Care Home: Sloane House Nursing Home

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What the care home does well Offering prospective residents the information they need to enable them to decide whether the home is suitable. They make sure pre-admission assessments provide enough information to staff in meeting the residents` needs. Maintaining good systems to monitor and meet residents` health care needs, and making sure residents have ready access to health care services. Making visitors welcome and supporting its residents to keep in touch with their families and friends. Meeting residents` varied dietary needs. A nutritious, balanced diet is provided and residents generally enjoy the food served. Taking concerns, complaints or allegations seriously and managing them in accordance with the appropriate procedures. Providing a safe and relaxed environment for residents, staff and visitors. This includes the gardens of the home, which are kept well so that residents and their visitors can enjoy them. Managing the home effectively and having good arrangements to monitor the quality of services that the home provides. What has improved since the last inspection? They have addressed the requirements we made at our last inspection. This has resulted in improvements to: medicine administration; choice for residents; deployment of staff; and the use of risk assessments when helping people to mobilise. What the care home could do better: Always record any changes to a person`s needs in their care plans and supporting risk assessments, as it is important that staff have up to date written guidance about care delivery. Always record the application of a prescribed external cream, so it is clear whether this treatment has been administered. Make sure all staff complete appropriate safeguarding training, so each staff member is properly prepared and confident to carry out their responsibilities in this respect. Carry out a five-yearly test of the home`s electrical installation, as this check was overdue at the time of inspection. Make sure the servicing of hoists is always carried out at the appropriate intervals, as this is important for people`s safety. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sloane House Nursing Home Sloane House Nursing Home 28 Southend Road Beckenham Kent BR3 5AA     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: David Lacey     Date: 1 6 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Sloane House Nursing Home Sloane House Nursing Home 28 Southend Road Beckenham Kent BR3 5AA 02086503410 02086505009 managersloane@dsl.pipex.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Mills Family Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users 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 Date of last inspection Brief description of the care home Sloane House is a large, detached building in a residential area of Beckenham. It has been converted for use as a care home providing nursing care for older people. The home has a team of qualified nurses, supported by care and ancillary staff. There are single and shared bedrooms, most of which have en-suite facilities. Accommodation for residents is on different floors, with access by passenger lift. The home has some offCare Homes for Older People Page 4 of 31 Over 65 33 0 Brief description of the care home street parking at the front and a back garden with patio. There are bus and rail services nearby, with links to the public tram service. The fees for this home range from 600-900 pounds each week (this information given to the CQC in June 2009). Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included an unannounced visit to the home. The registered manager was present during the inspection and assisted with the visit. The inspection visit included a tour of the premises, and discussions with residents, visitors and staff members. Practice was observed and relevant documentation was examined. As part of the inspection, we invited written comments from a sample of residents, relatives, and staff members. Responses were received from ten residents, seven relatives and four members of staff. This feedback is included within this report and has been taken into account in forming our judgements. The care home provided us with its Annual Quality Assurance Assessment (AQAA) in April 2009, which we also took into account. This self-assessment document focuses on how outcomes are being met for people using the service and gives us some numerical Care Homes for Older People Page 6 of 31 information. As part of our inspection, we considered notifications and any other information we have received from or about the home. We also considered the report of our Annual Service Review (ASR) of Sloane House, carried out in November 2008. The last inspection of this service was completed on 05/09/2007. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 31 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. Residents are assessed before being offered a place in the home, to make sure their needs can be met. Residents are normally provided with enough information about the home to decide if it is the right home for them and, when they move in, most have contracts with terms and conditions. Evidence: The content of the homes statement of purpose and service user guide was satisfactory, though it was brought to the managers attention that contact details for the commission needed amendment to reflect the change in regulatory body to CQC. Six of the ten residents who responded to our survey stated they had received enough information to help them decide if this home was the right place for them, before they moved in. One resident stated s/he did not receive enough information and three residents did not know whether they had received this. With regard to this latter finding, many residents had been assisted by their representatives to choose the home, and in some instances the representatives had the information. Five of the Care Homes for Older People Page 11 of 31 Evidence: seven relatives who responded to our survey stated they always get enough information about the home to help them make decisions, one stated this sometimes happened, and one stated this was never the case. A relative visiting the home said she had helped her relative choose Sloane House. They had looked at other homes but liked the friendly, homely atmosphere. They said people had been welcoming and it was made clear the resident could choose how to spend the day and whether to have breakfast in bed, which s/he likes to do sometimes. Residents needs are assessed before they move in to ensure the home is suitable. Pre-assessment information covering all main areas of need was seen on a sample of three residents files. Eight of the residents who responded to our survey confirmed they had received a contract, with written information about the homes terms and conditions. One respondent stated s/he did not receive a contract and one did not know whether s/he had received one. At the inspection visit, the contracts for three residents were selected for inspection. Two of these residents had completed contracts on file, showing their terms and conditions. The third residents file had a copy of a letter to the person holding power of attorney asking that person to sign and return the contract. Sloane House does not offer intermediate care, therefore standard 6 does not apply. Care Homes for Older People Page 12 of 31 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. Residents care plans are based on assessment of their needs and provide guidance to staff, though not all plans viewed reflected changes to residents needs. Residents have good access to local health care services and are satisfied with how their health care needs are met. The administration of medicines is satisfactory. Evidence: Residents and relatives spoken with during the inspection were generally satisfied with the ways in which their care needs were being met. For example, the inspector met with a resident and her visting relative. The visitor said the homes staff should be congratulated for the standard of care they give to her relative, as she is much improved since being in the home, and is always well groomed and cared for. A resident speaking about her leg dressings said the staff change these dressings regularly as theyre trying to keep my skin in good condition. Four of the ten residents who responded to our survey stated they always receive the care and support they need, with six stating this is usually the case. Five of the seven relatives who responded to our survey stated the home always meets the needs of their relative, with two stating this is usually the case. Four of the relatives stated the home Care Homes for Older People Page 13 of 31 Evidence: always gives the care to their relative that they expected or agreed, two said this is usually the case and one relative did not answer this question. Of the four staff members who responded to our survey, one stated s/he always receives up to date information about residents needs, for example, in the care plan, and three stated this is usually the case. Of the seven relatives responding to our survey, three stated the home always responds to the different needs of individual residents and three stated this is usually the case. One relative did not answer this question, which asked respondents to consider needs relating to disability, gender, age, race and ethnicity, faith and sexual orientation. Staff members we surveyed were asked a similar question, three replying they always have enough support, experience and knowledge to meet the different needs of residents and one stating this is usually the case. Four sets of care records were viewed, three in full and another examined in relation to wound management and mobility. Care records seen included pre-admission assessments, risk assessments and care plans. Care plans had been prepared to show how assessed needs would be met. Care plans seen had been regularly reviewed and there was evidence to show they had been discussed with residents and their representatives. One care plan seen did not reflect a change to the persons mobility needs that had been noted following review of the plan. The manager was asked to check this and confirmed the mobility care plan and supporting risk assessment needed to be updated. The change in the persons needs was significant, with the care plan review having concluded the person now had very poor mobility and needed a hoist and two carers for all transfers, whereas the care plan and risk assessment still stated the person could walk and transfer with a walking frame and one carer supervising (see requirements). Six of the residents who responded to our survey stated they always receive the medical care they need, three stated they usually receive this, and one that s/he sometimes does. The agreement between the home, the local primary care trust and the GP was seen, which confirmed the provision to the home of enhanced services of a visiting medical officer. In addition to medical care, residents had been supported by staff to receive regular dental, optical and podiatry care. The home employs two parttime physiotherapists, who were seen working in the home on the afternoon of the inspection visit. Other health care such as input from a dietician or a tissue viability specialist are obtained as needed. Appropriate equipment was being provided for a resident with pressure ulcers. Medicines are stored in three places within the home. At our last inspection, we were Care Homes for Older People Page 14 of 31 Evidence: concerned about temperature control in two of these sites, as the efficacy of some medicines can be adversely affected by storing them in a place where the temperature is more than 25 degrees centigrade. On this occasion, the temperatures were satisfactory though, as one site was exactly 25 degrees, the staff will need to continue to monitor this. It was evident that the home had met our previous requirement to ensure the date of opening a medicine is always recorded where the manufacturer recommends a discard date. Oxygen was being stored in the home for one resident. Although there was an appropriate hazard sign on the door of the room 3 clinical room, there was no sign on the door of the room where the oxygen was actually being stored (see requirements). This room was next to two residents bedrooms. The home has two cabinets within its clinical room for the storage of controlled drugs (CD), though one was empty at the time of inspection. The CD records and stock checked during the inspection were satisfactory, and our previous requirement and recommendation in this respect had been met. The medicine administration records (MAR) of four residents were sampled for inspection. They were generally satisfactory, although the administration of one residents aqueous cream had not been recorded on the MAR when applied as required in the evenings. The nurse assisting the inspector with examination of medicines confirmed the cream would normally be applied other than just in the mornings. It is important that this aspect of care delivery is recorded (see requirements). During the visit, the inspector sat in on the handover between staff on the morning and afternoon shifts. All care staff attended, including the manager. It was a productive meeting at which residents care and progress was discussed, and staff coming on duty were briefed about any changes or specific needs. However, the meeting took place in the dining room which has large windows opening on to the conservatory where residents and some of their visitors were sitting. The weather was warm so these windows were open for ventilation. The manager later confirmed to the inspector she was aware this raised issues about privacy and handling information about residents in a confidential way (see recommendations). Residents and relatives spoken with said they are treated with respect by staff members. There were no concerns raised to us about privacy or dignity, either during the inspection visit or by respondents to our survey. Care Homes for Older People Page 15 of 31 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. Arrangements are in place to provide residents with social activities, and to support their continued contact with their families and friends. Where possible, residents are enabled to make personal choices. A nutritious, balanced diet is provided and residents generally like the food served. Evidence: Four of the ten residents who responded to our survey stated there are always activities arranged by the home that they can take part in if they want, four said this is usually the case and one resident stated there are sometimes such activities available. One respondent did not know whether the home arranged such activities. Generally, people spoken with during the inspection were satisfied with the activities on offer. A relative made positive comments about the work of the homes activities coordinators. One of the residents spoken with preferred not to take part in most of the activities. Four of the seven relatives responding to our survey stated the home always helps their relative to keep in touch with them, if that was applicable, and three stated the home usually does this. A resident commented that visitors appreciate their cups of tea and coffee. Care Homes for Older People Page 16 of 31 Evidence: We had previously required the home to make sure that each resident is supported to exercise choice whenever this is possible. Minutes of residents meetings were seen and showed that people were invited to give their views and choices about aspects of life in the home, such as the choice of clothing to wear and preferred times for getting up or going to bed. Of the seven relatives responding to our survey, two stated the home always supports people to live the life they choose, one that it usually does, two that it sometimes does so and two did not answer this question. At lunchtime during the inspection visit, two carers came to assist a resident from the lounge to the dining room. The resident said she wanted to have her lunch where she was, and the carers provided her with a small table so she could do this. Six residents responding to our survey stated they always like the meals at the home, three stated they usually do and one stated s/he sometimes likes the meals provided. Minutes of residents meetings seen during the inspection showed that people were invited to give their views about the content of menus and quality of food provided. People said they can have snacks in the evening if they wish, and a relative said youre not allowed to go hungry here! Care Homes for Older People Page 17 of 31 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. Residents and their representatives may be assured that the home will address fully any complaints they raise, in accordance with its procedures. The home has procedures in place to safeguard its residents, and it is evident these procedures are followed. The home needs to make sure every staff member completes adult protection training. Evidence: Nine of the ten residents who responded to our survey stated there is someone they can speak to informally if they are not happy. Minutes of the most recent residents meeting seen during the inspection showed that people were asked if they know how to make a complaint and that people attending the meeting did so. However, although six residents responding to our survey knew how to make a formal complaint, four did not. Of the seven relatives who returned our questionnaire, four stated they knew how to make a complaint about the care provided if they needed to, one stated s/he did not know how to do this and one that s/he could not remember. One relative did not answer this question. The home should continue its efforts to make sure all residents and their representatives are aware of the homes complaints procedure (see recommendations). Three relatives stated the home always responds appropriately if they have raised any concerns and two stated the home usually did so. Two relatives did not respond to this question. All four staff members responding to our survey confirmed they knew what to do if someone has concerns about the home. Care Homes for Older People Page 18 of 31 Evidence: The homes complaints file was seen, and showed the nature of complaints received and the actions taken. The AQAA stated there had been four complaints in the past year, and four complaints were seen recorded on the file. They included two complaints about clothing items, one complaint not upheld and one complaint referred by the commission. The commission had received a complaint about the home, concerning the care of a resident during her final days. This was referred to the provider for investigation under their procedures. These procedures were followed and the outcome of the investigation reported to the complainant and to the commission within an appropriate timescale. We are aware of a safeguarding alert raised by the home last year to the local (Bromley) social services. The home had followed its procedures and had notified the commission about the alert, giving detailed information, and recorded it on their AQAA. Staff responding to our survey knew what to do if someone has concerns about the home and those spoken with during the inspection visit were aware of their reporting responsibilities with regard to safeguarding residents. The homes whistleblowing procedure makes it clear the provider supports whistleblowing, refers to relevant legislation and encourages the reporting of any concerns. The AQAA confirmed staff members have safeguarding training as part of their induction and attend courses run by Bromley Council. However, one of the qualified staff spoken with said she had yet to complete adult protection training. As she is sometimes in charge of the home, this is particularly important. There were some gaps apparent with regards to adult protection training in the training matrix supplied for inspection (see requirements). Care Homes for Older People Page 19 of 31 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. Residents benefit from living in a clean, comfortable and well-maintained environment. Evidence: The home was clean, tidy and free from unpleasant odour. All of the ten residents who responded to our survey stated the home is always fresh and clean. Residents spoken with during the inspection were satisfied with their bedrooms, saying they are comfortable and have the facilities they need. One resident who was seen in her room was very pleased with the good view over the garden from her armchair. A visitor said the home is kept clean and tidy, and she likes to take her relative out into the garden, which she said is well cared for. Many of the residents like to sit in the conservatory, as it has good natural light and a nice view over the garden. There was a display in the conservatory to mark the 65th anniversary of the D-Day landings. On VE day in May, the home had held a celebration with foods of the time prepared, such as rock cakes and potted meat sandwiches. Photographs of the party were on display and showed residents, their families and staff enjoying the day. The weather was warm on the day of inspection and the temperature inside the conservatory was noticeably warmer than elsewhere in the home. Opening the doors at each end of the conservatory provided through ventilation and staff were making sure people had fluids available. It was understood there are Care Homes for Older People Page 20 of 31 Evidence: plans to install an external awning to give more shade and thus reduce the temperature in the conservatory. Three bedrooms were assessed against the standards and found to comply, with the exception of door locks. In two cases, there were no locks fitted and in the third room there was a lock but no keys were available. Residents should be offered the facility of locking their rooms if they wish (see recommendations). The laundry was working effectively on the day of inspection. The laundry assistant gave a sound explanation of how she carries out basic infection control, including how she handles soiled laundry. Care Homes for Older People Page 21 of 31 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. Residents needs are met by suitably competent staff members, though not enough staff have yet completed NVQ awards in care. The homes recruitment practices are robust, and protect and support residents. Evidence: We had required the home at our last inspection to make sure staff are deployed so that residents are supervised and receive prompt attention for their personal care needs. Four of the ten residents who responded to our survey stated staff are always available when they need them, with five stating this is usually the case and one person not answering this question. Of the four staff members who responded to our survey, three stated there are usually enough staff to meet residents individual needs, with one stating this is sometimes the case. Staff rotas seen for the previous month showed that staffing levels and skill mix had been consistent. When the inspector arrived, there were two nurses and six carers on duty, caring for twentyseven residents. There was another carer on an induction programme who was supernumerary to the rota. The registered manager was in charge of the home, and there were two catering staff, two cleaners, a laundry assistant and an administrator. Overall, people were satisfied with how staff carry out their duties. Residents and relatives spoken with during the inspection visit were positive about the homes staff. A resident said, the staff are very nice to me, and a relative of another resident said, Care Homes for Older People Page 22 of 31 Evidence: the staff here are very good and explained how staff members help the person she was visiting. Four of the ten residents who responded to our survey stated staff always listen to them and act on what they say, four residents stated staff usually do this, one that they sometimes do and one resident stated this is never the case. Of the seven relatives responding to our survey, three stated staff always have the right skills and experience to look after people properly, three stated they usually do and one relative did not answer this question. All of the staff members who responded to our survey confirmed their employer had carried out checks, such as CRB and references, before they started work in the home. Three staff members files were selected for inspection and each contained the recruitment information needed to protect and support residents. Three of the four staff members who responded to our survey stated their induction had covered everything very well that they needed to know to do the job when they started, and one stated the induction had mostly covered everything. The home asks for feedback by questionnaire about its induction programme from staff when they complete it. The staff training matrix supplied for inspection showed that effort is made to ensure all staff members undertake mandatory training. Comment has been made under standard 18 about adult protection training. Three of the four staff members who responded to our survey stated they were being given training that is relevant to their role, helps them understand and meet peoples individual needs, keeps them up to date with new ways of working, and gives them enough knowledge about health care and medication. The other staff member did not reply to this question. The manager confirmed the information given in the AQAA showing that only one-third of permanent care staff hold NVQ at level 2 or above. She said that others are currently undertaking this programme, and that there has been a turnover of staff recently. It was understood the home will be making efforts to increase the proportion of its staff with NVQs (see recommendations). Care Homes for Older People Page 23 of 31 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 and their representatives may be assured that the manager has the necessary skills and experience to run the home well. Processes for assuring the quality of service provision are good. The home promotes the health and safety of its residents, visitors and staff members. Evidence: The registered manager was in charge of the home during this inspection visit. She is an experienced manager whose fitness to be the manager of Sloane House has been determined by the commission following a process of assessment. Of the seven relatives responding to our survey, four stated they are always kept up to date with important issues affecting their relative, two said this is usually the case and one did not answer this question. Three of the four staff members returning our questionnaire stated the ways in which they share information about residents with other carers and the manager usually work well. The other staff member stated these ways always work well. During the visit, the inspector sat in on the handover between Care Homes for Older People Page 24 of 31 Evidence: staff on the morning and afternoon shifts. All care staff attended, including the manager. Residents care and progress was discussed, and staff coming on duty were briefed about any changes or specific needs. Staff were also reminded to ensure residents did not dehydrate in the hot weather and to offer plenty of fluids. The home seeks feedback by questionnaire as part of its quality assurance programme, surveying residents, their relatives and friends, and staff members. The findings from the 2008 year were available for inspection. It was evident that regular meetings are held for residents and their relatives. Minutes of residents meetings showed that people are invited to give their views and choices about aspects of life in the home and the quality of services provided, and that action had been taken to make changes where the need for improvements was identified. Staff members have regular meetings, chaired by the manager, and minutes of these were made available for inspection. Meetings are held with nursing staff and with care workers, and with all staff together. The manager had also met formally with night staff. The homes AQAA had relevant information that was clear and supported by evidence. We were informed about changes made and how the home intends to make further improvements. The data section of the AQAA was completed accurately and fully. The administrator explained the home does not hold money on behalf of residents, though there is a safe if any valuable items need temporary storage. No staff members assist residents with their financial affairs. Additional charges, such as for hairdressing, newspapers or toiletries are invoiced to either the residents or their representatives so residents do not need to pay for these items at the time. Receipts and invoice lists were available for inspection. The staff members responding to our survey stated the manager gives them enough support and often meets them to discuss how they are working. Staff members spoken with at the inspection felt supported and part of a team. Supervision sessions are held though there was not enough evidence to show these happen frequently enough. For example, one of the staff files seen showed only one supervision session so far for this year (see recommendations). A sample of health and safety service files were viewed and most were found to be satisfactory, with appropriate servicing and monitoring having been carried out. The exceptions were the five-yearly check of the homes electrical installation and the servicing records for hoists. It was evident from discussion with the manager and from correspondence on file that the overdue electrical check was being arranged, and the manager agreed to forward confirmation that hoists had been checked by a competent person (see requirements). There were satisfactory procedures in place to ensure risk Care Homes for Older People Page 25 of 31 Evidence: of fire is reduced and therefore ensure peoples safety, and the LFEPA (fire authority) had confirmed in June 2008 that the premises comply with legislation. At our last inspection, we had required the home to make sure that moving and handling risk assessments are followed at all times when staff are assisting residents to mobilise. We also recommended the homes July 2000 manual handling policy and accompanying documentation dated are reviewed, and it was evident the manager had done this. During the present inspection, two carers were seen using a hoist to assist a resident to transfer from her wheelchair to an armchair in the conservatory. Their practice was safe, they explained to the person what they were doing, continually checked she was comfortable, and maintained her dignity throughout the process. The inspector later viewed this residents care plan and supporting risk assessment, and it was evident the carers had followed these. During the afternoon of the inspection, two physiotherapists that are employed by the home came on duty. As part of their role, they offer advice and guidance to staff about moving and handling issues for individual residents. Care Homes for Older People Page 26 of 31 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 31 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 7 15 The registered person must ensure that changes to a persons needs are always reflected in their care plans and supporting risk assessments. It is important that staff have up to date written guidance about care delivery. 31/07/2009 2 9 13 The registered person must ensure that the appropriate warning sign is displayed on the door where oxygen is being stored. Oxygen is potentially hazardous so it is important that people are aware of where it is being stored. 31/07/2009 3 9 13 The registered person must ensure that the administration of a prescribed external cream is always recorded. 31/07/2009 Care Homes for Older People Page 28 of 31 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 It is important to record that a prescribed medication has been administered. 4 38 13 The registered person must ensure it is evident that the servicing of hoists is carried out at the appropriate intervals. This is important for peoples safety that hoists are maintained well. 5 38 13 The registered person must 31/07/2009 ensure a five-yearly check of the homes electrical installation is carried out. This important check was overdue at the time of the inspection visit. 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 31/07/2009 1 10 The registered person should ensure staff handovers take place so that discussions cannot be overheard by residents or visitors to the home. The registered person should make sure the home continues its efforts to ensure all residents and their representatives are aware of the homes complaints procedure. The registered person should ensure residents are offered the facility of locking their bedrooms. The registered person should ensure the proportion of its Page 29 of 31 2 16 3 4 24 28 Care Homes for Older 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 care staff with NVQ awards is increased to achieve the minimum standard. 5 36 The registered person should ensure care staff receive formal supervision at least six times each year. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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