Care Home: South Efford House

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What the care home does well South Efford House provides a good standard of care. Residents said `staff are always kind and helpful`, `Nothing is ever too much trouble`. The home undertakes a thorough assessment of peoples needs before they are admitted. This ensures that people needs can be met and that people are fully involved in choosing the services they receive. A detailed plan of care is written for each resident. This process involves the resident and documents their specific preferences about how they are cared for and supported. Staff have a good understanding about the care needs of residents and recognize the importance of providing care in a consistent manner. Residents spoken to said that staff respect their privacy and dignity when supporting them with personal care tasks. Visitors said that they are always made to feel welcome and relatives are kept well informed of any important issues. Residents live in a house that is generally clean and comfortable. There are beautiful gardens, which have recently been landscaped to improve the access and seating area for those wishing to enjoy the homes lovely rural setting. Residents said that there is always someone to speak to and those asked said that they would know who to speak to if they needed to raise a concern or make a complaint. Staff said that they are well supported by management and are encouraged to undertake regular training relevant to their role and the needs of residents. What has improved since the last inspection? The home has recently updated the information available to people who may be thinking about moving into the home. The information is now available in an easy read format with all details about the home and services up to date. The review of this information will further ensure people can make an informed choice about where they live. A fridge has been purchased for medication requiring cold temperature storage. The rear garden has been further landscaped to provide additional seating, raised flower beds and level access pathways. New carpets have been fitted in the dining room and lounge. The new chairs in the dining area provide safer and more comfortable seating for residents when they are eating their meals. The ground floor bathroom has been fully re-furbished to provide residents with a modern and comfortable wet room. In addition the home has also refurbished a treatment room so that residents can see visiting professionals such as the Chiropodistin private. What the care home could do better: The home should further develop their risk assessment process to ensure that any identified risk has an action plan detailing how the risk will be managed. Any agreement made to support a resident with their finances should be agreed, documented and reviewed as part of the individuals care plan. Consideration should be given to improving the communal seating areas in the home. Residents who do not wish to watch the television in the main sitting room but do not want to be in the rooms would benefit from the addition of a separate seating area. Consideration should be given to installing an en-suite facility in the ground floor bedroom. This would promote the privacy and dignity of the resident using this room. Appropriate locks should be fitted to all bedroom doors. This would promote the privacy of residents and further ensure the protection of their personal belongings. Lighting in all bedrooms should be sufficient to ensure the comfort and safety of residents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: South Efford House Bridge End Aveton Gifford Kingsbridge Devon TQ7 4NX     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: Wendy Baines     Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: South Efford House Bridge End Aveton Gifford Kingsbridge Devon TQ7 4NX 01548550141 01548550141 southefford@crocuscare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Crocus Care Limited Name of registered manager (if applicable) Ms Linda Elizabeth Dodd Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home South Efford House is a care home providing accommodation and personal care for 22 older people aged over 65 years, who may also have physical disabilities and/or dementia.It is has been owned since 2004 by Crocus Care Ltd, which also owns three other care homes in South Devon. The Responsible Individual is Ms Clare Hunt.The home is a detached, period property, situated close to the riverbank outside village of Aveton Gifford, near Kingsbridge in the South Hams. The house has three storeys, but accommodation for residents is provided on the ground and first floors. There is a passenger lift and a stair lift to the first floor. There are sixteen single rooms and three shared rooms. The bedrooms are generally of Care Homes for Older People Page 4 of 29 care home 22 Over 65 22 22 22 0 0 0 Brief description of the care home a good size and most have an en suite toilet. Some also have an en suite bath or shower, but these are not adapted for use by people with disabilities. There are two bathrooms with assisted baths and appropriate aids are in place. The lounge and a separate dining room are situated on the ground floor. The premises have extensive grounds to the front and rear, with level lawns. Many rooms have pleasant views over the gardens and the surrounding countryside Parking space is available at the front of the house. Staff accommodation is currently provided in a selfcontained adjoining annex. Written information regarding the home and the services provided is on display and is given to prospective and new residents. A copy of the most recent CSCI Inspection report is available. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means that people who use the service experience good quality outcomes. The Key Inspection was unannounced and took place on the 13th January 2009. The visit started at AM and finished at PM. The home did not have a Registered Manager at the time of the Inspection but the Acting Manager was present throughout the visit. The Inspector completed a tour of the premises and was able to meet and talk with residents in private and in a group setting. All staff on duty were observed and spoken with in the course of their daily duties. Care Homes for Older People Page 6 of 29 Records inspected included care and staff records. Questionnaires were sent out to a sample of residents and staff and the information received back was mainly positive. To protect peoples confidentiality, one issue relating to the specific needs of a resident has not been included in the report but passed to the Manager to address. What the care home does well: What has improved since the last inspection? The home has recently updated the information available to people who may be thinking about moving into the home. The information is now available in an easy read format with all details about the home and services up to date. The review of this information will further ensure people can make an informed choice about where they live. A fridge has been purchased for medication requiring cold temperature storage. The rear garden has been further landscaped to provide additional seating, raised flower beds and level access pathways. New carpets have been fitted in the dining room and lounge. The new chairs in the dining area provide safer and more comfortable seating for residents when they are eating their meals. The ground floor bathroom has been fully re-furbished to provide residents with a modern and comfortable wet room. In addition the home has also refurbished a treatment room so that residents can see visiting professionals such as the Chiropodist Care Homes for Older People Page 8 of 29 in private. 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.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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their families can be confident that they will be given good information to help them make an informed choice about this home. The homes admissions procedures ensure that residents needs are fully assessed and known before they move in. Systems are in place to ensure that people are made to feel welcome and to help them quickly settle into their new surroundings. Evidence: The home had a Statement of Purpose, Service user Guide and color Brochure detailing information about the home, the staff and the services available. These documents are given to anyone who maybe considering moving into the home and are also available within the main reception area for anyone who may be visiting. Care Homes for Older People Page 11 of 29 Evidence: Information completed by the home prior to the inspection visit stated that they had recently reproduced this information so that it is easier to read and up to date. The care records of people who had recently moved into the home were looked at in detail during the inspection. The Inspector was also able to speak to some of these residents and ask the staff how they felt people had settled in. Files looked at contained a detailed Pre-admission assessment, which included information about the persons needs and support they may require should they move to the home. This had been completed by the manager and included information from family, Gps, hospital and Social Services. Where possible people had been offered the opportunity to visit the home and have a short stay prior to moving in. One resident had moved into the home due to an emergency,the home had managed this situation well. An assessment of the persons needs had been completed within the first two days of arriving and the resident had been provided with all the necessary information about the service and facilities available. A review meeting had taken place to enable all parties concerned to make a decision about whether or not the home was appropriate as a long-term arrangement. When it is decided that a person will move into the home the manager sends them a Welcome letter and a guide about what to expect on the day they move in. The manager said that this was made available due to feedback from some new residents about how confusing they found the first few days in their new surroundings. This also included a new system of allocating a specific staff member to support the new resident on their first few days in the home. Some of the new residents spoken to said that they had been made to feel very welcome by all the staff. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health needs of residents are well met with evidence of good multi-disciplinary work taking place when required. Personal support is offered in a way, which promotes and protects the residents privacy, dignity and independence. The Systems for the administration of medication are good with clear and comprehensive arrangements in place to ensure residents needs are met. Evidence: The Inspector had access to all records during the visit. The records of five residents were looked at in more detail. The inspector was also able to meet some of these residents and speak to staff about their care needs. Each of the residents had an individual plan of care detailing their specific needs and how they would be supported. This information had been put together using the information provided prior to the resident moving in and through an on-going assessment by the home. The care plans Care Homes for Older People Page 13 of 29 Evidence: were well written and included specific preferences about how the person likes to be supported and their preferred choice of routine during the day and night. For people requiring a higher level of care information was available to staff in step- by -step guidelines. Staff spoken to said they felt that this very detailed information was essential to ensure that care is provided in a consistent manner at all times. The care plans had been reviewed regularly. One of the care plans needed updating to reflect that a resident was no longer being supported to return home but would be remaining in the home as a permanent resident. Staff spoken to had a good understanding of the healthcare needs of residents. An example was given of a recent concern when staff observed changes in a residents behavior. Due to good monitoring procedures the home was able to respond promptly and seek advice and support preventing any further deterioration in the individuals health. Care plans contained detailed information about peoples personal and healthcare needs. At the point of admission the home makes every effort to gather as much information as possible about peoples medical history and long- term healthcare needs and this information is available to give staff a better understanding of the person concerned. Examples of recording included details of oral care, a falls register, Nutritional screening and weight monitoring. Individual care plans stated when particular monitoring processes were in place such as fluid intake, and monitoring charts were found to be well maintained and up to date. Continence care is promoted and assessment and advice sought from the Continence adviser when required. Risk assessments were found to be in each care plan for different areas of care including Prevention of falls, Moving and Handling and Pressure Care. Discussion took place with the manager for the need to develop the risk assessments to show how any identified risk will be managed. There are clear procedures for the administration and storage of medication. Medication records were found to be satisfactory. Staff who administer medication have been trained. There had been a recent review of the homes process for repeat prescriptions. Systems were in place to ensure that the home, GP and Pharmacy all received a copy of the repeat prescription details so that any errors could be identified quickly and addressed. Since the last inspection the home has purchased a separate fridge for medicines requiring low temperature storage. Separate care plans were available for residents requiring Insulin and agreed protocols were completed and kept under review by the GP. There was evidence of good liaison with the Community Care Homes for Older People Page 14 of 29 Evidence: Health services. Residents and visitors spoken to and responses in questionnaires showed that residents feel they receive the care and support they need. Residents said that staff respect their privacy and dignity when assisting them with personal care tasks. The Inspector observed that staff speak to residents in an appropriate and friendly manner, and knock on bedroom doors before entering. The homes understanding of issues relating to privacy, dignity and choice was also reflected in the written documentation and individual care plans. Care plans contained very detailed information about each individuals preferred choice of daily routine and how they like to be supported. One care plan stated that the resident must be offered a choice each day about what they wear. The staff spoken to were very aware of individual residents daily routines. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle and the activities they take part in. The home has sought the views of residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. Meals are well balanced. Mealtimes are flexible and relaxed, staff are patient and helpful, and allow individuals the time they need to finish their meals comfortably. Evidence: When people first move into the home information is recorded about any particular interests they may have and ways they may like to occupy their time during the day. The manager said that this information is developed as the staff get to know the individual and is used to help plan activities for the home. Residents said that they can choose how to spend their time and they are encouraged to make suggestions regarding the choice of activities.Several residents spoke about the Christmas celebrations that had been enjoyed and a photo album displayed pictures of a Christmas fancy dress party and various other events. The home has Care Homes for Older People Page 16 of 29 Evidence: beautiful gardens, which are easily accessible and residents said that they enjoy spending time sitting and walking outside during the summer months. The home has good links with the local community and organizes a annual garden party for residents, friends and familys. Shopping trips are provided by car to the local town of Kingsbridge and other places of interest. Residents were pleased to show the Inspector the homes budgie, a pet,which several said they had enjoyed owning when they lived in their own homes. Information about local events and visitors to the home such as the hairdresser, chiropodist and mobile library were clearly displayed on the homes notice board. A weekly activities plan is completed for each resident and this is reviewed as part of the homes care planning process. Visitors spoken to said that they were always made to feel welcome and kept informed of any important issues. One resident said that visitors are offered tea and cakes by the staff as soon as they arrive. The Inspector was able to join residents for the lunchtime meal. The meal served was of a good standard and feedback within questionnaires confirmed that the food is enjoyed by most residents. A menu plan showed a varied and nutritionally balanced range of meals and any special dietary needs were documented and catered for. Some of the residents spoken to said they chose to eat their meals in their rooms and these were brought to them at meal times on a tray. Drinks and homemade cakes were served in the afternoon, and jugs of juice were available around the home. Kitchen staff spoken to said that a choice of meals is always offered and any special requests are recorded. Observation during the tea time meal suggested that some residents may need to be reminded that a choice is available if they do not like what has been offered. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at South Efford House can feel confident that their concerns will be listened to and taken seriously. There are sufficient systems in place to ensure that people are protected from abuse. Evidence: The home has a written complaints procedure, which is given to each resident and displayed clearly around the home. The information provided by the home prior to the inspection stated that a How to complain guide has recently been produced in an easy to read format. Residents spoken to said that the manager is always available and the staff are always kind and helpful. All of the residents spoken to said that they felt staff and the manager would be available if they had a problem. During the inspection the manager was approached several times by residents to answer questions about their care and daily arrangements or just to have a chat, and at all times she responded in a sensitive and respectful manner. The manager said that there were several systems in place in the home to ensure that residents are able to raise any concerns. These included, regular residents meetings, a befriending/keyworker system and a recently added suggestion box in the main reception area. Examples were given of changes that had been made within the home following feedback from residents. This included a Welcome Pack for new residents to Care Homes for Older People Page 18 of 29 Evidence: ensure they would know what to expect when they first arrived in the home. The Commission for Social Care Inspection has not received any complaints since the last Inspection. The home had written policies and procedures relating to Safeguarding and the protection of vulnerable adults. Staff receive training in Safeguarding as part of their Induction and on-going training programme. The home supports some residents to manage their finances. Small amounts of money are securely stored for residents in the home. Receipts are kept and any transactions recorded. These records were sampled and found to be in good order. The support provided to residents with their finances had not been documented as part of the residents care plan. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is generally clean, comfortable and well maintained. However, a lack of attention to some areas including, locks on bedroom doors, lighting, and en-suite facilities could be detrimental to residents privacy, dignity and safety. Evidence: A tour of the premises took place during the inspection visit. All of the communal areas were seen and a sample of residents bedrooms. Information about the home, facilities, staff on duty, and events were clearly displayed in the main reception area. A passenger lift, and stair lift is available to the first floor for residents who may have difficulty using the stairs. The home has a beautiful garden, which can be safely accessed by residents. During the last 12 months the rear garden has been landscaped to include pathways, raised flower beds and seating areas. The lounge and dining room were pleasantly decorated and comfortably furnished. Since the last inspection new carpets have been fitted in both these rooms. The chairs have also been replaced in the dining room to improve the comfort for residents when Care Homes for Older People Page 20 of 29 Evidence: eating their meals. The television was positioned at one end of the sitting room and this was being watched by several residents. However, several residents who were sat at the other end of the room were not able to see the screen. The inspector spoke to these residents who said that they chose not to watch TV and preferred to sit quietly. Although residents spoken to said that they did not mind the TV being on it would be beneficial if the home had a separate quiet room so that people could make a choice about where they sit. There were various aids and adaptations in place to assist residents such as a bath lift, mobile hoist, grab and handrails and raised toilet seats. There is an assisted bath on the first floor, and a recently refurbished wet room on the ground floor. In addition to the wet room the home has also refurbished a designated room for chiropody visits and any other occasions when residents require a private area for treatment. Residents bedrooms were generally well decorated and contained plenty of personal items. One of the bedrooms on the ground floor opens into the dining area and due to the absence of an en-suite facility residents using this room would need to walk through the dining area to access a toilet and bathroom. Previous Inspections have noted that consideration should be given to installing an en-suite facility to ensure residents privacy and dignity. It was also noted that this room was cold looking and unappealing and would benefit from redecoration. The manager said that consideration was being given to the long term use of this room. The Inspector spoke to the manager about the poor lighting in one of the residents bedrooms and the absence of a bedside lamp. Risk assessments have been carried out for all hot water outlets and valves fitted in some parts of the home. The manager said that this has not been possible in the older part of the home and in these areas large print warning signs have been put in place, and temperature checks carried out on a regular basis. No progress has been made in fitting bedroom doors with locks to aid residents privacy and the security of their belongings should they be absent from the home. Locks are not provided on rooms used as a respite facility. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed to meet the care needs of the current residents. Staff are provided with training opportunities to enable them to develop their knowledge and skills in caring for residents. The acting manager is supported well by the staff team and senior staff within the organization, with all staff demonstrating an awareness of their roles and responsibilities. Evidence: Staff were described by people living in the home as kind and caring with nothing being too much trouble. People said that they were supported promptly indicating that staff were employed in sufficient numbers to meet the needs of those currently living in the home. On the day of the Inspection there were three care staff, cook, handyman, Head of Care and acting Manager. The rota and discussion with staff confirmed that this would be a normal shift in the home with the addition of one waking and one sleeping night staff. Photographs of the staff on duty were posted on the homes notice board to ensure that residents know who would be supporting them. Care Homes for Older People Page 22 of 29 Evidence: Throughout the inspection staff were attending to chores, assisting residents and spending time with residents in the communal parts of the home. One staff member was offering residents the opportunity to have their nails painted. The Personal files for six members of staff employed at the home were examined, some of these were files of staff recently appointed. All files contained the necessary pre-employment checks including two written references and a Criminal Record Disclosure (CRB). New staff were provided with in-house Induction training to ensure they are given information about the care home and the people living there. Individual training records were available and all staff had access to the homes on-going training programme. Staff spoken to had a very good understanding of residents needs and said that they have access to all the information they need to fulfill their role in the home. Staff files confirmed that staff complete and update training in Health and Safety, Moving and Handling and First Aid. The manager confirmed that all staff either had or were in training for a National Vocational Qualification, a Nationally recognized qualification for which staff must demonstrate their knowledge and skills in supporting older people. At the time of the Inspection plans were in place for staff to attend Safeguarding Adults training. Residents files contained lots of information about different types of Dementia and staff were knowledgeable and sensitive when discussing this area of care. The homes Head of Care had attended a recent Dementia care training course and fed back to the staff team. Staff spoken to confirmed that they have opportunities to attend regular staff, handover meetings and 1:1 supervision sessions. At the time of the Inspection the home did not have a Registered Manager. There was an acting manager in post and an application had been made to Register with the Commission. The acting manager said that she was being well supported by the Responsible Individual for the organization and could access support at any time. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents who live at South Efford House benefit from living in a home that is well managed with an open, positive and inclusive atmosphere. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents, staff and relatives. Evidence: At the time of the Inspection the home did not have a Registered Manager. The Commission for Social Care Inspection had been advised of this situation and an Acting Manager was over seeing the day- to- day running of the home with support from the Responsible Individual for the organisation. An application for Registered Manager had been submitted to the Commission and this was in the process of being dealt with by Care Homes for Older People Page 24 of 29 Evidence: the Registration team at the time of the visit. The Acting Manager was present throughout the inspection and was able to assist fully with all parts of the inspection process. The atmosphere in the home was warm and welcoming. Staff spoken to had a good understanding of the needs of the people they care for and showed particular understanding regarding issues relating to dignity and respect. There is a quality assurance system in place and residents, relatives and staff views are regularly sought. Since the last key Inspection questionnaires for residents have been simplified to make them easier for residents to understand and complete and a suggestions box has been placed in the main reception area. The home also gives out a quarterly One thing questionnaires for residents, staff, families and professional asking them to suggest one thing that the home could do to improve the service. Several examples were given of changes that had been made as a result of this feedback. The responsible Individual visits the home on a monthly basis and completes a report, which is available to the Commission if requested. Residents or their representatives manage their financial affairs. Where monies are held in safekeeping for residents there was clear evidence of records kept of incoming and outgoing payments. Discussion took place with the acting manager about the need to ensure that the agreed arrangements to support people with their finances should be docmented and kept under review as part of the Individuals care plan. Fire prevention measures were in place and the Fire logbook was being maintained with detailed checks and tests of fire safety equipment, as well as fire safety training for staff. The manager said that window restrictors were in place on all windows above ground level. A record was kept of all accidents in the home and this information was available for inspection. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The home should update the care plan identified during the inspection to reflect the change to the original plan of care when the resident moved in. Risk assessments should be developed to ensure that they clearly show how any identified risk will be managed. The home should ensure that all residents are aware that there is an alternative if the meal they are offered is not to their liking. Any arrangements agreed between the home and resident regarding the management of their money should be documented and reviewed as part of the residents care plan. The Registered Provider should give consideration to improving the communal seating areas in the home. Residents who wish to watch the television should be able to do so in a comfortable position with a clear view of the screen. Residents who choose not to watch television would benefit from an alternative room to sit in. The Registered provider should consider installing an ensuite toilet facility in the ground floor bedroom. This would promote the dignity and privacy of the resident using this Page 27 of 29 2 3 8 15 4 18 5 20 6 21 Care Homes for Older People room. 7 24 The Registered provider should install suitable locks to all bedroom doors in the home. This would promote the privacy of residents and further ensure the protection of their personal belongings. The Registered Provider should ensure that all bedrooms have sufficient lighting to ensure the comfort and safety of residents. 8 25 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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