Care Home: Stanshawes

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What the care home does well Generally the home was found clean, tidy and warm and free from unpleasant odour. Staff were working as a team and interacting with residents. The residents seen looked well cared for at the home. The home stated in the Annual Quality Assurance Assessment that the Service User Guide is avaliable for every resident (can be provided in different languages if required) to ensure that every prospective resident receives information about the home before choosing to come and live in the home. All new residents receive a comprehensive needs assessment prior to admission and if possible care plans are obtained from the social worker prior to admisssion if they are funded by Social Services. What has improved since the last inspection? The manager stated that involving the residents more in the community to maintain outside links was her focus since she started work at the home and that she achieved this through the cooperation of the residents, their families and activity organisers. Through this initiative the home now has links with many social groups such as the Women`s Institute, the Quilting club, the British legion and the Salvation Army. These links are extremely important to the residents - many of which were members of these groups prior to admission to the nursing home. The manager told us that following her appointment as the home manager there have been significant improvements in staff induction, supervision, monitoring and training. This has greatly improved staff retention and the home has only had 4 staff leave in the last 6 months all of which have reported at exit interview that they are sad to leave and have sited very genuine reasons for their resignation. The manager has also developed better relationships with the residents and the relatives to ensure that they are more involved with how the home runs and involved with any changes that are made for example, choosing the colours of the soft furnishing for the bedrooms. What the care home could do better: At this inspection we noted that the kitchen and dry food store had not been cleaned for quite some time. After discussion with the agency cook we were led to believe that there was lack of clarity as to whose responsibility it was to keep the kitchen clean. We noted that the home had a cleaning schedule but this was not being followed. The home must ensure that these areas are clean at all times to prevent the risk of food contamination. Ensuring that prescribe medical devices are applied as prescribed to an individual would ensure that person`s needs are adequately met. Ensuring that all medicines administered are signed for on the Medication Administration Record sheet would prevent errors and protect the residents.Furthermore it could be better if medications are not left in the blister packs without explanation to why they were not administered. This relates to one individual. We recommend that the temperature of the fridge should be recorded daily in order to identify any problem that may affect the potency of the medicine stored it We recommend completing the documents put in place for monitoring care given to residents in order to verify that care had been given as stated in the care plans. We also recommend that the home liaise with the dispensing pharmacy to have clear direction on the labels and on the MARS in relation to how the medication is to be administered. This related to "As directed" medications. Key inspection report Care homes for older people Name: Address: Stanshawes 11 Stanshawes Drive Yate South Glos BS37 4ET     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Grace Agu     Date: 2 5 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: Stanshawes 11 Stanshawes Drive Yate South Glos BS37 4ET 01454850005 01454850006 stanshawes@fshc.co.uk www.fshc.co.uk Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) care home 48 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Manager must be a RN on parts 1 or 12 of the NMC register May accommodate up to 48 persons aged 50 years and over who are receiving nursing care. Staffing Notice dated 04/06/1999 applies Date of last inspection Brief description of the care home Stanshawes is a Company owned Home, situated on the outskirts of Yate, in a residential location close to local shops, amenities and social venues. It is a purpose built Home designed to accommodate a maximum of forty-eight residents requiring nursing care over the age of 50 years. The Home provides accommodation over two floors. There are 36 single and 6 double bedrooms. Whilst none of the rooms have separate en-suite facilities, all rooms have a wash hand basin. There is a lounge and dining room on each floor. All areas of the Home are accessible via a lift. The Home is set in its own grounds. Car parking is available for several cars. Visitors are welcome Care Homes for Older People Page 4 of 31 0 Over 65 48 Brief description of the care home to the Home at any time. In house activities and entertainments are provided. Fees range between GBP534 - GBP604. 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 was an unannounced site visit as part of a key inspection that was undertaken over nine hours to review the requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. A tour of the building was undertaken and a number of records were viewed. Six residents, two staff members and one relative was spoken with on the day. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: At this inspection we noted that the kitchen and dry food store had not been cleaned for quite some time. After discussion with the agency cook we were led to believe that there was lack of clarity as to whose responsibility it was to keep the kitchen clean. We noted that the home had a cleaning schedule but this was not being followed. The home must ensure that these areas are clean at all times to prevent the risk of food contamination. Ensuring that prescribe medical devices are applied as prescribed to an individual would ensure that persons needs are adequately met. Ensuring that all medicines administered are signed for on the Medication Administration Record sheet would prevent errors and protect the residents. Care Homes for Older People Page 7 of 31 Furthermore it could be better if medications are not left in the blister packs without explanation to why they were not administered. This relates to one individual. We recommend that the temperature of the fridge should be recorded daily in order to identify any problem that may affect the potency of the medicine stored it We recommend completing the documents put in place for monitoring care given to residents in order to verify that care had been given as stated in the care plans. We also recommend that the home liaise with the dispensing pharmacy to have clear direction on the labels and on the MARS in relation to how the medication is to be administered. This related to As directed medications. 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 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 8 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 9 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. The policy and procedure for admission of a prospective service user is robust to ensure that the individual(s) make a positive choice of moving to the home with assurance that their needs will be met. Evidence: The Annual Quality Assurance Assessment stated that the Service User Guide is avaliable for every resident (can be provided in different languages if required). We noted from the care files we looked at that new residents receive a comprehensive needs assessment prior to admission and that Care plans were obtained from the Social Worker prior to admisssion. The manager told us that prospective residents are encouraged to come and visit the home with their family before making a decision about placement. The family members of one resident we spoke with confirmed that they had recieved Care Homes for Older People Page 10 of 31 Evidence: terms and conditions of their stay at the home. The manager told us in the AQAA that when a resident is admitted for respite care the home ensures that all staff are aware that the person intends to return home to ensure that they are assisted to maximise their independence to enable them to do so. Care Homes for Older People Page 11 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 needs are assessed and respected. Doctors and other health professionals are involved in their care. However, the home has not complied with instructions in relation to applying one residents medical devices. Some drug administration practices are not satisfactory. Evidence: At this inspection four care files were reviewed. Each care file had evidence of preadmission assessment before all the residents were admitted to enable the home to determine its suitability to meet the residents needs. Detailed care plans were noted in most of the care files reviewed followed by daily day and night entries detailing how the assessed needs were being met. There was also documentation in relation to risk assessments, manual handling assessments and pressure sore prevention. All of the above were regularly reviewed and updated when needs changed. There was evidence that where possible residents are consulted before care plans are developed. Weekly key worker entries were noted in the care files reviewed. Care Homes for Older People Page 12 of 31 Evidence: We noted that one resident with a medical condition had prescribed devices from the Occupational Therapist. The manager told us that instructions on how and when to use these devices were included in the mobility care plan to support staff in ensuring that the devices were applied in order to minimise the effect of the condition. However, we noted that the prescribed devices were not applied but were left in the room even though the instructions were also clearly displayed in the persons room. The individual told us that the devices were not being applied. The persons relative also told us that they have raised a concern with the deputy manager in relation to the devices not being applied and that this is why the instruction was left in the room to remind staff of the importance of applying the devices. Furthermore, some individuals were noted with long unclean fingernails which we believe impact on their dignity in relation to their personal hygiene. These were brought to the attention of the nursing staff and action was taken immediately to deal with both situations. We also noted during the course of the inspection that a volunteer was visiting the home and assisting with cutting and cleaning residents fingernails. The manager stated that care plans of those individuals would be reviewed and that adequate monitoring would be put in place to ensure that they are clean and comfortable at all times. We also noted that some care documentation (Daily Personal Care Schedul) kept in the rooms to monitor care given to residents as part of the care plans were not regularly completed even though this was noted in the staff meeting notes. We recommend that this is regularly completed as we believe that as a working document lack of completion could make it difficult for care given to be monitored. The manager stated that she would ensure that action is taken to ensure that this is implemented. There was evidence of other health professional visits to include the GP, Chiropodists, Opticians and Dentists. People living at the home told us in discussion that they were treated with respect and were enabled to maintain their right to privacy. Staff were noted knocking on the doors and waiting for a response before going in to attend to the resident. Procedures for medication administration, handling, records and storage were assessed. The home had policy and guidelines on handling medication. Care Homes for Older People Page 13 of 31 Evidence: A local pharmacy provides medication using a monthly monitored dosage system. A check of the blister packs indicated that most of the medication had been administered as recorded. However one persons medication was left in the blister packs without coded explanation in relation to non administration. The home must ensure that all medication prescribed are given and signed for and are not left in the blister packs without explanation. This is in relation to one individuals medication on 21/06/09. All medication seen were stored securely. Medicines trolleys are used to transport medication around the home on each of the two floors. Controlled drugs were stored correctly and recorded in a register. A policy is available to enable residents to look after their own medicines. All medication is ordered and received by staff. The pharmacy supplies printed medicines administration record sheets each month. Records of administration of medicines were clear. Records are kept of medicines received into the home. Waste medication is recorded and disposed of via the supplying pharmacy. The home sent us a notification in relation to a medication error. The home told us that they were unable to explain how a non prescribed medicine patch was noted on one individual. The home told us that the patch was removed as soon as it was noticed and that there was no ill effect caused to the person. The manager told us on the day of the visit that investigation into the error is ongoing however they have not been able to establish how it happened. The manager stated that she had increased weekly checks of blister packs and boxes in order to prevent further occurrence. Ensuring that all Medicines administered are signed for on the Medication Administration Record Sheet (MARS) would prevent errors and protect the residents. This relates to three persons medication on 21/06/09, 23/06/09 and 25/06/09. Furthermore, it would be better if labels have clear direction on the medication and on the MARS in relation to how the medication is to be administered. This related to As directed medications. We recommendation that the home liaises with the dispensing Care Homes for Older People Page 14 of 31 Evidence: pharmacy to implement the above. We also noted that the temperature of the drug fridge was not recorded regularly the last recording was on 12/06/09. This means that the potency of the medicines in the fridge cannot be guaranteed and may loose their effectiveness. We discussed all the above with the manager and have issued requirements and made recommendations where applicable to ensure that chances of drug errors are minimised/prevented. Staff receive in-service training on death and dying to ensure that care and comfort is given to residents in their final days and time of death. The home has a manager with palliative care experience. 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. Residents are enabled to maintain links with their families and are also provided meaningful activities. The food is nutritious with varied choices available. Evidence: The home is mindful of the type of activities to provide for the residents based on their capabilities. Each resident is assessed for the timing of provision of care as far as is practicable, their wishes are considered and where it is not possible the relatives and/or advocates are involved to ensure that individualised care is provided. The manager told us that the home has an Activity Coordinator who is also a licensed Reflexologist. Activities organised for the residents include Skittles on Mondays, Art and Craft on Tuesdays, Sing Along on Wednesdays, Bingo on Thursdays and Reminiscence on Fridays. We noted an activity file where residents participation is recorded and monitored to ensure that those who are not able to participate are seen on a one to one basis including residents who are bed bound and those who prefer to stay in their rooms. The home told us in the Annual Quality Assurance Assessment (AQAA) that it has developed links with the community and has plans for the Pet Tharapist to visit the Care Homes for Older People Page 16 of 31 Evidence: home, and for the Quilting Group and Womens Institute to hold a meeting at Stanshawes. All these activities will provide the residents with better interaction with the community. Other activities include a monthly coffee afternoon to be arranged for all the residents, relatives, visitors, members of the outside community. This will ensure that the residents can maintain contact with the local community even if they are unable to leave the home. The manager told us that some of the planned activities include a garden party for residents and relatives (residents to choose theme), Strawberries and Cream coffee morning, Summer Fete and small trips out for example to Thornbury Village and Avon Valley Railway. At the residents meeting trips were discussed and the residents decided that they would like to go out in smaller groups so that the residents who were more able (for example, able to use toilet facilities when out) can go further a field and the residents who were more dependant on nursing care could visit places closer to the home. Staff were noted interacting with the residents in an informal and personalised manner. The visitors book showed that relatives and representatives regularly visit the residents. Residents spoken with stated that they had regular visitors. One resident stated that their family lives locally and visit regularly. One relative met on the day made positive comments about the home and confirmed that they were always made welcome at the home. The lunch on the day looked nutritious and balanced and the residents spoken with stated that they enjoyed their meal. The home plans for the menus to be displayed on the tables so that the residents have easy access to them. 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. Individuals living in the home are enabled to complain and are confident that their complaint will be listened to. Practices at the Home ensure protection of service users from harm and abuse. Evidence: The Home has appropriate procedures in place for the management of complaints. The complaints procedure was noted displayed at the entrance of the building This document contains information about the Care Quality Commission to enable individuals to contact the Commission if they were not satisfied with the outcome of their complaint to the organisation. The information was updated, to include the Commissions new address. There were six recorded complaints since the last inspection. Records show that these complaints were responded to and the manager told us that the complainants were satisfied with the outcome. In relation to Adult Protection procedures, records showed that all staff have been trained in the Four Seasons policy and procedures, as this is included in the induction training for all staff. The manager is experienced in the procedure for reporting suspected abuse to appropriate authorities. For example a strategy meeting took place in relation to a suspected maltreatment of a resident by a care worker. The manager told us that the member of staff will not be returning to the home. The Commission Care Homes for Older People Page 18 of 31 Evidence: was satisfied with the action taken to protect residents following the incident. There is a copy of the South Gloucestershire Council policy on The Protection of Vulnerable Adults from Abuse at the Home to ensure that staff are aware of the protocol to be followed if incidents of abuse occur. Two new staff members files reviewed evidenced that two satisfactory references and Criminal Record Bureau Disclosures had been obtained before commencement of employment to ensure that individuals living in the home are adequately protected. The home has a Whistle blowing policy to enable staff to report any bad practices without fear of any reprisal and staff files showed evidence of training on Protection of Vulnerable Adults. A relative told us at a discussion on the day of our visit that they are satisfied with the services and care provided at the home. Records of residents monies viewed tallied with the amount in the individual accounts in the safe. People spoken with stated that they felt safe at the home. Staff we spoke with told us that they are aware of the whistle blowing policy and would report bad practices regardless of whether the person is a friend. Registered nurses had their Personal Identification Numbers verified by the Nursing and Midwifery Council before commencement of employment and periodically thereafter. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents enjoy a pleasant, safe and homely environment however the kitchen fails to meet good standards of hygiene. Evidence: Stanshawes is a Company owned Home, situated on the outskirts of Yate, in a residential location close to local shops, amenities and social venues. It is a purpose built Home designed to accommodate a maximum of forty-eight residents requiring nursing care over the age of 50 years. The Home provides accommodation over two floors. There are 36 single and 6 double bedrooms. Whilst none of the rooms have separate en-suite facilities, all rooms have a wash hand basin. There is a lounge and dining room on each floor. All areas of the Home are accessible via a lift. The Home is set in its own grounds. A tour of the building found the home to be comfortable with an array of soft furnishings, which made the home very homely. The home was clean, tidy and odour free and care and domestic staff were noted undertaking their duties on the day. In relation to improvement at the home since the last inspection the home told us in the Annual Quality Assurance Assessment that redecoration throughout the home has commenced. All bedrooms have new bedspreads and curtains (the colours of which Care Homes for Older People Page 20 of 31 Evidence: were chosen by the residents or if they were unable, by their relative). Carpets within the bedrooms are gradually being replaced. The home no longer has any unpleasent odour due to the new air freshening sysyem that has been installed. We noted that annual servicing in relation to Gas Installations and heating systems, Safety of Electrical Installations, along with checks of the emergency lighting and Fire safety systems have been carried out. There is evidence of this and of annual lift and hoists servicing. The homes facilities support good practice for the prevention of the spread of infection. Appropriate Policies and Procedures are in place. While we aware that the organisation has made and are making further improvements at the home we were disappointed with the uncleanliness and untidiness of the kitchen and the dry food store area. We noted the work-tops; and the shelves had dried grease and the floor of the kitchen was very untidy. We also noted that the dry food store was untidy and dusty. The manager told us that there was a cleaning schedule however this was not being followed. This situation puts the health and safety of the residents, staff and visitors at risk and must be addressed to ensure protection of all concerned. A requirement has been made for the kitchen to be deep cleaned and to ensure that the cleanliness is regularly maintained. This service was visited by the South Gloucestershire Environmental Service December 2008 and was awarded a five Star rating. 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. The residents enjoy good, warm relationships with staff. The homes recruitment procedure offers protection to the residents and there are adequate numbers of staff to meet the needs of the individuals living in the home. Evidence: On the day of the inspection there were thirty eight residents at the Home. The rota showed that there were two registered nurses 8am-2pm and eight care assistants 8am-2pm. There also two registered nurses 2pm-8pm and six care assistants 2pm-8pm. One registered nurse from 8pm-8am and five care assistants (one care assistant on induction) from 8pm-8am.This is regularly monitored to ensure that residents needs are adequately met. Other supporting staff include domestics, kitchen staff, a maintenance person, Activity Coordinator and an administrator. In relation to staff training the manager stated that almost all staff have attended updates in manual handling and that fifteen staff are booked for the same updates on 10/07/09. Eleven staff members have First Aid Certificates. The manager told us that the home is organising training for three staff members and, four staff members to Care Homes for Older People Page 22 of 31 Evidence: attend training on the Protection of Vulnerable Adults and Infection Control respectively. Nine staff members have attended training updates in Health and Safety. The manager told us that the head office is arranging more training for staff on this subject. Eight staff members have National Vocational Qualification (NVQ) at Level two, four have recently commenced and four staff members are awaiting registration for course at NVQ Level two. Two house keeping staff met on the day met on the visit stated that they had attended Protection of Vulnerable Adults from Abuse, Control of Substances Hazardous to Health and Infection Control training. There is a system in place to ensure that the correct procedure is followed when recruiting staff and the system also requires the cross checking of the process before a person is employed. Two samples of this were seen. All new staff undergo intensive induction training provided by Four Seasons Health Care; this training complies with Skills for Care induction programme. 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. The home is well managed; it ensures that there is adequate protection in relation to health and safety of residents, staff and visitors. Evidence: On the day of inspection there was a good, friendly interactive atmosphere at the home. Most residents looked well cared for and were talking to staff in an informal way. Staff and residents spoken with told us that there have been improvements at the home and that the home is better managed since the new manager started in December 2008. Ms Cathryn Shipsides is the new manager for Stanshawes Nursing Home. Cathryn has a Diploma in Higher Education Nursing (Registered Nurse) and a qualification in Palliative Care (Lymphodema level 3). Cathryn has four years experience in palliative care and two years experience as a deputy manager in three Star rated home. Since joining the organisation the manager has attended all the statutory training Care Homes for Older People Page 24 of 31 Evidence: including risk assessment and health and safety. Other training attended includes male and suprapubic catheterisation and a syringe driver update. Cathryn stated that she has attended Mental Capacity Act training and Deprivation of Liberty Safeguards. Her aim is to commence National Vocational Qualification (NVQ) at level 4 in Care Management or the Registered Managers Award as soon as possible. The qualifications and experience will enable her to support staff members to provide high quality care for the residents. Cathryn is yet to submit her application for registration to the Care Quality Commission. The manager had a clear understanding of her role and responsibility within the home and was able to demonstrate understanding of the needs of the residents. There was evidence that the manager and her team were committed to maintaining good levels of service. Residents, relatives and staff spoken with on the day commented positively and highly of the managers ability to manage the home. Staff spoken with on the day of inspection stated that Cathryn is good, open and approachable. Ms Shipside stated in a discussion that she is well supported by the Regional Manager through regular supervision and would ensure that the home is provided with adequate resources for meeting the needs of residents at Stanshawes. There was evidence of staff meetings to ensure that staff remain focused on the vision of the home to provide quality care to the residents. At the last staff meeting (Registered Nurses) on 09/05/09 issues discussed include shift management of care plans and audits, Medication and Medication Administration Record Sheets. The home has robust policies and procedures in relation to aspects of health and safety. Records relating to health and safety were clearly written and accessible to staff. There was evidence that the home takes the health and safety of residents, staff and visitors seriously whilst maximising residents independence. Care Homes for Older People Page 25 of 31 Evidence: The fire logbook was viewed and was well maintained. The home was completing the appropriate checks on the fire equipment and recording of training and testing of equipment was satisfactory. Staff have attended fire drills to ensure that they have clear knowledge of action to be taken in the event of fire emergency. There is a service record of the Nurse Call system, fire alarm service and portable appliance tests (PAT) of all electrical appliances. We noted while reviewing the records that there were a number of accidents between January and May 2009, on some occasions there were injuries and some no injuries following the falls. Accident reports were clearly recorded and satisfactorily reviewed on each occasion. The manager told us that auditing accidents enables the home to establish if there is a pattern and a reason in order to undertake appropriate risk assessment to minimise/prevent accidents. Staff supervision was reviewed. Evidence from the records viewed showed that staff have received supervision. Staff spoken with confirmed that they have received supervision and that they benefited from the exercise. It afforded them the opportunity to express their opinion about the services provided at the home and to discuss areas of concern in relation to residents care. The manager told us that trained nurses have been allocated to undertake supervision activity with carers as a part of personal development. The home has different ways of monitoring the quality of its services. These include, residents and relatives questionnaires, monthly medication care plan audits residents care plan reviews from Social Services, Risk Monitoring reports on residents and six monthly organisational Team Audit Process (TAP) by managers to look at every aspect of the home. There is also a monthly health and safety check and weekly report to the regional Manager on staffing and agency usage. The statutory monthly providers visit enables the home to review practices and formulate an action plan to remedy any identified areas of concern. The home has policies and procedures to include Confidentiality, Protection of Vulnerable Adults from abuse and whistle blowing, complaints, Missing Persons Recruitment and Staff supervision. Residents monies were reviewed and it was noted that the amount recorded in the book corresponded with the amount found in the individual pockets in the facility Care Homes for Older People Page 26 of 31 Evidence: provided. All residents information was securely locked away. All residents have a lockable facility in the bedrooms for personal belongings. Care Homes for Older People Page 27 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 28 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 Ensure that prescribe medical devices are applied as prescribed to an individual. In order to meet persons needs. 16/02/2010 2 9 13 All signed medication must 16/02/2010 not be left in the blister pack without coded explanation. Furthermore all medication administered must be signed to prevent error and to protect the residents. To prevent error and to protect the residents. 3 26 16 Ensure that the kitchen is kept clean at all times including the dry food store. To ensure that food preparation is safe. 16/02/2010 Care Homes for Older People Page 29 of 31 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 Regular completion the documents put in place for monitoring care given to residents would enable the home to verify that care had been given as stated in the care plans. Liaise with the dispensing pharmacy to have clear direction on the labels and on the MARS in relation to how the medication is to be administered. This related to As directed medications. Temperature of the fridge should be recorded daily in order to identify any problem that may affect the potency of the medicine stored. 2 9 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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