Care Home: Sunningdale Court Nursing And Residential Home Hull

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What the care home does well The home always made sure that people had an assessment before they were admitted and obtained assessments and care plans completed by the local authority. This helped them to be sure they could meet peoples` needs. The care plans and risk assessments they produced were detailed and gave staff plenty of information on how people wanted, and needed, to be cared for. The staff were described as friendly and very helpful and they knew the residents needs well. One resident said, `I am very happy at Sunningdale` and another stated in a survey, `the staff are very good, when I press my buzzer they come`. One relative stated in a survey, `I am very satisfied with the care and attention my wife is receiving, I could not wish for anything better`. The home provided a good quality of life for people with plenty of activities to keep them occupied. Staff also ensured that residents were able to make choices about their lives. People who lived at the home stated they liked the meals and drinks provided. Alternatives were available if they did not like what was on offer for the main meal. The home provided a clean, pleasant and homely environment for people to live in. It had a friendly feel and people were able to bring in small items of furniture, pictures and ornaments to personalise their bedrooms. The home has a good record of training and 64 percent of care staff have completed national vocational qualification in care at level 2 and 3 with further staff progressing through the course. Nursing staff had access to training that enabled them to update their nursing skills. Complaints were dealt with quickly and sensitively, and staff were aware of what to do if they witnessed any incident or poor practice that concerned them. Peoples` finances were managed well with good record keeping. The home in general was well managed. Staff were supervised and residents and staff were consulted in meetings and questionnaires about how the home was managed. What has improved since the last inspection? The management of medication has improved regarding recording when new residents are admitted in the middle of the monthly medication cycle. This has ensured that staff keep a record of all medication admitted to the home. The manager has completed registration with the Commission. The homes redecoration and refurbishment plan has continued with the purchase of new chairs for the lounge upstairs, new profile beds and two large televisions, one for each lounge. The lounge, dining room, corridors and seven bedrooms have beenredecorated on the upper floor and the corridor and six bedrooms redecorated on the ground floor. Both shower rooms and a bathroom have been redecorated and provided with new accessories to smarten their appearance. What the care home could do better: When evaluating care plans staff should thoroughly check other areas of the care file and ensure relevant information is used to plan the changes required. Although the home was storing and recording a specific drug safely, for good practice it should be stored and recorded as a controlled drug. Nursing staff were to address this straight away. Recruitment had improved in that the home completed an initial povafirst check before people started work. However in two files examined staff had started work before the CRB had been returned and there wasn`t documented evidence they had been stringently supervised. This needs to be evidenced. The quality assurance system should be broadened to include questionnaires to health professional visitors. This will gain a wider view regarding the quality of the services the home provides. Staff supervision notes should be expanded to include a more comprehensive description of the discussion. This will improve documentation and aid review. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sunningdale Court Nursing And Residential Home Hull Birkdale Way Newbridge Road Kingston Upon Hull East Yorkshire HU9 2BH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Beverly Hill     Date: 1 7 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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: Sunningdale Court Nursing And Residential Home Hull Birkdale Way Newbridge Road Kingston Upon Hull East Yorkshire HU9 2BH 01482587924 01482222012 sunningdale@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashbourne Homes Ltd Name of registered manager (if applicable) Mrs Anne Caroline Bond Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 49 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 49 Dementia - Code DE, maximum number of places: 49 Physical disability - Code PD, maximum number of services: 49 Date of last inspection 49 0 49 Over 65 0 49 0 care home 49 Care Homes for Older People Page 4 of 30 Brief description of the care home Sunningdale Court is a care home with nursing, which provides accommodation for forty-nine people. Most residents will be over the age of 65years and some people will have needs associated with dementia or their physical disabilities. The home is situated to the east of the city of Hull, easily accessible by the citys link road and close to public transport services. Local amenities are within a short walk of the home. The home is purpose built and accommodation is located on two levels accessed by a passenger lift. There are twenty single bedrooms on the ground floor for people requiring nursing care, and twenty-five single and two shared bedrooms on the upper floor. None of the bedrooms have en-suite facilities. The home has a lounge and dining room on each floor and a further sitting room decorated in the 1940s style on the ground floor. There are two bathrooms and a shower room on each floor. The home has a secure garden at the rear with a raised pond and garden furniture and car parking spaces at the front. Information about the home and its services can be found in the statement of puurpose and service user guide, available from the manager. There is a copy of the service user guide in each of the bedrooms. The homes weekly fees range between 350.50 pounds for residential care to 453.50 pounds depending on the level of nursing care required. There is a top-up fee of 11.00 pounds per week for each resident. There are additional costs for optional extras such as hairdressing, chiropody, newspapers and magazines, and toiletries. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is 2 star. This means that the people that use this service experience good quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key unannounced inspection on 9th January 2007 and including information gathered during a site visit to the home, which took approximately nine hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Sunningdale Court. We also had discussions with the registered manager, care staff members, the cook and a relative. Information was also obtained Care Homes for Older People Page 6 of 30 from surveys received from residents, staff members and one reviewing officer from the local authority. Comments from the surveys and discussions have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were to be met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected in a safe and clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment (AQQA) within the agreed timescale. The AQAA is a self-assessment that focusses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Sunningdale Court, the staff team and management for their hospitality during the visit, and also thank the people who spoke with us and completed surveys. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? The management of medication has improved regarding recording when new residents are admitted in the middle of the monthly medication cycle. This has ensured that staff keep a record of all medication admitted to the home. The manager has completed registration with the Commission. The homes redecoration and refurbishment plan has continued with the purchase of new chairs for the lounge upstairs, new profile beds and two large televisions, one for each lounge. The lounge, dining room, corridors and seven bedrooms have been Care Homes for Older People Page 8 of 30 redecorated on the upper floor and the corridor and six bedrooms redecorated on the ground floor. Both shower rooms and a bathroom have been redecorated and provided with new accessories to smarten their appearance. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that residents needs are assessed prior to admission in order for staff to be sure their needs can be met. Evidence: We looked at four residents files during the visit, one for a person recently admitted in an emergency, to examine how the home ensured peoples needs were assessed. All files had assessments of need completed by the home. The assessment documentation covered all needs associated with health, personal, social and psychological care. The resident admitted in an emergency had received an assessment completed by the manager whilst they were still in hospital. Further assessment information was completed during the first few days of admission. The home also obtained assessments and care plans for people assessed by, and Care Homes for Older People Page 11 of 30 Evidence: funded by, the local authority. The assessment process enabled the home to decide whether the residents needs could be met in the home and whether any extra equipment was required. There was evidence that staff kept the assessments under review and updated them when changes occurred in peoples needs. Those residents at the home who receive nursing care have undergone an assessment by a NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required for each individual. There was evidence that people could have trial visits or respite stays at the home prior to any decision being made about a permanent admission. In a survey one person said, I have enjoyed my stay here, Im going home tomorrow and my son brought me to have a look around. The home does not provide intermediate care services so this standard does not apply. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people were planned for and met in the home. Evidence: Individual care plans were in place formulated with information from the homes inhouse assessments and risk assessments, and those obtained from the local authority and other health professionals involved in the persons care. The care plans were thorough and gave clear instructions to staff on how to meet the persons needs. They prompted staff to promote privacy and dignity and reminded them to encourage independence by stating what the person was able to do for themselves, for example, can wash their own hands and face and brush their own teeth. The care plans had details of peoples likes, dislikes and preferences. Staff recorded daily the care they had provided and there was evidence that issues were followed through to the next shift. Staff spoken with were aware of peoples needs by reading Care Homes for Older People Page 13 of 30 Evidence: care plans and having good handovers, and all seven staff surveys received stated that communication between themselves and with management was very good. Some of the keyworker recording was a mixture of the care they had provided and examples of keyworker roles and responsibilities. Some care staff were confused about what they should be recording in their keyworker records. Staff recorded on monthly weight charts, or more frequently if required. Monitoring charts were also in place, and correctly completed, for people requiring close attention with pressure area care or food and fluid intake. Nursing staff completed wound care charts detailing progress and had input from the tissue viability nurse when required. There was evidence that health care needs were met and people had input from a range of health professionals. Staff recorded in the care file when a health professional visited to provide advice or treatment. Risk assessments were completed for a range of issues and information transferred to care plans when required. Generally care plans were updated when needs changed, were evaluated monthly and reviews were held at six monthly intervals. In one instance there was an issue when care plan evaluations had not picked up on incidents that would have affected a change in care planning regarding the management of a residents particular behaviour. This was mentioned to the manager to develop a behaviour management plan so all staff can approach the situation consistently. People spoken with told us that staff treated them with respect and dignity and surveys received from people stated they were very happy with the care provided. Comments were, I am very satisfied with the care and attention my wife is receiving, I could not wish for anything better, I am looked after well, she is receiving all the attention she needs, everybody is friendly, I am helped in a nice way, and they always do what you ask them to do. All nine surveys stated they received the care and support they required, always. Relatives told us they were kept informed of issues affecting their loved ones and staff recorded an interaction log with relatives. Medication, including stock control, was well managed by nursing staff for people admitted for nursing care and by senior carers for people admitted for residential care. Medication was stored and recorded appropriately when admitted into the home and when administered to people. The home had a good returns system for medication and an appropriate destruction kit for controlled drugs no longer required. Senior carers had completed accredited medication training. The home had a small stock of Oromorph Liquid for one person, and whilst the strength was insufficient to be classed as a controlled drug, good practice dictates that Care Homes for Older People Page 14 of 30 Evidence: it should be stored and recorded as such. This was mentioned to the nursing staff to address. Also the homes suction machine, although relatively new, should be checked as working on a weekly basis. 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. Residents had a good quality of life due the provision of nutritious meals and the home ensuring appropriate social stimulation and opportunities for people to make decisions and choices about aspects of their lives. Evidence: Residents told us that routines were flexible and they could make choices about aspects of their lives. For example rising and retiring, what they have to eat and where they choose to have their meals, what activities they participate in, where they want to sit and whether they want to remain in their bedrooms. Staff spoken with were clear about how they supported people to be independent and to make even small choices, we ask people things not tell them, wed hold up two shirts for example and let them choose one and people pay a lot of money to live here, they can have what they want. Visitors were welcomed at anytime, although management advised that they had, protected mealtimes. This means that professional visitors were asked not to visit over lunch and tea-time to ensure residents were not disturbed and staff were available to assist residents without being called away. The home employs two activity coordinators, which amounts to forty-two hours per Care Homes for Older People Page 16 of 30 Evidence: week. There is a range of activities provided and people spoken with were happy with those on offer. People told us they had trips out to local facilities organised once or twice a week, sing-a-longs, flower arranging, cards, bingo, cinema club, indoor bowling, reminiscence, craft sessions, visiting entertainers, parties, dominoes and other games. There is a mobile shop for residents to purchase items from and the home produces a colourful newsletter that staff and residents contribute to. The home had developed links with schools in the area and local children visited to sing carols on the day of the visit, which was much enjoyed by residents and their relatives. Earlier in the year three residents visited the school to judge the childrens Easter bonnet parade. Residents also visited other homes in the group for coffee mornings, to get out and about and meet other people. It was clear that the activity coordinators and other staff members worked hard to provide a stimulating environment for people. People liked the food provided, which gave them two choices at lunch and the evening meal. Food was prepared by catering staff and served by care staff according to their knowledge of the residents. Meals were nicely presented and staff supported people to eat in a sensitive way, asking people if they would like gravy, salt, pepper and second helpings. The dining rooms were pleasantly set out with individual tables and chairs, placemats and serviettes. The dining experience was observed to be calm and pleasant. Catering staff received written information, diet notification, from care staff about residents nutritional needs, likes and dislikes on their admission. The cook stated that special diets were catered for and was clear about individual residents needs. The home had scored an, A with the local authority, scores on the doors scheme for food safety management, which was an excellent achievement and had also been awarded a, healthy heartbeat award for ensuring healthy alternatives on the menu. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an environment where people feel able to complain and protects people from abuse by staff training and adherence to policies and procedures. Evidence: The home has a complaints policy and procedure displayed in the home and records confirmed that any complaints were dealt with quickly. Those received were of a minor nature. Residents and a relative spoken with named the manager or other carers as the people they would go to if they were unhappy with something, I would tell the carers, they listen to you and would put it right and I would go to Anne (manager), she comes around to see us. We received nine surveys completed by residents, some with assistance from their relatives. All nine stated they knew how to complain and who to speak to if they were unhappy. Staff spoken with and comments in surveys received from them indicated they were aware of what to do if a resident or their relative made a complaint or raised a concern with them. In discussion staff members demonstrated a clear understanding of what to do if they witnessed, or it was reported to them, any incidents of poor practice or abuse. All had received in-house training, and senior staff and the manager have received more indepth training with the local authority. Care Homes for Older People Page 18 of 30 Evidence: In discussion the manager demonstrated knowledge of the referral and investigation procedures, which were part of the multi-agency policies and procedures for safeguarding adults from abuse. She has updated safeguarding of adults training planned with the local authority in April 2009. Since the last inspection there has been three safeguarding of adults referrals. All were investigated with two resulting in further training for staff and one resulting in extra monitoring for the resident during visits. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean and safe environment for people to live in and staff to work in. Evidence: People spoken with were happy with their home, Im quite happy with the lounge and and my bedroom, I wouldnt change a thing and my room is always clean, I cant complain about anything. All nine residents surveys received stated the home was clean and fresh, always. The home was warm, clean and tidy with no malodours. The home was well maintained with a redecoration and refurbishment plan in place that detailed actions and when they had been completed. In the last twelve months the home had purchased twelve profile beds, and redecorated the upstairs lounge and dining room, several bedrooms, both shower rooms and a downstairs bathroom. The home is arranged over two floors with people requiring nursing care and more observation on the ground floor. The upper floor is divided into two sections for people with both nursing and residential care needs. There is a lounge and a dining room on each floor and an additional lounge on the ground floor decorated in the 1940s style with memorabilia from the era. Residents use the room to watch old movies and for Care Homes for Older People Page 20 of 30 Evidence: family parties. All the rooms were light and airy, nicely decorated and homely in appearance. Bedrooms were personalised to varying degrees depending on the taste and style of the occupant. All the rooms had lockable facilities to store valuables and all the doors had privacy locks. There was a rolling programme of redecoration for bedrooms. The rear garden was easily accessible and secure. It had a raised pond and garden furniture for use in warmer weather. The front garden had two boats as planters and the manager was pleased that the home had won, the best commercial garden for a business awarded by the local authority. The home had an appropriate laundry for the size of the building and employed sufficient domestic staff, who obviously work hard to maintain the standards Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a well trained and friendly staff team, which means that people can be sure their needs will be met. A gap in recruitment for some staff means that not all checks are in place prior to the start of employment. Evidence: The home had appropriate staff on duty during the day and night. Discussions with staff members and examination of rotas indicated the home had two trained nurses and seven care staff on duty during the day and one nurse and three care staff at night. The manager was supernumerary. Each day there was also a cook and kitchen assistant, three domestic workers, one of which worked in the laundry, an administration officer and maintenance personnel. The home also employed two activity coordinators Monday to Friday - a total of forty-two hours per week. Residents and a relative spoken with were very complimentary about the staff team, the staff are all right, they treat us well, excellent staff, the staff are always pottering, keeping the place clean and tidy, very friendly staff, I like everything about the staff, they always do what you ask them to do, they dont always come quickly but they do come and they are all real friendly. All nine surveys received from residents stated that staff listened and acted, always and eight stated staff were available either, always or usually. The ninth stated staff were available, Care Homes for Older People Page 22 of 30 Evidence: sometimes. Other comments in surveys were, carers are always friendly and helpful, the staff are very good, when I press my buzzer they come and sometimes the staff are busy but they explain why, then they come to me. Staff were observed interacting well with residents and their relatives. Communication was courteous with an appropriate amount of banter with specific people. The home had a good training plan that included mandatory and service specific training. Discussions and examination of documentation showed that staff had access to a range of training which was sourced from external facilitators, in-house trainers, distance learning, DVDs with question and answer discussions and courses arranged by the Local Authority and the Primary Care Trust. Staff told us they received relevant training that kept them up to date and well informed. The manager identified staff that required updates and organised sessions for them. Nursing staff had training opportunities in order for them to continue with their registration requirements. According to information received the home had 64 percent of care staff trained to national vocational qualification in care at level 2 or 3. This was an excellent achievement and exceeds the requirement of 50 percent of care staff trained to this level. In addition the home had four staff progressing through level 2, and four progressing through level 3. The homes induction system for new staff ensured that they had an orientation to the homes way of working and completed skills for care standards, which were signed off by the manager when completed. This evidenced staffs competence in each section. The home generally had a robust recruitment policy and procedure, which consisted of application forms, reference checks, formal interviews and criminal record bureau checks. Four files were examined and in two, the staff member started their first shift after the initial povafirst check but prior to the return of the full criminal record bureau check. This is acceptable in exceptional circumstances only and must not be routine practice. The exceptional circumstance should be documented and evidence of stringent supervision should be in place. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed ensuring safety, and providing residents and staff with the opportunity to express their views on the services provided. Evidence: The registered manager has worked in the home for thirteen years, five of those years as the manager. She has completed her Registered Managers Award and keeps herself up to date with relevant training. Staff spoken with, and surveys received from them, described the manager as approachable with an open door policy. Comments were, she is firm but fair, she is supportive and gets things done, she is always available and you can see the manager and ask her about anything, she will always let us know how we are doing. Residents knew the managers name and told us they would go to her if they had any complaints. This told us that the manager got out and about the home meeting people rather than remaining in the office. Staff stated they were supported with regular Care Homes for Older People Page 24 of 30 Evidence: supervision sessions and staff meetings. Documentation examined showed us that staff received formal, one to one supervision every two months in line with national minimum standards. There were some instances when issues discussed one month were not followed through and checked out at the next. The supervision notes could also be expanded to include a more comprehensive description of the discussion. Staff told us in discussions and in surveys that morale was high, communication between them was very good and the home was a nice place in which to work. Some comments were, the home has a happy and homely feel, if we have any concerns we can also go to the nurses, its a lovely peaceful home to work in, good team work and we give everyone a warm welcome. Staff and residents meetings were held and the home produced a colourful newsletter to keep people informed of events, activities arranged, staff changes, residents news and information items. The home had a quality assurance system which included monthly audits and questionnaires to residents, their relatives, care management teams and staff, although this year the staff questionnaire had not been completed. Included in the audit was a monthly check of the National Midwifery Council register to ensure nurses employed in the home maintained their registration. To improve the home could send a relevant questionnaire to visiting health professionals to gain their view of the home. Also the full date, including the year, needs to be on the questionnaire to make absolutely clear when they had been sent out. There was evidence that information from the audits and questionnaires was collated and action plans produced to address any shortfalls. The home produced, on time, their annual quality assurance assessment document (AQAA) required by the Commission. It gave us information about what the home is doing well and what they hope to improve on. The AQAA stated that the company has introduced an incentive scheme for good attendance, which has lad to improvements. The home is in receipt of both parts of the local authority quality development scheme, awarded for the development of care planning, key worker systems and the formulation of quality monitoring systems. The home managed residents finances, deposited for safekeeping, on a computerised system connected to the bank and allows the administrator to reconcile accounts daily, weekly and monthly. Receipts are obtained for all deposits and withdrawals with close contact with relatives when the accounts are running low. There is also a residents fund raised via fundraising events and donations. The fund is spent on items for the residents use, 1-2 trips out each week and entertainment. Care Homes for Older People Page 25 of 30 Evidence: The home is a safe place for people to live in. Equipment is serviced and repairs completed quickly. Fire alarm checks and drills are carried out and staff receive appropriate health and safety training in areas such as, fire safety, infection control, first aid, basic food hygiene and moving and handling. Some residents require bedrails for their safety and most occupy profile beds with integrated rails. Risk assessments are completed and those bedrails not integrated with the bed have been secured safely, and are checked monthly but also visually checked at each use. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Staff must only be employed 31/01/2009 after a povafirst but prior to the return of the full criminal record bureau check in exceptional circumstances. These need to be clearly documented and show how stringent supervision has been arranged. This will ensure that residents are supported by people who have been thoroughly checked and are suitable to work with vulnerable adults. 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 When evaluating care plans staff should thoroughly check other areas of the care file and ensure relevant information is used to plan the changes required. Nursing staff should develop a system of checking the suction machine and associated equipment on a weekly Page 28 of 30 2 9 Care Homes for Older People basis and record their findings. 3 4 9 33 For good practice Oromorph liquid should be stored and recorded as a controlled drug. The quality assurance system should be broadened to include questionnaires to health professional visitors. This will gain a wider view regarding the quality of the services the home provides. Staff supervision notes should be expanded to include a more comprehensive description of the discussion. This will improve documentation and aid review. 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. 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. 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