Care Home: Rose Villa Care Home (N) Limited

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What the care home does well The home always made sure that people had an assessment before they were admitted and obtained assessments and care plans completed by the local authority. This helped them to be sure they could meet peoples` needs. The care plans and risk assessments they produced were detailed and gave staff plenty of information although information could be streamlined more. The home provided a good quality of life for people with plenty of activities to keep them occupied. Staff also ensured that residents were able to make choices about their lives. People who lived at the home stated they liked the meals and drinks provided. Alternatives were available if they did not like what was on offer for the main meal. One person stated in a survey, `the cook always tries to oblige`. The home provided a clean, pleasant and homely environment for people to live in. It had a friendly feel and people were able to bring in small items of furniture, pictures and ornaments to personalise their bedrooms. The staff were described as friendly and very helpful and they knew the residents needs well, `everything he needs is seen to` and `I was looked after when I had a fall`. The home has a good record of training regarding national vocational qualification in care at level 2 and 3. More than 56 percent of care staff are trained to this level with further staff progressing through the course. Complaints were dealt with quickly and sensitively, and staff are aware of what to do if they witness any incident or poor practice that concerns them. The home in general, and residents finances, are well managed. Residents and staff are consulted in meetings about how the home is run. What has improved since the last inspection? The way the home manages medication has improved and nursing staff displayed good practice when ensuring residents received the medication that was prescribed for them. Wound care charts have improved and staff now record a description of any wound so progress can be monitored. An annual development plan has been produced to ensure that the quality of care provided is monitored and planned for systematically. There have been lots of improvements in the environment both internally and externally. Rooms have been decorated, recarpeted and new furniture purchased. Two new shower rooms have been installed and two large televisions purchased for the two lounge areas. New dining room furniture is in place. What the care home could do better: The home had lots of different places to record the care provided to people during the day. This needs to be coordinated more efficiently to avoid confusion for staff and to ensure that important information is not missed. The way the home recruited staff needs to improve to ensure people are only employed after all checks are in place or in exceptional circumstances, when staff are employed after an initial check but before the full police check is in place, they are very closely supervised. There should be a system in place for staff to check important equipment such as suction machines and items that are used with it. This will ensure that it remains in working order and ready for immediate use. Closer scrutiny is also required when auditing health and safety issues such as bed rails, risk assessments and accidents so things can be picked up quickly and practice changed if required. The laundry and sluice areas should be inaccessible to residents when not in use. Staff receive supervision but this could be recorded better to ensure it covers the philosophy of care in the home and all areas of practice, as well as the training and development needs of staff. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rose Villa Care Home (N) Limited 269 - 271 Beverley Road Kingston Upon Hull East Yorkshire HU5 2ST     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: Beverly Hill     Date: 1 2 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. 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 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Rose Villa Care Home (N) Limited 269 - 271 Beverley Road Kingston Upon Hull East Yorkshire HU5 2ST 01482472151 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Alexander Bauld Type of registration: Number of places registered: Dr Chanshyam Singh Chauhan care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The registered persons must demonstrate, at all times, that they are staffing the Home to meet the needs of the service users in residence. The registered persons should take account of the Residential Forum staffing levels within the development of the service and work towards these. Date of last inspection Brief description of the care home Rose Villa is a care home with nursing provision for up to thirty-six people. It is situated approximately one mile from the centre of Hull close to bus routes and local facilities, such as shops and Pearson Park. The home has fourteen single and eleven shared bedrooms over three floors, which are accessed by a passenger lift. Some of the bedrooms have en-suite facilities. The home has bathing and/or shower facilities Care Homes for Older People Page 4 of 30 Over 65 36 36 36 0 0 36 Brief description of the care home on each floor. Communal areas consists of a large room divided into three distinct areas. These are two lounge areas, one with a conservatory attached, and a dining area. The garden at the rear of the building is accessible by a ramp. Information about the services provided can be found in the statement of purpose and service user guide displayed in the home. The current fees per week range from 350.50 pounds to 393.50 pounds plus the nursing band payment for nursing care. There is a top up fee of 5 pounds for a shared bedroom and 10 pounds for a single bedroom. Residents pay additional costs for optional extras such as chiropody, toiletries, hairdressing and newspapers/magazines. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is 2 star. This means that the people that use this service experience good quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key unannounced inspection on 23rd October 2006 and Annual Service Review on 3rd December 2007, including information gathered during a site visit to the home, which took approximately nine hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Rose Villa. We also had discussions with the registered manager, care staff members and a relative. Information was also obtained from surveys received Care Homes for Older People Page 6 of 30 from residents, staff members and one visiting health professional. Comments from the surveys and discussions have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were to be met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected in a safe and clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people that live in Rose Villa, the staff team and management for their hospitality during the visit, and also thank the people who spoke with us and completed surveys. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? The way the home manages medication has improved and nursing staff displayed good practice when ensuring residents received the medication that was prescribed for them. Wound care charts have improved and staff now record a description of any wound so progress can be monitored. An annual development plan has been produced to ensure that the quality of care provided is monitored and planned for systematically. There have been lots of improvements in the environment both internally and externally. Rooms have been decorated, recarpeted and new furniture purchased. Two new shower rooms have been installed and two large televisions purchased for the two lounge areas. New dining room furniture is in place. Care Homes for Older People Page 8 of 30 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 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that people are only admitted after an assessment of their needs has been carried out. This enables them to be sure they can meet peoples needs. Evidence: We examined four care files during the visit, one for a resident recently admitted to the home. The home completed an initial inquiry form when they were first contacted by social services or prospective residents and this provided them with sufficient information to make a decision about whether they can meet the persons needs. There was also evidence that a full assessment completed by social services was obtained prior to admission, for people funded by the local authority. During the initial days of admission the assessment process continues in order to gather information for a full plan of care. Some of the homes assessments contained basic information and could be broadened Care Homes for Older People Page 11 of 30 Evidence: to give a fuller picture of how the persons condition affected their abilities. The manager showed us a new assessment and care planning system that is being introduced. The documentation prompts staff to complete more information about the resident. The ones completed so far were very thorough and addressed the issue of basic information. Staff were working through each resident to transfer information onto the new system. The home needs to formally write to the prospective resident or their representative following the pre-admission assessment to confirm their needs can be met in the home. The home mainly accepts people for nursing care and at times this can be in an emergency but the manager confirmed as much information as possible is collected to be sure their needs can be met. Those residents receiving nursing care have undergone an assessment by a NHS Registered Nurse from the local Primary Care Trust to determine the level of nursing input required for each individual. The home does not provide intermediate care services. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are planned for and met in the home. Evidence: Three care plans were examined during the visit. The care plans were detailed and lengthy and contained information about assessed needs and how staff were to meet them. They included directions regarding what the person was able to do for themselves and stated preferences, likes and dislikes. There was evidence that care plans were updated when changes in need occurred and they were evaluated on a monthly basis with reviews held six monthly. There were some care plans examined that had been added to over time which had resulted in duplicated information in several areas. The amount of information new staff would have to read was substantial because of this. It was also noted that some generic care plans, for example the one for oral hygiene, had sections in them that did not apply to all residents. The manager showed us the new care plan system that has just been introduced and to date staff have transferred information for approximately Care Homes for Older People Page 13 of 30 Evidence: five residents. The new system will streamline the information and should resolve the issues above. Staff spoken with knew the residents needs well and told us that communication between each staff member was very good, so that when there are changes in need they all get to know in handovers and general discussions. Residents and relatives spoken with were happy with the care received, which they confirmed respected privacy and dignity, and people said their health care needs were met. All six surveys received from residents indicated that they received care and support, including medical attention as required, always or usually. One person did state that they felt their relatives finger nails could recieve more attention and they had noted they were uncomfortable in bed with their nightwear twisted so required more frequent checks. A review had been called and these issues addressed with management to the satisfaction of the family. A health professional stated in a survey, I have never had to raise any complaints and they stated that health needs were met, always. There was clear evidence that people had access to a range of health professionals such as, GPs, district nurses, specialist practitioners, dieticians, physiotherapists, opticians, dentists and chiropodists. People attended outpatient clinics as arranged. Risk assessments were completed and relevant information transferred to care plans. Wound care charts clearly stated the type of wound and dressing required and reviews of treatment plans occurred. Advice was sought from the Primary Care Trust Tissue Viability Nurse as required. The home had several means of recording daily support, which some staff completed more comprehensively than others. These included a key worker log, day and night sheets for handover information, new standex forms for personal hygiene, monitoring charts for pressure relief and food and fluid intake, and a nurses tick-box checklist that confirmed monitoring charts had been completed. The nurses then recorded daily on the computer. Some information was recorded on forms meant for specific purposes, for example, daily care tasks were recorded on pressure relief monitoring charts and on the key worker log, which was meant for recording one to one time with residents. The current system means that various bits of information are disseminated on different pieces of paper and this has led to some confusion for staff and important information omitted. The new standex documentation system when implemented fully will address the problem and staff will have one designated recording tool. Medication was managed appropriately and safely. It was stored in accordance with regulations and recorded when entering or leaving the home and on administration to people. The nurses managed the medication and displayed good practice in actually Care Homes for Older People Page 14 of 30 Evidence: seeing the prescriptions issued by the GP and checking these against what is ordered from the pharmacy. It is recommended that the suction machine is checked on a weekly basis, and recorded as such, to ensure it remains in working order and accompanying equipment checked and changed when the expiry date approaches. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided a good quality of life for people with flexible routines, a range of activities, good links with families and the community, and the provision of nutritious meals. Evidence: In discussions with residents and staff it was clear that routines were flexible. There were no set times for rising and retiring and visitors confirmed they were welcomed at any time. One visitor spoken with was very complimentary about the care their loved one received and stated they were offered refreshments every time they visited. Staff spoken with were clear about how to support people to maintain their independence and how to ensure they continue to make choices about aspects of their lives, the care plan tells us what people can do for themselves and we ask people, give them the opportunity to say and do things themselves - we encourage people. The home had a weekly activities plan, displayed on notice boards throughout the home. Activity coordinators were employed for three full days each week and were very enthusiastic about their role. The home provided a range of indoor activities such as bingo, craft work, reminiscence therapy, card games, exercise games such as Care Homes for Older People Page 16 of 30 Evidence: bowls, one to one chats with less active people, discussions with flashback cards, and coffee/beer and cakes sessions to get people chatting together. The home also arranged outings to local facilities and one person spoke of a trip to The Deep. Other trips out were to garden centres. One person did comment in a survey that they would like to have more trips out. The home had also provided an interactive computerbased game for use with the television. Church services were arranged in the home and local clergy visited specific individuals at their request. On the day of the visit children were visiting from a local school for a carol concert and staff were completing a dress rehearsal for the pantomime they are putting on for the residents. The home had a warm and pleasant atmosphere. People spoken with enjoyed their meals and during lunch some residents were observed seated at the dining tables, some had their lunch seated in the lounge with a table in front and some people preferred to stay in their own bedrooms. Comments were, the meals are very good and I enjoy everything we get. The cook confirmed they had a good budget and generally bought whatever they wanted. Nursing and care staff informed her of residents nutritional requirements and special diets, and the menus rotated over a period of four weeks. There were always two choices at main meals but she confirmed there were further alternatives if required. The home scored a B in the local authoritys food management assessment system, scores on the doors, which was a good achievement. The cook confirmed they were also working towards the healthy heartbeat award issued by the local authority for the provision of healthy alternatives. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided an environment where people felt able to complain and express their views. Residents were protected from abuse by staffs awareness of policies and procedures and completion of appropriate training. Evidence: The home had a complaints policy and procedure displayed in the home. The complaints procedure would benefit from the addition of further contact information such as the local authority and primary care trusts. Also updated information regarding the Commission should be inputted into the procedure in the complaints folder that staff use. People spoken with felt able to complain if they needed to and most mentioned the manager by name or their key workers as the person would talk to if they were unhappy about something. Staff were also aware of what to do should a resident or visitor raise any concerns with them. Generally complaints received were minor and dealt with straight away. A complaint form was available which included the nature of the complaint, any evidence and discussion that had taken place, the outcome of investigation, any recommendations required and whether the complainant was satisfied with the outcome. The home follows the local authority multi-agency policy and procedure for safeguarding adults from abuse and most staff have completed safeguarding training. Care Homes for Older People Page 18 of 30 Evidence: Staff spoken with confirmed training had taken place and were knowledgeable about what to do if they witnessed anything that concerned them. The registered manager has completed safeguarding training and, has demonstrated in the past, that they are fully aware of the safeguarding policies and procedures. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided a clean and safe environment for people living there and the proprietors were committed to continual improvement of the home. Evidence: The home was warm, clean and tidy with no malodours. Residents spoken with were happy with their home and six surveys received from residents all stated the home was clean and fresh either always or usually. The home is built on three floors accessible by a passenger lift. Doorways to bedrooms, communal space, corridors and bathing facilities were wide enough for people in wheelchairs or with walking frames to pass by comfortably. Bedrooms were personalised to varying degrees dependent on the choice and taste of the occupant. People were able to bring in small items of furniture, ornaments and pictures with which to decorate their bedrooms. Shared bedrooms had privacy screens and lockable facilities were provided to enable residents to secure any valuables. All bedroom doors had a door stop, which enabled the door to remain open and was connected to the homes fire alarm system. The home had an ongoing maintenance and redecoration plan and work was meeting set targets. Since the last visit there has been extensive repairs to the roof and the Care Homes for Older People Page 20 of 30 Evidence: exterior of the house has been painted and new windows installed where required. New fencing has been erected at the front of the house. The lounge and dining areas have been redecorated, recarpeted and new furniture purchased. In addition two large television sets have been installed. Bedrooms are nicely furnished and decorated and there is an ongoing system of renewal. Several more hospital-type beds and a stand aid hoist have been purchased to assist residents and staff with moving and handling. Two new shower rooms have been installed and the residents/families kitchen renewed. Any recommendations made by environmental health during their last visit have been met. The home had a separate laundry room that was appropriate for the number of residents living there. New flooring had been fitted since the last visit. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by well-trained and competent staff. A gap in the homes recruitment process meant that people were supported by care staff that did not have all the required checks in place. Evidence: The home was well staffed with six or seven care staff and one nurse on duty in the mornings, four care staff and a nurse in the evenings and three care staff and a nurse at night. At times there were two nurses in the mornings, as evidenced on the day of the visit. The home employed an activity coordinator three full days a week and had sufficient catering and domestic staff. The registered manager was supernumerary to the care rota and the home also employed a business manager Monday to Friday. Residents and relatives spoken with and surveys received from people were complimentary about the staff team describing them as, friendly, very helpful, everything he needs is seen to, very well looked after and the manager and nurses are very approachable. One relative did comment in a survey that sometimes their loved one had to wait longer than they liked for attention at night. This was mentioned to the manager to check out response times at night and to see if it was an isolated incident. Care Homes for Older People Page 22 of 30 Evidence: The home had a staff training plan that included mandatory and service specific training and an ongoing training programme ensured that staff remained up to date. Some health and safety training was behind schedule due to closure of the local authority training centre during the floods experienced in the city in 2007. Care staff spoken with were pleased with the amount of training they received, although did comment that there was no monetary incentive to complete national vocational qualification (NVQ) in care. To date seventeen care staff have completed NVQ in care at level 2 or 3. This equated to 56 percent and is an excellent achievement. There were also four additional care staff members progressing through the course. All five surveys from staff also confirmed training was relevant and kept them up to date. Qualified nurses had access to sufficient training to support them with continued registration requirements. The homes induction programme consisted of an orientation to the homes way of working and ensured that new staff completed skills for care induction standards, which were signed off by senior staff on completion. The home generally recruited staff in a robust way with checks and references obtained, and selection via an interview prior to employment. However it was noted that on two of the staff files examined, staff were employed after a povafirst check but prior to the return of the full criminal record bureau check. This is appropriate in exceptional circumstances only and should not be as a matter of routine. The exceptional circumstances need to be documented and discussed with the Commission, and stringent supervision arrangements need to be in place until full checks are returned. Two references received but missing from two separate staff files had to be requested again and were in place prior to the writing of this report. An ongoing general audit of recruitment files as part of quality monitoring would pick up any shortfalls. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was managed well and was a safe place for people to live in and staff to work in. Evidence: The registered manager is a qualified nurse with over twenty years experience. He has completed the required management modules of the Registered Managers Award and relevant training to keep himself up to date with nursing practices. Staff spoken with stated he was a, wonderful, brilliant and approachable manager who, gets things sorted. Residents and relatives knew the managers name, which told us they were out and about the home rather than remaining in the office. The registered manager confirmed they had an open-door policy and, as their office was close to the entrance, families could see the manager as and when they visited. There was also a business manager for the administrative side of the homes management. The quality assurance system consisted of weekly, monthly and annual audits covering Care Homes for Older People Page 24 of 30 Evidence: areas such as medication, bedrail checks, care plans, risk assessments, kitchen hygiene, the environment internal and external, infection control, accidents and nutrition. There were also questionnaires sent to residents and their relatives, staff, and professional visitors asking a range of questions such as meals, activities and customer satisfaction. Action plans were produced to address any shortfalls and results were published in the newsletter. Although accidents, bedrails and risk assessments were audited, closer scrutiny may be required when auditing them as one person had a repeat accident and the risk assessment was slow in being produced. Also two beds with bedrails did not have protectors in place, and the laundry and two sluice rooms were accessible to residents. These issues were discussed with the manager to address quickly. Other than these health and safety issues the home was a safe place for people. Equipment was serviced regularly and fire alarm checks and drills were carried out. The manager was in the process of reviewing residents who used bedrails to check that they were required. The majority of bedrails used were integrated with the hospital type bed or profile bed, which lessened the risk of injuries. The bed rail risk assessment tool conformed to health and safety guidelines. Residents and staff had the opportunity to make suggestions about the running of the home in meetings, which were held every one to two months. Relatives were also invited to attend the residents meetings. There was also evidence from meeting minutes that issues identified in audits and surveys were discussed with staff and changes in practice made. There was evidence of staff supervision, which consisted of discussions about training courses undertaken each month rather than discussions about issues affecting residents and the staff members key worker role. There was also some evidence of observation of practice, for example with infection control techniques. The supervision sessions for care staff need to be more structured with evidence of one to one discussions covering the standards required, that is the philosophy of care in the home, all aspects of practice and career development needs. The supervision form should be consistently signed by the supervisee as well as the supervisor. The business manager confirmed that each resident had a small amount of personal allowance held for safekeeping by the home. Receipts and signatures were maintained for monies received into the home and when expenditures were made. The home managed finances via a computerised system and an accountant completed an annual financial audit. The home also had a residents fund set up to receive donations and make expenditures for the benefit of residents. This was administered by the deputy manager with input from the staff team and consultation with residents. Care Homes for Older People Page 25 of 30 Care Homes for Older People Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 All staff must have full 31/01/2009 checks in place prior to the start of employment. In exceptional circumstances staff can be employed after a povafirst check but prior to the return of the criminal record bureau check. Stringent supervision arrangements must be in place when this occurs. This will ensure that only appropriate staff are employed to support vulnerable people. 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 3 The home should formally write to prospective residents or their representatives following the assessment stating their ability to meet the persons needs in the home. Recording of care provided should be reviewed to avoid confusion and ensure there is a clear system for staff. This will prevent the possibility that important information is Page 28 of 30 2 7 Care Homes for Older People omitted. 3 9 The suction machine should checked on a weekly basis to ensure it remains in working order and accompanying equipment checked and changed when the expiry date approaches. The home should fit privacy locks to the bedrooms doors when rooms become vacant unless the occupant requests a lock in the meantime. This will ensure that bedroom doors have privacy locks as standard when a new occupant is admitted. Supervision for care staff should cover one to one discussions of the philosophy of care in the home, all aspects of practice and as well as training and development needs already covered. This will ensure staff practices are monitored effectively. Supervision forms should be consistently signed by the supervisee. Closer scrutiny should be made when auditing health and safety issues such as accidents, bedrails and risk assessments. This will ensure that correct equipment and updated information is in place for the safety of residents and guidance of staff. 4 24 5 36 6 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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