Care Home: Pilling Nursing Home

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What the care home does well The manager has worked at the home for about 19 years, and in that time has led the continued development both of the environment, and the standard of care provided to people who live at the home. She has a good understanding of what `best practice` is, and stands as an excellent role model for the staff she leads. "We can talk to matron about any problems we have and she will try and find an answer" said a staff member. "The home is forward thinking and always striving to improve wherever possible. It`s a good place to work", said another staff member. "Excellent staff and matron, could not expect better", said a relative. The manager has a competent and experienced deputy manager, and long term experienced staff who lead by example with good practices, encouraging the same in younger staff. Varied training courses are available for all staff. The home holds the Investors In People award, which shows a commitment to developing staff. Assessments and care plans are detailed, showing staff how to best look after people living at the home. They show all areas of need, and preferred daily routines. Daily records are detailed and complete. Visitors are welcome at any time, and communication between the manager, staff, residents and their families is continuous, with the manager always making herself available. We saw staff in the home taking time with residents as they went about their work. Residents often called into the managers office to ask about things and we saw many walking around the home going from lounge to lounge, with staff chatting or having a comforting hug with residents. Residents were tactfully helped with personal care tasks. Visitors called in through the day, making themselves at home, with some helping their relatives at lunchtime, and some joining in the activities with them. One staff said "A family home atmosphere is promoted, and the home is like one big family for both residents and staff". An activities coordinator provides interest every week-day afternoon, with music and singing, crafts and games. Entertainers sometimes visit, and ministers from different denominations regularly call. Meals are home-cooked, varied, with well-balanced choices. "We have observed that the cook tries hard to please the residents, providing special meals if needed", and "Meals are very hot and tasty", were two comments from relatives. "Jolly good meals", said a resident, "only fools would turn them down". The outside and inside decoration of the home appears well maintained, and the manager said that the maintenance of the home is ongoing to keep a good standard to the environment people live in. All of the home was clean, tidy and homely at this visit. What has improved since the last inspection? The laundry floor has been replaced, and is now easy to clean and water resistant. Wheelchairs we saw seemed clean, maintained, and used correctly. Decoration around the home has been ongoing, with some bedrooms beingredecorated and re-carpeted on a rolling plan. A high dependency bath has been installed. A new flat screen television has been wall mounted in one lounge, as it is less of a hazard to people with dementia. A member of staff now accompanies the matron when she carries out pre-admission assessments. This makes the carer familiar to the resident, and hopefully makes admission an easier process. Administration staff have been employed to work at the home. This allows the matron to be more involved in the care provision and staff supervision. What the care home could do better: The manager needs to ensure the individual care plans and assessments are regularly audited to make sure they consistently hold clear information about individual need, so that staff are able to provide the right care, and interventions when necessary. The recorded care provided should include when people have received a bath or shower, linked to the planned bathing chart. The care plans need to include more detail on social interests to help direct activities and stimulation of residents, particularly for people with dementia. The odour noted in some bedrooms needs to continue to be monitored, and the planned action addressed as soon as possible, in liaison with the residents and relatives. This is to ensure people continue to live in a pleasant environment. Staff supervisions and appraisals should always be regular and up to date. The manager should complete the Annual Quality Assurance Assessment (AQAA) so that it holds more detailed information about how the home operates and is developing, linked to the National Minimum Standards for Care Homes for Older People. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Pilling Nursing Home Smallwood Hey Road Pilling Lancashire PR3 6HJ     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: Jennifer Hughes     Date: 1 5 1 2 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. 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 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Pilling Nursing Home Smallwood Hey Road Pilling Lancashire PR3 6HJ 01253790010 01253790010 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Pilling Care Homes Limited Name of registered manager (if applicable) Mrs Sandra Connelly Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 15) Dementia - Code DE (maximum number of places: 14) The maximum number of people who can be accommodated is: 29 Date of last inspection Brief description of the care home Pilling Care Home is purpose built, providing residential and nursing care, and also care to people with dementia. The home has its own ample sized car park to the front, and has a good sized garden area to the rear, with outside seating to use in warm weather. It is situated in the rural village of Pilling, with the local shops a short walk away, and the small towns of Garstang and Knott End a short drive away. It has been equipped to suit the needs of its residents, for example there is a passenger lift, assisted baths, Care Homes for Older People Page 4 of 28 14 0 Over 65 0 15 care home 29 Brief description of the care home and ramps at entrances. It is two storey, with single and double rooms sited on both floors, and toilets and bathrooms conveniently located. There is sufficient communal space, with two lounges and two dining areas. Staffing is provided over 24 hours, every day of the year. At December 2008, the fees ranged from £390.00 to £521.00 per week. Further details are available from the manager. Care Homes for Older People Page 5 of 28 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: This was an unannounced visit to the home, in that the owner and manager were not aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 6 hours. During the visit we (Commission for Social Care Inspection) spent time speaking to residents, staff, and the manager. We also spoke to some visitors. Every year the registered person is asked to provide us with written information about the quality of the service they provide, and to make an assessment about the quality of Care Homes for Older People Page 6 of 28 their service. It also asks about the managers own ideas for improving the service provided. We use this information, in part, to focus our assessment activity. Surveys were sent and received from residents and their relatives, and staff from the home. During the site visit, staff records and residents care records were viewed, alongside the policies and procedures of the home. We also carried out a tour of the home, looking at both private and communal areas. Everyone was friendly and cooperative during the visit. What the care home does well: What has improved since the last inspection? The laundry floor has been replaced, and is now easy to clean and water resistant. Wheelchairs we saw seemed clean, maintained, and used correctly. Decoration around the home has been ongoing, with some bedrooms being Care Homes for Older People Page 8 of 28 redecorated and re-carpeted on a rolling plan. A high dependency bath has been installed. A new flat screen television has been wall mounted in one lounge, as it is less of a hazard to people with dementia. A member of staff now accompanies the matron when she carries out pre-admission assessments. This makes the carer familiar to the resident, and hopefully makes admission an easier process. Administration staff have been employed to work at the home. This allows the matron to be more involved in the care provision and staff supervision. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear information about the home is provided which enables people to make an informed decision about their admission to the home. The comprehensive assessment that is carried out for all residents means that a service is provided that is tailored to an individuals needs and preferences. Evidence: Information about the home is available initially in a short brochure to outline briefly the service the home provides. A more detailed brochure informs on residents rights, philosophy of care, the homes mission statement, equal opportunity policy and the terms and conditions of staying at the home. Easier to read information is available for residents regarding day to day living at the home. This information is constantly being updated and improved. Individual records are kept for each of the residents, with a set procedure for admitting someone to the home. A comprehensive pre-admission Care Homes for Older People Page 11 of 28 Evidence: assessment form was seen on three selected files. These are used by management to check that staff in the home are able to give the appropriate care to each person, before the decision is made that the home is the right place for them to live. The manager carries out the initial assessment of need, and is accompanied by another staff member. This makes the carer familiar to the resident, and hopefully makes the admission a little easier, and more person centred. All staff read the assessment prior to the resident being admitted, as well as being informed by the manager. A care plan is devised from the assessment, informing staff of what care the person needs, and how to carry out that care. Staff were able to discuss the relevance of peoples past experiences to their current needs, showing that the care focused on individual need. All of the survey responses from residents stated that they had plenty of information about the home before they arrived, and always received the care and support they needed. Staff surveys said that they always had up to date information about residents. We have a handover about every resident before every shift, stated one survey. Care Homes for Older People Page 12 of 28 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. The health and personal care needs of residents are well met in this home. Residents benefit from the support of healthcare professionals. Evidence: We randomly chose three residents files to case track during this visit. We saw that they all had current care plans in place, identifying the areas of need for each person. The manager is in the process of updating all of the risk assessments and staff instructions, and we saw that these give very good information and address any interventions needed to diffuse difficult situations. We saw that all of the care plans were reviewed every month by qualified staff, updating any changes in the care required. The manager needs to make sure she audits these regularly to make sure they are clear for staff to follow, and there is a clear path to follow on changing needs and changing care provision linked to that need. A bathing chart was available, but it was not always recorded when residents Care Homes for Older People Page 13 of 28 Evidence: refused this, and if it was done at another time. The home follows the good practice of photographing any poor skin areas needing treatment as soon as it has been noted. This way progress can be monitored, and there is evidence of the care provided. All of the staff we spoke to were well informed on how to look after people in the home, and their particular needs. The home meets the individual needs of the different kinds of residents said one staff member. We feel that staff use their common sense and initiative, they listen and act on any requests, said a relative on a survey. Records of visits from health care professionals such as GPs, Community Psychiatric Nurses, and chiropodists, clearly note the reason for the visits, and the action by staff in response to it. We saw the manager and staff dealing with relatives about a sensitive situation, showing empathy, and making the relatives feel secure and confident in the actions to be taken. The manager confirmed that the medication procedures have not been changed since the last visit, and the qualified staff who administered medication continued to follow guidance given by the pharmacy inspector. Records we viewed were up to date and complete. The manager confirmed she regularly audits the medication and the records. Im very happy with the home, said one relative, My relative is off the drug completely that she was given at the other place. The atmosphere is great here. There is a dementia unit, but everyone joins in together and are free to wander. We visit the home nearly every day, and find the matron and her staff to be very hardworking, kind, helpful and supportive, said another relative. Care Homes for Older People Page 14 of 28 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. Meals are nutritious and mealtimes relaxed, which encourages people to enjoy food and mealtimes. There are varied activities, and most people are stimulated and motivated by joining in. Evidence: During observation over lunch time, we saw staff making sure all of the residents had their meals, and tactfully monitoring that they were able to eat them. Positive encouragement and assistance was given to those who needed it most, while more able residents were politely given their chosen meal to eat with minimal assistance. Some visiting relatives liked to help their relatives over meal times, and also enjoyed the same meal while they were there. Some residents stayed in the lounge to have their lunch, and staff chatted as they helped at the speed the residents wanted to go. There is a varied four week menu in place, with plenty of choice. Residents are asked every day by the cook what they would like from that days choice. The cook said she was happy to make something else if there was nothing suitable. The main meal at this visit was chicken goujons, chips and peas, or cheese and onion Care Homes for Older People Page 15 of 28 Evidence: pie with leeks, followed by sponge and custard. Corned beef hash was prepared for tea. Birthdays and special occasions are celebrated with buffet teas and cakes. Residents and relatives we spoke to agreed they enjoyed them. I know my relative is well loved and cared for here, was a comment. The home respects the individuals in the home, and we saw one resident call at the managers office wanting some breakfast, as she had just got up at mid morning. Staff gently helped her, and made sure she had the breakfast she wanted. A designated activities coordinator works every weekday afternoon, providing various activities. A musical afternoon took place at this visit, with plenty of singing and swaying and encouragement to join in. She respected the rights of people who were not interested. Reminiscence sessions are always popular, and individual attention with board games are enjoyed. Most care plans included some information on social interests, although more detail could be included to help direct activities and stimulation, particularly for people with dementia. Some care plans seem to be directed at the clinical areas of care only. Staff we spoke to were able to tell us what residents enjoyed doing in the home. The home has purchased a car, which allows staff to take a couple of residents at a time out for trips to shops and cafes if they want a change. A hairdresser visits, the mobile library, outside entertainers, and ministers from different churches call regularly. One relative said My mother has been resident for nearly 10 years. That is testament to the care and attention she has received. Care Homes for Older People Page 16 of 28 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 are confident all of their concerns will be listened to and acted upon. Staff have a good understanding of safeguarding issues, which protect people who live at the home from abuse. Evidence: There is a complaints procedure in place, with a complaints book to record any complaints which may have come to the managers attention. There has been one complaint since our last visit about the care provided by staff to one individual. We saw that the home has addressed the issues raised, in full liaison with the complainant, who was satisfied with the actions taken, and social services. The home was given guidance on the timescale on responding to complaints, and the manager has provided training to staff to ensure this is followed in her absence. The home is forward thinking and always striving to improve wherever possible, said a staff member. A relative said My mother finds the home very comfortable, the staff are always kind and helpful. They are cheerful and treat her as an individual person. She has no complaints. Responses from surveys showed that relatives and people living in the home know how to make a complaint. Care Homes for Older People Page 17 of 28 Evidence: Staff confirmed they attend abuse awareness training, and were clear on what to do if they had any concerns about a persons welfare. We noted further training for staff in how to deal with challenging behaviour. People at the home said they felt safe and well looked after. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment in this home is kept at a good standard. It provides people with a welcoming and homely place to live. Evidence: The garden area at the back of the home is neat and tidy, and a seating area makes it a nice place to be in warmer weather. The garden backs onto open fields, where goats and horses graze, and the home is based on a quiet lane, so residents have a peaceful place to sit or walk around. Maintenance is ongoing, with continued decoration and refurbishment where necessary. We saw that a couple more bedrooms had been decorated since our last visit, and a bathroom and the laundry have new flooring. New bay windows have been installed at the front of the home. Daily issues are reported by staff, with the maintenance man dealing with them as soon as possible. All tests of lighting, fire alarms, nurse calls and water temperatures are carried out very regularly, with clear records made. At this visit the nurse calls were out of order. The manager had immediately put a contingency plan in place to ensure all residents Care Homes for Older People Page 19 of 28 Evidence: were very regularly checked while the nurse calls were being repaired. This was completed that day. The two lounges, dining rooms, bedrooms and bathrooms were all clean and tidy. I have lots of my own things in my room said a resident. We saw all of the bedrooms were very personalised. We noted some odour in some bedrooms. The manager said she was aware of this, and along with monitoring the residents care needs, she also showed us flooring samples she was considering that would be easier to keep fresh than carpeting. This decision would be in liaison with the residents and their families. She had also purchased specialised air freshening equipment. Grab rails, assisted baths, lifting and bathing hoists, and raised toilet seats all go towards helping the mobility of people around the home. The laundry is small, but an organised system is used by staff, to try and make sure peoples clothing is cleaned and returned efficiently. Training and procedures are in place for staff, to make them aware of the best ways of working to keep themselves, and the people in the home, safe. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home operates a good recruitment policy, which ensures that only people suitable to this type of work are offered an appointment. Training is provided, and this means that residents receive appropriate care and attention. Evidence: Personnel files of two staff showed that the necessary recruitment checks had been carried out, to ensure the protection of residents. References and Criminal Records Bureau disclosures were available. The manager confirmed that for nursing staff professional qualifications are also checked. The manager and the administration support ensure all the information is complete before the new staff start work. Documents state that the home is an equal opportunities employer, and staff sign to ensure this is implemented. All staff undergo a comprehensive induction that is signed and dated by the manager when completed. The staff we spoke to said they shadowed more experienced staff when they first started work at the home. The staff group are a mix of qualified nursing staff and care staff, experienced, or young and enthusiastic, both male and female. The workforce also includes some overseas staff. Student nurses and student social workers also sometimes work on Care Homes for Older People Page 21 of 28 Evidence: placement at the home. Most of the staff tend to be long-term. Training is always available. I feel the home gives me all the support I need, said a staff member. Ongoing training for staff is in place, both in mandatory subjects such as moving and handling, fire safety, infection control and abuse awareness, but also additional information such as challenging behaviour, dementia awareness, and confidentiality. Courses are also provided for qualified staff to ensure they are updated. All staff have had training in the content of the Mental Capacity Act. 75 of the care staff hold National Vocational Qualifications. The rotas showed appropriate numbers of qualified and unqualified staff on duty through the day and night. The manager confirmed she constantly assesses the numbers of staff linked to the needs of the residents. Care Homes for Older People Page 22 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems for consulting with residents and their families are good, with a variety of evidence that residents views are sought and acted upon. Systems and practises in the home protect the health, safety and welfare of the people using the service. Evidence: The registered manager is long standing at the home, with many years experience of running a care home. She holds nursing qualifications. The manager said that she tries to regularly audit records to ensure they are complete and consistent. We noted that some care plans did not give the staff clear guidance on the care to provide, or interventions to use to diffuse difficult situations, although when we spoke to staff they were able to discuss the correct procedures. Some plans also did not always address the social aspect of the care in full, and how to best stimulate an individual, although staff spoken to knew what residents enjoyed doing. The manager needs to allow time to audit the assessments and care plans, to make Care Homes for Older People Page 23 of 28 Evidence: sure written records are clear in their instruction to staff. The manager has further developed the recording system with the addition of a Minor Incident Book, where records are held for all residents, to be able to more easily identify patterns of behaviour, and so address them as necessary. My mother finds the home very comfortable, the staff are always kind and helpful. They are cheerful and treat her as an individual person, said a relative. Another relative said that they feel very involved in everything happening at the home. Staff are supervised informally on a daily basis, and regular formal supervision also takes place. The manager said that staff appraisals needed updating, a comment confirmed in a survey by a staff member who said she had not had an appraisal for a long time. Both the manager and her deputy have recently attended appraisal training, and intend to put it to use. An annual survey is used by the home to residents and their families, to help with feedback about the service provided. The last survey in 2008 gave very positive responses, saying they were confident in the care, the standard of care was good, staff had good attitudes, the atmosphere was pleasant and friendly, there was good food and entertainment and clean comfortable beds. Possible improvements suggested were regarding new chairs, and more biscuit choices. Relatives called into the home through the day. They were very comfortable speaking to the manager and staff who always gave time to visitors, and also to residents who occasionally stopped at the managers office to ask something. Staff meetings are held every month, discussing items such as activities, training and any refurbishment due. Staff are also involved in decisions, and helped choose some equipment they would be using with residents. There are monthly staff meetings, and an open door policy, confirmed one staff member. We saw the manager also working with staff providing hands-on care when necessary. This gave opportunity to lead by example showing best practice. Monthly resident meetings, which used to be held, are planned to be made regular again, and we saw the notice explaining this. Residents and their relatives will be invited to these. Records show regular fire training for staff, and the manager confirmed that the maintenance and servicing of equipment was up to date. Care Homes for Older People Page 24 of 28 Evidence: There was no change in the financial procedures of the home. The home has no involvement with residents finances unless they lack capacity and there is no other representative. The home returned the Annual Quality Assurance Assessment document when we asked for it. It held some basic information about the home, and we discussed with the manager how to include more relevant information, linked to the National Minimum Standards for Care Homes for Older People and the procedures of Pilling Care Home, to give us a good picture of how the home operates and is developing. Care Homes for Older People Page 25 of 28 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 28 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The care plans and assessments should be regularly audited to make sure they hold clear information about individual need, for staff to be able to provide the right care, and interventions where necessary. Staff should ensure the records of care provided includes monitoring when people have received a bath or shower, linked to the planned bathing chart. The care plan should include more detail on social interests to help direct activities and stimulation, particularly for people with dementia. The odour noted in some bedrooms needs to continue to be monitored, and the planned action addressed as soon as possible, in liaison with residents and relatives. The AQAA should be completed to hold more detailed information about how the home operates and is developing, linked to the National Minimum Standard for Care Homes. The manager should ensure all staff supervisions and appraisals are up to date. 2 8 3 12 4 26 5 33 6 36 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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