. We would like to thank all the residents, relatives, and staff for their assistance with the inspection. What the care home does well: What has improved since the last inspection? What they could do better: Three requirements have been made. The home must ensure there are satisfactory access arrangements for wheelchair users to the front and rear of the building. The home must also have an assessment made of the premises by a qualified professional to advise on how the building can be made as accessible and functional as possible to residents, especially those with significant mobility difficulties and other physical disabilities. The handbasin and radiator in the downstairs toilet must have thermostatic valves fitted so that the temperature of the hot water and the surface of the radiatior are always at a safe level. Seven recommendations are made to improve care practice further in the home. It is recommended that a simplified pictorial version of the Statement of Purpose and the Care Homes for Older People Page 7 of 29 Service User Guide is made so that important information about the home is in as accessible a format as possible for potential residents. The registered persons should ensure that there is an annual audit of the medication arrangements in the home to ensure they are working as effectively as possible. The management team should also in their business plan for the home identify how choice can be increased for residents who wish to have a single room. The manager should investigate how best to maintain the posture and comfort of residents by the provision of suitable cushions, and the heights and types of seating used throughout the home. It is recommended as an extra precaution to safeguard residents monies that two staff signatures are needed on records of their income and expenditure. The manager should also obtain an up to date assessment of fire safety arrangements in the home to ensure that the homes fire safety plan takes account of the decreasing mobility and increasing frailty of residents, as well as any changes to existing fire doors. At the conclusion of the inspection the manager and owner indicated that they are keen to follow up all areas identified for improvement and recommendations made and that they are committed to a process of continuously raising standards within the home. 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 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed information about the home is available so that residents and families know what they can expect from Paulmay Dementia Care. People moving into the home can be confident that their needs and wishes will be fully assessed and an appropriate plan for meeting these needs will be drawn up. As a result their needs are met. Evidence: When we visited we were very happy with the reception we got and the look of the home. This was the comment of one relative. The statement of purpose and service user guide are both clear and comprehensive and provide useful information to prospective residents. It is recommended that a simplified pictorial version of these documents is made so that important information about the home is in as accessible a format as possible for potential residents. Care Homes for Older People Page 10 of 29 Evidence: We looked at the case notes for three people living in the home. Each person has a detailed assessment provided by an appropriate care professional such as a social worker. In addtion the home uses an assessment checklist which is very comprehensive and was completed for each person. From this assessment a detailed care plan is drawn up indicating how each area of need is to be met. The main need of the people at the home relates to their dementia. The staff training records show that all staff have received training on dementia which equips them to carry out their work appropriately. The staff were also observed to have good understanding of the needs of people with dementia and were able to support them appropriately with complex and at times challenging behaviours. The care plans cover all essential areas with an emphasis on achieving specific goals. As a result residents and relatives can be confident that the residents needs and wishes will be identified and responded to by the home. Care Homes for Older People Page 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide detailed information so that the needs of residents are met. Residents health needs are met by the careful attention paid by staff at the home. The home is good at ensuring there are safe and effective arrangements in place in relation to medication. Staff are good at treating residents with respect. Evidence: Paulmay Dementia Care provides person-centred care, friendly staff, and a home-like environment. This was the comment of a health professional who knows the home well. The care plans are based on the needs and wishes of each resident from their initial assessment. They clearly record what each resident needs from the care staff. The care plans are comprehensive and include physical health, personal care, dietary needs, communication skills, mobility, religion and culture and care needs at night. In addition the manager has trained staff to adopt a person-centred approach that emphasised the individuality of each resident. Each resident also has a risk assessment Care Homes for Older People Page 12 of 29 Evidence: so that each resident is as safe as possible. They all have a moving and handling assessment designed especially for people with dementia. A nutritional assessment is also available. The care plans and risk assessments are reviewed on a monthly basis. The residents case notes are well organised and easy to follow. Daily reports are also completed for each resident. It was observed that some of the people living in the home show aggressive behaviour linked to their dementia. The care plans contain guidance on how this should be managed, and the staff were observed supporting people in a kind, patient and appropriate manner. A professional who has regular contact with the home said: My client has settled well here. They are less agitated now. Ive worked with the home for years and they work hard to support people with some very difficult behaviours. There is a clear record of the healthcare input received by each resident and these records reflect their individual needs and demonstrate close working with other care professionals. Each resident is seen as needed by the homes GP, as well as having domiciliary visits from a dentist and optician, with chiropody available if required. As a result of the quality of the care plans and the close attention paid to peoples heath needs the residents experience of Paulmay Dementia Care home is of a caring and supportive environment that responds in a sensitive and skilled way to their individula needs and wishes. The home is to be congratulated on the high standard achieved in these important areas. We looked at the medication system in the home. The home does not use a monitored dosage system. The manager explained that they had an excellent service from the pharmacist who visits the home and provides training for staff. It is recommended that the pharmacist does an annual audit of medication arrangements in the home to ensure they are working as effectively as possible. The home has larger than usual medication charts so that they are easier to fill in and check. These include a photo of each resident. The medication received in the home is recorded on MAR (medication administration record) sheets. These sheets had been completed correctly. Staff have all received medication training. As a result residents are protected by medication arrangements in the home. Throughout the inspection the staff supported people in the home with their personal care, meals and moving around the home. This was done in a manner that respected peoples privacy. Residents can see visitors in their bedroom or in the lounge. Staff knocked on peoples doors before entering. Care Homes for Older People Page 13 of 29 Care Homes for Older People Page 14 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. The home is good at making residents feel at home and comfortable and that their cultural and religious needs are met. Residents are benefitting from a range of stimulating activities. The home is good at welcoming and encouraging relatives to be actively involved with the residents at Paulmay Dementia Care. Residents benefit from having choices about how they lead their life at the home. Residents have nice food in nice surroundings with their individual preferences catered for. Evidence: Staff are good at treating people as individuals, for example residents birthdays are celebrated in the home. Religious needs are responded to so that a minister from the Roman Catholic church visits the home. The residents were seen to enjoy having the homes pet cat around. Cultural needs are responded to with two of the residents particularly enjoying the Irish music that was being played on the day of the inspection. The Expert by Experience observed the morning activity session involving dancing, music, puzzles, and sorting objects. The Expert by Experience commented that: Care Homes for Older People Page 15 of 29 Evidence: The expressions on peoples faces while dancing and singing showed obvious enjoyment. Reminiscence work is carried out, with one resident being helped to identify family members in their photo album. The Expert by Experience considered that the staff to resident interaction is exceedingly good with residents benefitting from the good staffing levels. One resident said: There are a lot of fun activities we can join in if we want to. A relative wrote on their feedback form: My relative has their nails done, and their hair done. They enjoy the music, sing-songs and parties. As a result of the individual and group stimulation provided residents are helped to maintain concentration levels. In turn this is promoting each residents level of wellbeing. Residents and relatives both appreciate the welcoming atmosphere in the home that helps to put everyone at their ease. Most residents have family members visiting regularly. The owner explained that the home had always had an open door policy so that relatives are free to visit whenever they want. Relatives spoken to said they found the staff at the home particularly welcoming and attentive to their, as well as the residents needs. Residents are offered choices in how they spend their time. Two people prefer to spend much of their time in their, and staff were seen to be checking regularly on their welfare. The residents are able to express choices about when they get up and when they eat. On the day of the inspection residents ate their lunchtime meal a little later than usual since some had slept later, indicating that routines in the home can be flexible to meet the needs of residents. The Expert by Experience noticed that, when offered hot drinks, residents had a choice of tea or coffee which was then served with biscuits on a separate tray for each resident. We spoke to residents about food in the home. They said they enjoyed the meals. We looked at the record of food provided in the home and this was traditional and nutritious. Lunch took place in a relaxed manner. The needs of residents who needed a finely chopped meal were appropriately met. It is recommended consideration is given to pureeing separately the different elements of the meal for people who need food in this form. A choice of meal is available as required. Care Homes for Older People Page 16 of 29 Evidence: They try different ways to get my relative to eat. This was the comment of one relative and indicates that staff work hard at encouraging people who may at times not wish to eat to take in some nutrition so they keep as healthy as possible. Another relative wrote on their feedack form: The meals are very nice-my relative always enjoys their food here. I would enjoy the food here myself- I have been here at mealtimes and it always looks delicious. 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. The residents benefit from complaints and safeguarding adults procedures that make sure that they are safe and secure whilst at the home. Evidence: I have no concerns about the care of my relative at Paulmay Dementia Care. This was the comment of a relative who visits the home regularly. The complaints procedure is available in the service user guide and includes details of who complainants can contact. We looked at the record of complaints. There had been one complaint since the previous inspection. This had been investigated and resolved. Staff training records show that all staff have attended in-house training on the protection of vulnerable adults. We spoke to a member of staff who showed an understanding of what to do if an allegation or incident of abuse took place. The home has a copy of Barnets adult protection policy and procedures. The manager and deputy were due to go on safeguarding adults training to ensure they kept their knowledge and practice in this area up to date. The home has not had to make any safeguarding adults referrals in the past year. As a result of the training and support staff have in safeguarding adults residents are kept safe at the home. Care Homes for Older People Page 18 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. Residents at Paulmay Dementia Care enjoy an attractive, comfortable and cosy living environment that adds considerably to their quality of life. The lack of an accessible living environment makes it more difficult for residents to move freely around the home. Residents are protected by the high standards of cleanliness and hygiene in the home. Evidence: Paulmay Dementia Care is a large double-fronted semi-detached house over two floors. The home has an attractive and well-maintained garden at the rear, with a pleasant patio area with seating available. The communal area in the home consists of a combined lounge and dining area. This comfortably seats all the residents. The decoration is traditional and in good order, with new carpeting, furniture and equipment purchased over the past year. The home is not suited for people with severe mobility issues. The downstairs toilet has two steps to get into it. The access to the rear garden is by external steps. The one bathroom in the home is on the first floor and requires people with mobility problems to use the stairlift. Access issues were highlighted by the Expert by Experience being a wheelchair user. In order to comply with the Disability Discrimination Act the home must be accessible to people who use wheelchairs. This is particularly important since some residents now need a wheelchair when going out and sometimes within the home. These issues were discussed with the Care Homes for Older People Page 19 of 29 Evidence: manager and the owner of the home who had already been considering how best to make the home more accessible. In the short term the home must ensure there are satisfactory access arrangements for wheelchair users to the front and rear of the building. The home must also have an assessment made of the premises by a qualified professional to advise on how the building can be made as accessibe and functional as possible to residents, especially those with physical disabilities. The Expert by Experience considered that the posture of residents could be enhanced by improving cushioning arrangements on the chairs in the lounge. It is recommended that the manager investigates how best to support residents by the provision of suitable cushioning, and by ensuring that the type and height of seating throughout the home is appropriate for residents. Currently there are two shared bedrooms in the home. A relative said: My relation gets on well with their room-mate. My relative likes to share and they feel they are looking after their room-mate. When vacancies arise residents are offered a single room if they would prefer this. When the home is at full capacity there are limited opportunities for this to happen. It is therefore recommended that the management team in their business plan for the home identify how choice can be increased for residents who wish, or need, to have a single room. The home is always spotlessly clean. The home is always clean and so are the patients-it never smells. These were the comments of relatives who visit the home very regularly. Throughout the inspection the home was clean and hygienic. Staff confirmed there is a weekly collection of clinical waste. Staff work hard to deal with the cleaning and hygiene issues presented by residents with continence issues. Care Homes for Older People Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel secure and well looked after at Paulmay Dementia Care because their needs are met by the committed and experienced team of staff at the home. Residents are protected by the homes rigorous recruitment procedures for new staff. Residents enjoy a very good quality of life because staff are both caring and competent and have the training they need to support people well. Evidence: I am very pleased with all the staff and they work very hard. I feel I can talk to them if I have a problem. This was the view of one of the residents. A relative wrote: We are very happy with the staff- they are always very helpful and always listen if we have any concerns. The staffing structure in the home consists of the manager, deputy manager, two senior carers and a team of carers. There are eleven staff on the staff team, including the manaager. The staff rota was inspected. There is one main day shift from 9am to 9pm with three care staff on most of the time. The manager is also around to provide extra support as needed. Agency staff are not used. A member of staff said: Care Homes for Older People Page 21 of 29 Evidence: We have never been short of staff since I joined the home hence we meet individual service users needs. The manager confirmed that all staff have completed their NVQ Level 2 in caring for older people and eight are studying for level 3. This is a significant achievement for a small home. As a result of the homes commitment to training the residents receive more effective and skilled support from the staff team. Staff turnover at the home has been exceptionally low, with most staff having worked at the home for a number of years. The recruitment records for one newer and one more established members of staff were inspected. Both had completed the necessary recruitment checks including a CRB (Criminal Records Bureau) disclosure and two written references. Written feedback from staff confirmed that they get a comprehensive induction when they start working at the home so they know from the start how to support residents appropriately. As a result residents are protected by the procedures the home has in place when employing staff. The manager is very experienced and knowledgeable in the care of older people. She trains the staff on dementia and is familiar with current good practice in this area, for example how to implement a person-centred approach to supporting people with dementia that emphasises peopes needs and wishes and individuality. As a result staff support residents in a way that promotes their well-being as well as managing effectively the challenges of some residents behaviour at times. Staff also have regular team meetings that keep the staff up to date on changes within the home, as well as any issues in relation to residents. Care Homes for Older People Page 22 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. Residents benefit from having the home run by a manager who is very experienced and qualified to manage a care home. The home acts on the feedback from residents, their families and other key parties. In general the home has good health and safety procedures to ensure the residents are kept safe and secure, however these must include arrangements for the closer monitoring of temperatures of the water and heating in the home so that residents are protected at all times. Evidence: Here its so lovely- my relative is very well looked after-Id like to come here myself! This was the comment of one of the relatives. The manager, Marjorie Gurry, is also one of the owners of the home. She has the appropriate skills and experience, including a MSc in Psychology and a MA in Care Management. She is committed to achieving high standards within the home, especially in healthcare, as well as making sure residents are looked after well. One member of staff said: Care Homes for Older People Page 23 of 29 Evidence: The service makes residents feel at home and being loved and cared for by people who enjoy what they are doing. Both the inspector and the Expert by Experience judged that the existing layout of the building contributes to the very homely and family-like atmosphere in the home and that this adds considerably to the residents quality of life. However the layout and lack of space also presents particular problems for people with significant mobility problems, especially those who use wheelchairs. Mr and Mrs Gurry acknowledged these factors and are considering their options to reduce these shortcomings. It is recommended that the home produces a business plan identifying ways in which current building limitations can be minimised so that people they support have as accessible a living envioronment as possible, as well as considering other alternative solutions. Written feedback from relatives about the home was very positive. The manager had completed the AQAA ( Annual Quality Assurance Assessmnent) which provided detailed information about the running of the service and areas needing improvement. Residents meetings are held regularly so that residents can contribute their ideas on how the home is run. As a result the home is run in a way that is always trying to improve further the service on offer and is responsive to the key parties involved, especially the residents. Another member of staff had written: The service always takes the service users needs as a priority so it gives its staff the right support, training and knowledge in order to meet the needs of people under their care. This helps the service users to live a full and happy life. The manager explained that the home only holds small amounts of money for a few of the residents. Records relating to residents finances were clear, up to date and accurate. It is recommended as an extra precaution to safeguard residents monies that two staff signatures are required on records of income and expenditure. A range of records was looked at, including health & safety and fire safety. These records were detailed, up to date and accurate and confirmed that the home is being run responsibly with essential checks being made and acted on. The home had current certificates covering gas, electricity and legionella testing. A fire evacuation procedure is in place and displayed around the home. A fire safety risk assessment is also in place and kept under review. Fire drills take place three monthly. The hot water from the handbasins in the upstairs and downstairs toilets was too hot, as was the radiator in the downstairs toilet. These were all adjusted to a safe temperature during the inspection. The handbasin and radiator in the downstairs toilet must have thermostatic Care Homes for Older People Page 24 of 29 Evidence: valves fitted so that their temperatures are always at a safe level. The front door is kept locked in order to safeguard residents and this lock is linked into the alarm system and will release as needed. It is recommended that an up to date assessment by the LFEPA (London Fire & Emergency Planning Authority) of fire safety arrangements in the home is obtained to ensure the homes fire safety arrangements take account of the decreasing mobility and increasing frailty of residents, as well as any changes to existing fire doors. 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 19 23 The manager must ensure 31/01/2009 there are satisfactory access arrangements in the home so that residents and visitors with mobility problems can access the home. To enable people in wheelchairs to be able to access the home. 2 22 23 the manager must ensure an 31/01/2009 assessment is made by a qualified professional on how to make the environment at the home as accessible as possible for residents and visitors. To ensure that residents with mobility problems can get around the home as easily as possible. 3 38 13 The manager must ensure that thermostatic valves are fitted to the handbasin and radiator in the downstairs toilet so that temperature of the hot water and the 31/01/2009 Care Homes for Older People Page 27 of 29 surface of the radiator is always at a safe level. To ensure residents safety is maintianed. 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 It is recommended that a simplified pictorial version of the statement of purpose and the service user guide is made so that important information about the home is in as accessible a format as possible for potential residents. It is recommended that the pharmacist does an annual audit of medication arrangements in the home to ensure they are as effective as possible. It is recommended that the home investigates how best to support residents by the provision of suitable cushions, and the heights of and types of seating used throughout the home. The management team should identify in their business plan for the home how choice can be increased for residents who wish to have a single room. The home should produce a business plan idenitifying ways in which the current building limitations can be minimised so that residents have as accessible a living environment as possible, as well as considering alternative solutions. Two staff signatures should be required on records of residents income and expenditure. The home should obtain an up to date assessment by the LFEPA of fire safety arrangements in the home to ensure that the homes fire safety arrangements take account of the decreasing mobility and increasing frailty of residents, as well as any changes to existing fire doors. 2 9 3 22 4 23 5 32 6 7 35 38 Care Homes for Older People Page 28 of 29 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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