Care Home: St Peter`s Residence

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What the care home does well This home continues to deliver a high standard of care, support given enables people to feel valued and appreciated and enjoy their retirement years. A recently admitted resident said "I found that the whole appearance of the home welcoming and happy, on moving in I found the love and cheerfulness very reassuring, it helped me settle in quickly" Individuals that have lived there for some time tell us that they feel the environment is relaxed and hospitable, and that nothing is too much trouble. The sisters of the congregation display a loving caring attitude, this combined with a professional approach is cascaded to all care staff. The following comments we received reflect how residents feel, " The sisters and staff are always pleasant, I never feel a burden when I need help", "all of my needs are cared for, it is a beautiful place to live in retirement", "staff here always listen and act in your best interest". People entering the home feel confident that the service helps achieve positive outcomes for individuals. Residents tell us that every opportunity is given to accommodate individuals` interests and hobbies. The following remarks were representitive of the majority received,"We can choose to join in the many events that take place or sit in the quiet room to read and enjoy the tranquility of the home", "we are able to go out for shopping trips and attend functions", "events here are very varied and cater for every taste". Residents feel confident and reassured by the service and those running it, in comments, we heard the following "I know that they will always act in the best interests of residents", "to the Little Sisters this is a vocation and not just a job, that is why so much effort is made to make it such an excellent service" the home is well run and the sister in charge is always interested in the welfare of the residents, residents come first". To make sure that care staff have the required skills and knowledge the home provides an excellent staff training programme and invests heavily in staff development. What has improved since the last inspection? The home provides a well equipped and well maintained environment. The standard of decor is high which makes this a lovely pleasant place to live or to visit. Ongoing refurbishment including redecorating. and replacement of furnishings has taken place. Each unit has a tea bar facility now so that residents or relatives can make refreshments. What the care home could do better: The home provides a very good service with few areas of shortfall. Medication procedures are satisfactory and make sure that residents are supported safely with administration of prescribed medication. The procedure for returning unwanted medication needs to be more robust with the receiving pharmacist signing for all returned and unwanted medication. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Peter`s Residence 2a Meadow Road Stockwell London SW8 1QH     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: Mary Magee     Date: 1 1 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: St Peter`s Residence 2a Meadow Road Stockwell London SW8 1QH 0207-735-0788 Telephone number: Fax number: Email address: Provider web address: lsplondonstpeter@aol.com Name of registered provider(s): Name of registered manager (if applicable) Sister Mary Brennan Type of registration: Number of places registered: Little Sisters of the poor care home 56 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: 56 The registered person may provide the following category of service only: Care Home Only (CRH - PC) 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 St. Peters Residence is a purpose-built residential care home for elderly people. It is located in its own grounds in South West London. The home is surrounded by pleasant well-maintained gardens. The home has an abundance of communal areas, this includes a reception area, Chapel, parlour/guest rooms, arts & crafts room, shop, dining rooms, hairdressers, library, several lounges, tea/coffee bar, laundrette, linen stores and several toilets as well as a large entertainment hall. Living accommodation is located on the first and second floors. Each floor has two units of 15 and 13 Care Homes for Older People Page 4 of 30 Over 65 56 0 Brief description of the care home residents respectively. Each unit has its own manager, staff group, lounges, dining room, kitchen, bathrooms and toilets. All bedrooms are for single use and have ensuite facilities. All floors are serviced by a lift. The home is one of a number of homes owned and managed by the congregation of Little Sisters of the Poor, which is a religious order dedicated to the care of the elderly. The fees are from £360 to £490 per week. 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: We undertook this unannounced key inspection in early December, it was carried out by one inspector over a two day period. Prior to the inspection we received a completed AQAA (annual quality assurance assessment). This provided detailed information on how the service operates, the areas identified for further development. We received written surveys from twenty two residents. In addition comments were received from fifteen residents spoken with during the inspection visits. We met with three visitors and two volunteers during the visits to the home, they also supplied us with details of their experiences of the the services at St Peters. A monitoring officer as well a health care professional (psychologist) visiting residents also gave us her professional views on her experiences and the practices observed. Care Homes for Older People Page 6 of 30 We used case tracking to evaluate the services delivered to residents, four residents were selected for this. A number of records were examined during the inspection, this included the personnel files for residents and staff, records relating to maintenance and upkeep of the premises. Discussions were held with the registered manager, the trainer, the human resource manager, interviews were held with six staff members. A tour of the building was conducted. All the communal areas were viewed as well as four bedrooms in each unit. We are grateful to the management , staff and residents who were helpful and courteous throughout the inspection process. 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 30 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 does not admit a person unless a needs assessment is first completed and that it is satisfied that it can meet these assessed needs. People entering the home to live know and have confidence that the home will meet their needs. Evidence: We case tracked four residents to evaluate the quality of care delivered from time of pre admission assessment to current care package. Two of these were admitted in recent months. Both residents had a full needs assessment completed first before they were admitted. In addition a care management assessment was also held with the homes own information. All twenty two surveys received from residents confirm that they have written contracts with the home on the service provided. We found during discussions with numerous residents that no person has moved to the home without having a full needs assessment completed first. The home enables people to sample Care Homes for Older People Page 11 of 30 Evidence: life at the home and have trial periods. Residents feel confident that the service has suitable arrangements in place to meet the needs of residents. Residents spoken to compliment the sisters and staff for their dedication and hard work, the following is Representative of many remarks received, we enjoy living in such a caring and loving environment where people are treated with the utmost dignity and respect. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has excellent arrangements in place to promote and support the people living in the care home. Health care is promoted. Residents health is observed and monitored by vigilant staff, in addition good working relationships are developed with external health professionals. Residents are treated with respect and their rights to privacy and dignity is upheld by staff that know the standards expected. Evidence: Case tracking was used to evaluate the care delivery for residents. Four residents were selected, one from each unit. The selection process we used was based on admission criteria, also areas where residents are identified as having more complex care needs. Staff training is ongoing to ensure that each staff member can provide the level of care identified in the residents care plan. External professionals such as district nurses, psychiatric nurses and psychologists work with staff to contribute to residents care. We heard from a psychologist present of the good work done by staff in supporting residents with psychological difficulties. The remarks received also complimented the support given to residents in the management of psychotic medication and of the Care Homes for Older People Page 13 of 30 Evidence: prompt response in seeking medication reviews. It is evident that the team have confidence in the ability and competency of staff at the home in monitoring and supporting people with psychological needs. We found that care plans are in place for each resident. The care plans are based on needs assessments and include the support and care needed to maintain and assist with personal and health care needs.All areas identified in needs assessments are included in the care plans. Signatures of residents are sought where possible and the majority of care plans are signed by the relevant resident, residents confirmed with us that they are consulted on care planning. Care plans are evaluated every month. Daily progress notes are recorded that reflect individuals progress and the response to treatment and care given. We spoke to six carers during the inspection. We found evidence from discussions that each carer is familiar with the needs of the residents they support and the particular areas of need where changes are arising. According to the residents when spoken to they are pleased with the quality and calibre of staff present at the home, and that they value the good practice shown by the sisters. We know that the unit sister will make sure that everything is done correctly was the comment from a resident. Six monthly reviews take place for all residents which are quite detailed, monthly evaluations are less detailed because of this. This is not satisfactory as on occasions the monthly evaluations are not always fully reflecting all the changes taking place. It is recommended that when monthly reviews are undertaken that these are more detailed on the changes that arise and that all care plans are updated promptly to refelct the changes arising. Risks are identified and included with written care plans. Mobility is promoted with residents encouraged to exercise in the spacious areas around the home. Handrails on corridors and an exercise room are available for those that need these facilities. A physiotherapist is employed to assist those experiencing difficulty with mobility and develop suitable exercise programmes. The home actively good practice in moving residents safely. It places much emphasis on appropriate moving and handling risk assessments and guidance for all staff. For each resident that requires any support in transferring an up to date risk assessment is in place. The trainer is also involved in undertaking risk assessments and reviewing the guidance, and observing working procedures. The home is good at promoting the health of residents. We observed records of the support given to residents to promote all areas of health and well being. Appropriate interventions are carried out for those at risk of falling, referrals are made to falls clinic and recommendations followed. For those at risk of falling from the bed, risk assessments are in place with agreements on the use of cot sides. We found that some of these need to be reviewed and recommend that all those residents requiring cot sides that arrangements are regularly reviewed. Residents are supported to access to specialist medical services, hospital appointment, chiropody and dental treatment. Monthly observations take place of blood pressure and temperatures and records are made of these. Appropriate action is taken too if the findings are of concern. Nutritional screening takes place on admission, frequent Care Homes for Older People Page 14 of 30 Evidence: screening takes place following this. Action is taken to respond to any concerns regarding weight gain or loss. The home provides pressure relieving equipment, no residents currently experience pressure sores. The management and promotion of continence is good. Advice is sought if incontinence is present and any suitable aids and adaptions recommended are supplied. The home has a GP service and hold a surgery every week so that residents can see the GP as often as necessary and receive rapid medical attention, those who wish to maintain their own GP can do so, if the GP is willing to visit the home. There is a large well equipped surgery for consultations with the GP as well as a chiropody/medical room. We observed medication procedures. Medication is administered by staff that are assessed as competent to administer this. According to residents they receive prescribed medication at the required time, medication records too when examined show no omissions. We looked at the management of controlled drugs, all records of conrolled drugs are held on the appropriate register with two signatures present. Control drug stocks were found to be correct. All the medication prescribed is provided by one local pharmacist thus assuring continuity and rapid response when necessary; ie for antibiotics etc which are delivered to the home promptly. We found some areas of shortfalls in medication procedures and where improvements are needed. Unwanted medication is returned to the pharmacist , however the returns book has neither a stamp or signature present to acknowledge the returns. A requirenment is stated. For those residents that are assessed as competent to self medicate there is no copy of a risk assessment present or how this is monitored. A recommendation is made. One of the strengths of this service residents tell us is the way people are respected, they find that the arrangements for personal and health care make sure that privacy and dignity is respected at all times. People are asupported with maintaining their appearance and are supported to have regular baths and showers. The hairdresser visits the home twice weekly. We spoke to a number of residents that value this service without having to go out. All staff are instructed at induction on how to treat people with respect. The unit sisters strive to promote good practice among the staff by constantly promoting the well being of residents. Residents shared with us their positive experiences since moving to the home. We heard of how staff behave and treat older people with respect, we have our wishes respected, My views are heard and taken on board staff are always kind and never a cross word I like the fact that is peaceful here, no loud music or raised voices 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home provides an environment that people find stimulating and that matches individuals expectations and preferences, it satisfies social, cultural, relegious and leisure interests. The home has a strong presence in the community. Residents are supported to maintain contact with family and friends and have close links with community groups. Evidence: Residents tell us that the home is a great place to live. It offers appropriate stimulation, it is tailored to suit lifestyles and considers individuality. Book reading was observed to be a popular hobby with residents, this is promoted by a well stocked library that has books available in large print. Previous life history is taken into account following admission, consideration is given to facilitating personal choice in relation to participation. The home benefits from the presence of an activities coordinator as well as volunteers. Exercise groups, quizes and games are led by volunteers. A range of group activities take place in the craft room, these range from knitting, crochet, card making, painting, the finished products are available to purchase at events. Regular fundraising events take place which involve residents. The home has a coffee shop cafe/bar, also a Care Homes for Older People Page 16 of 30 Evidence: confectionary shop, these are staffed by residents when possible. Events such as bonfire nights are celebrated by residents, residents told of the bonfire supper they recently enjoyed where a great fireworks display took place in the garden. We observed that for the festive season of Christmas a full programme was planned. Residents tell us how much they enjoy this the celebration of this special feast at the home. The home was beautifully decorated throughout with Christmas lights and ornaments. For people that experience dementai the home uses the Sonas method to encourage and stimulate all senses. The spiritual needs of residents are considered, a chaplin is present that is allocated to assure the spiritual needs of residents. Residents that wish to are supported to daily mass in the chapel. Those unable to go to the chapel can connect up to the service by video link to their bedroom. Retired clergy now resident at St Peters also concelebrate mass. We heard of the outings organised and how the minibus is used, recently residents went to the West End to see the Christmas lights. Recently the annual balloon release took place, this event remembers people past and present from the home. The home has a strong presence in the community and involves local secondary schools in entertaining residents. In turn residents are invited and attend the school parties thus giving a sense of belonging to the community. Mealtimes are a social occasion and give residents a chance to chat and catch up with friends. There are five dining areas, one on each unit plus the main dining hall on the ground floor. Residents that choose to may take meals in their own rooms. A number of changes in kitchen staff (chefs) have taken place in recent year, some have had positive impacts residents say. Weekly menus are devised to represent and considers the preferences of residents. Residents views on food vary, the majority find that their particular views regarding meals are considered and that they are satisfied with th meals served. Occasional blips in the cooking preparation are experienced but these are raised with the chef and are promptly addressed. We observed that specials efforts are made to consider those that prefer another option at mealtimes, dietary needs are fully considered. We spoke to one resident that requires gluten free diet, this she says is afforded. Residents that need assistance at mealtimes receive help and encouragement from additional staff at this time, sisters from the convent help at mealtimes. We found examples of residents with poor nutritional intake and low body weights at the time of admission. However these areas have been addressed successfully and good progress has been made from encouraging and assisting the resident. While case tracking we observed how residents are supported to manage their finances independently for as long as possible. Care Homes for Older People Page 17 of 30 Evidence: We were invited to and shared lunch with residents. The lunch was three courses, salmon pate and toast was the first course, followed by braised beefsteak and a mixture of fresh vegetables. Tiramusu was served for dessert. tea and coffee was available after. We found that the quality of the food is good and that any disatisfied customers feel able to voice their opinions if they are disatisfied. Resident told us that there is a book available so that they can comment on each meal, they feel their comments are listened to and acted upon. Residents are supported to exercise choice over their lives. The views of residents are encouraged, in meetings and through quality assurance surveys. Individuals are supported to manage their own financial affairs for as long as possible Care Homes for Older People Page 18 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. Residents and relatives feel confident in the open culture adopted by the home. Opportunities are given to raise any issues directly, make suggestions or complaints, and know that they are responded to appropriately. The home has robust procedures in place to protect vulnerable people from abuse or neglect. Evidence: The recruitment process is rigorous. The home endeavours to only recruit and engage staff that can demonstrate they value and genuinely care for older people. As part of the induction programme all staff receive training on safeguarding policies and procedures. Staff when spoken to demonstrate an awareness of the need to protect vulnerable people from any form of abuse or neglect. Training records show that staff continue to receive training on this subject, also that future training plans to address training needs with regular referesher courses. Residents too feel confident that management and supervisory arrangements are good and that there is always leadership on the units. They tell us that in charge of each unit is a sister from the Little Sisters community, residents feel that they can raise any concerns with the sister in charge and know that any issues raised will be addressed. The home addresses all concerns and complaints in accordance with complaints procedures. Records we found show that issues are dealt with and addressed promptly. Care Homes for Older People Page 19 of 30 Evidence: This may be due to the fact that residents can speak to manager directly if there are areas that need addressing. In doing so the home responds promptly to minor issues and moniitors these to ensure there is no underlying issue. All residents are given a copy of the complaints procedure when they move into the home. Care Homes for Older People Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy living in a comfortable, safe, well maintained environment. Both individual and shared accomadation is spacious and attractively furnished, individuals keep familiar objects and possessions around them. The premises is wheelchair accessible throughout. Evidence: This home is beautifully presented and provides a comfortabl pleasing environment for people to live in harmony. A significant investment is made in order to retain the standard of the premises, ongoing refurbishment takes to retain this high standard. On entering the home peace and tranquility is palpable. Residents tell us that they enjoy living in such a pleasant environment, the following comments are a sample of those we received, one could not ask for a nicer place to live, both inside and outside of the home are all well kept, it is lovely to view all the pictures around the home. The reception area of the home is attractive, inviting and peaceful, with side rooms that are used for meetings/interviews/visits. On the ground floor is a chapel for worship, an entertainments hall, coffee bar, craft room, and shop, quiet lounges and a large dining room. The layout of the premises is good. Residents accommodation is arranged over four units located on the first and second floors. Each of the four units has a separate Care Homes for Older People Page 21 of 30 Evidence: lounge and dining room and tea bar. Relatives are able to make use of the tea bar too. A lift is provided to access all the floors. A gallery is available directly onto the chapel on the upper floors so that wheelchair users may participate in church services. The entire home is attractively decorated and contains good quality furnishings and fittings. A programme of maintenance is in place with any items requiring attention seen to promptly. The garden is beautifully landscaped additional pots with shrubs have ben added to enhance the front garden. The home is well designed with each bedroom benefiting from a good supply of natural light, majority have views onto the garden. Temperatures are kept comfortable throughout the building. The standard of hygiene is very good, all areas of the home seen were fresh smelling and not masked by air fresheners. The home employs a number of housekeeping staff that have responsibility for maintaining the high standard of hygiene, these include two laundry assistants, a seamstress and a full time gardener. The spacious corridors make it a pleasure for residents to exercise comfortably, either by walking or using their wheelchairs independently. Equipment is available for those requiring additional aids, we observe handrails, hoists and pressure relieving equipment in use. An exercise room is also suitably equipped for the physiotherapist sessions that take place twice weekly. Attractive good quality curtains, pictures and flower arrangements are seen on corridors and in all communal lounges. Twelve bedrooms were viewed thre in each unit. They were comfortable and attractive. Residents had personalised them with items of furniture and personal possessions such as photos and pictures. All bedrooms have en suite facilities. The home has a number of specialist baths on both floors so that people with restricted mobility can be assisted to bathe comfortably. Care Homes for Older People Page 22 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. Recruitment procedures are robust and operate to safeguard residents. Only staff that are fully vetted are employed at the home. Staff receive training and development that gives them the desired skills and competencies to care and support the residents. Evidence: The home employs a large team of staff , housekeeping and maintenance staff are included in the team. Over 81 of care staff have achieved NVQ level 2 in care, housekeeping staff are also now completing NVQ level 2 in housekeeping. In the past the home has employed a number of nurses in the staff team, a small number of nurses remain in employment. A human resource officer manages staff personnel files. These are well organised. We examined the personnel files for five of the most recently recruited care staff. The findings are that thorough recruitment takes place. Following the receipt of completed applcation forms a face to face interview takes place demonstrating the selection process, records are kept of these. The home endeavours to recruit staff that can demonstrate a clear committment to caring and respecting individuals. Appropriate documentaion is sought for all staff before they commence employment. Documents seen include two relevant references, CRB enhanced disclosures, copies of relevant work permit and passport. The service sees induction and any probationary period as being an extension of Care Homes for Older People Page 23 of 30 Evidence: recruitment. Staff complete an induction within the first six months of appointment, this is managed by the trainer. Workbooks are completed during this time. Areas of competencies are constantly observed and when appropriate signed off by unit sister. A new trainer is now employed by the home. She arranges in service training, also uses external training faclitators. She also undertakes a lead role in undertaking risk assessments, updating reviews and drawing up guidance for staff on appropriate maneouvres to use for transferring people safely. Records of training seen confirm that training needs are identified and responded to satisfactorily. The needs including dependency levels of current residents were observed as well as staffing rotas, staff skills. Based on the information seen in records, also staff feedback appropriate numbers of suitably trained staff are on duty at all periods to care and support residents. Some comments received from a few staff members suggested that workloads can vary and that additional staff members would be beneficial. It is recommended that staffing levels are kept under review. Care Homes for Older People Page 24 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. People enjoy living in a home that is well run and that is safe and secure. Safe working practices are adopted to promote the health and safety and welfare of residents and staff. The home benefits from an open and transparent process of management that provides reassurance and confidence to the residents and staff team. Evidence: The registered manager is experienced and skilled. She gives good clear leadership to both residents and staff. Residents tell us they are feel reassured by her presence. The home has a quality assurance system in place, this involves the views of residents and stakeholders. There is evidence that the service continues to be run in the best interests of residents. There is a committment to learning and development of the staff team. The outcome the most recent evaluation and quality monitoring process confirmed that there is a high level of satisfaction among residents and that the service helps people Care Homes for Older People Page 25 of 30 Evidence: achieve good outcomes. The home encourages residents who wish and are capable, to manage their own money and valuables, and make sure they have the facilities to do this safely. For those that require support from the home in managing finances we viewed how these financial transactions are monitored and audited. The sister in charge of each unit supports those residents that need support and makes sure that they receive the personal allowance. Records are made of each transaction on outgoings and income, individuals receive weekly personal allowances to buy what they require such as toiletries. Individuals hold bank accounts are used to deposit savings. A regular audit should be completed of the financial transactions by the person completing Regulation 26 visits. Residents feel that their views are welcomed, although resident meetings have been less frequent in recent months. The manager recognises this and spoke of plans to increase the frequency, this was recorded in the AQAA too. The home is run in the best interests of people using the service. We heard from every resident spoken to that life at the home is good, routines are organised to suit residents The home has the relevant policies and procedures in place, it was observed that many of the polcieis are due to be reviewed. A recommendation is made. Each unit has a sister in charge who provides supervision to care staff, supervision takes the form of direct observations of working practice. This method works well in promoting good practice and stamping out any poor performance. Unit meetings also take place. Individual supervision on a one to one basis is less frequent and records are not maintained. It is recommended that staff receive formal supervision at least six times a year and that records are maintained of this. We observed records relating to the maintenance and servicing of the premises and the equipment. Fire precautions are respected, regular fire drills and testing and servicing of fire fightng equipment takes place. Staff receive training in fire prevention every year. All new staff receive induction training that cover safe working practice topics. The environment is maintained to a high standard, repairs are responded to promptly. The home has systems in place to regularly assess the environment for and address any hazards to health and safety. 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 9 13 All prescribed medication not required by the resident must be dipsosed of safely by returning to the dispensing pharmacist. pharmacist A record is kept of all medicines leaving the home or disosed of to prent mishandling 31/01/2009 2 9 13 For those residents self administering medication appropriate risk assessments need to be in place To ensure that any areas of risk associated with medication is identified and managed appropriately 31/01/2009 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 Homes for Older People Page 28 of 30 1 7 The care plans should be reviewed fully by care staff every month, and then updated to reflect changing needs and current objectives for health and personal care. For residents that ( following risk assessments) require the use of a cot side these arrangement should be reviewed regularly and risk assessment regularly updated. It is recommended that policies and procedures of the home are reviewed and updated to reflect relevant changes to legislation A regular audit should be completed of the financial transactions unertaken on behalf of residents by the person completing Regulation 26 visits It is recommended that staff receive formal supervision at least six times a year and that written records are maintained of this 2 8 3 33 4 35 5 36 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. 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