Care Home: The Beeches (Rowley Regis)

What the care home does well Residents and relatives express satisfaction with the service provided by the Beeches. Staff demonstrated to us in discussion that they think in a `person centered` way that demonstrates their commitment to the service and the individuals they care for. They demonstrated that they have a good knowledge of the individuals needs that matched what residents told us and what we saw recorded in care records. From observation we saw that staff treat residents with respect and interaction with residents is positive. The home has a friendly and relaxed atmosphere. Residents told us they are happy with staff and `those up top` plus feel they are listened to, this view supported by what we saw from observation of staff interacting with residents. The environment is homely and as far as possible non institutional, this helped by the fact it is a relatively small home. What has improved since the last inspection? We noted improvement in a number of areas, the most obvious in respect of on going building work to improve the facilities available, with the addition of a conservatory to extend the dining room/lounge area and the fitting of new double glazed windows. Information about the home is easier for residents to access with such as service users guides available in all bedrooms. There are clearly good outcomes in respect of staff knowledge and this has undoubtedly been assisted by on going staff training that over the last year has included dementia care and infection control as well as updates on other critical areas of practice. Management have made the home`s staff recruitment process safer and formal supervision of staff has improved. What the care home could do better: Our main concerns related to the homes practices immediately before and after admission, this as there have been instances where there was no evidence of assessment of an individuals needs pre admission and initial care plans have not been prepared at this point in at least 2 instances, this despite an overall improvement in the way care plans are recorded. We saw some limited occurrence of medication not been signed out at the point of administration, this a matter the acting manager was looking into. There was also some prescribed creams not stored securely. Risk assessment in respect of some areas of safe working practices could be better, notably in respect of infection control and fire safety. There is also scope to improve how the home documents the safeguards it has put in place to protect residents when recruiting staff without an enhanced disclosure. There is also a need to ensure that there are completed inventories of residents property so that it is clear as to what property the individual has brought into the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Beeches (Rowley Regis) 17 Waterfall Lane Rowley Regis West Midlands B65 0BL     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: Jonathan Potts     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 31 Information about the care home Name of care home: Address: The Beeches (Rowley Regis) 17 Waterfall Lane Rowley Regis West Midlands B65 0BL 01215595055 01215611737 thebeeches.care@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Janet Wyatt Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home The Beeches is a large traditional Edwardian detached house located near the centre of Blackheath and the range of facilities this offers. The Beeches is registered to provide personal care to older people with dementia. The Beeches has been extended and adapted for its present use and there is currently further development to provide additional living space at the home. There is car parking available at the front of the home with a pleasant, mature garden to the rear. The home is sited off a steep hill and the drive to the home is also inclined. The building is in a commanding position, with some good views of the local area and Clent hills from some bedrooms. The home offers 11 single and 3 en-suite double bedrooms, two communal lounges a dining room, one bathroom, one shower room and five communal toilets. A shaft lift enables easy access between floors. The home is managed on a day-to-day basis by an acting manager who has regular support and contact from the homes provider. The acting manager supervises a team of seniors, carers and ancillary staff. Weekly fees for The Care Homes for Older People Page 4 of 31 Over 65 0 17 Brief description of the care home Beeches detailed in the homes service users guide state the point at which they commence (which is 430 pounds per week) and do not cover the full potential range of charges. 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: The inspection of the Beeches took place over two days and involved one inspector. We primarily assessed the homes performance in meeting key national minimum standards, but also considered how this related to outcomes for the residents living at the Beeches. We considered all the information we have received about the service since the last key inspection and used this to inform our planning in respect of the visit to the home. This included reading the homes annual self assessment which we received prior to the inspection. Our fieldwork involved us case tracking the care of a number of residents to assess whether these individuals received a service that met their expressed needs and aspirations. This involved us looking at care records, talking to residents and staff, observing practice and touring the building. We also looked at numerous others records relating to the management of the home. Care Homes for Older People Page 6 of 31 Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 31 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 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have access to a range of information as to the service the home provides, sufficient to inform them as to its appropriateness for their needs and preferences. The assessment process is not however robust enough to clearly identify the range of needs and preferences individuals may have, and whether the home is able to comfortably meet these. Evidence: We saw that the homes foyer contained information about the home in the form of the statement of purpose, last inspection reports and other information relevant to people moving into care, including the contact details for the local MP. We saw in various bedrooms that there is a document holder containing an up to date copy of the homes service users guide this detailing a range of useful information about the home including the complaints procedure, activities available, staffing arrangements, menus and other useful information. There was a statement as to the fees starting point but Care Homes for Older People Page 11 of 31 Evidence: not any indication as to the maximum possible fee for residency. A positive development is the availability of a website that gives information about the service and an insight into the providers aims, objectives and motivation. (www.southsidecare.co.uk). From sight of case files for two recently admitted service users we noted that there are weaknesses in the homes pre admission assessment processes as there was only one assessment of need carried out for the one resident prior to admission. In addition the home had not obtained copies of social workers assessments. Discussion with a relative of one of the aforementioned service users did however evidence that the manager did carry out visits to prospective service users, although the assessment documenting this visit did not carry a date, or signature. The acting manager and staff in discussion did however give a good account of these service users needs that agreed with information that was recorded in their case files, and the service users own perceived needs. Assessments must be carried out pre admission, these preferably agreed with service users or their representatives so that an initial care plan can be drawn up with the involvement of the service user in the assessment process. Following discussion the acting manager did draw up a format for an admission checklist that could be completed and used as a reminder during the admission process of the tasks completed and these still to be addressed. It was also noted that the home is not confirming its ability to meet assessed needs (although as stated they are not always formally assessed) in writing to prospective residents, this necessary to allay any possible concerns that service users or relatives may have about the home not been able to do so after their trial stay. This once again underlines the need for a robust assessment process prior to an individuals admission. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on individuals needs, although there has been slippage in providing care plans for new residents, this a matter the home has now responded to. Some areas in respect of medication handling could be better. Staff put the principals of respect, dignity and privacy into practice when caring for residents. Evidence: We looked at the records for 4 residents during the course of the visit. We found that two of these residents had care plans that were more detailed and improved over those we saw at the time of the last inspection with detail as to a range of personal, social, physical and mental health needs. 2 of the case files (both for recently admitted residents) did not contain any care plan, which was a concern although a number of staff showed that they were well aware of the needs and requirements of these individuals, this based on information they said they had drawn from case files, verbal updates from the acting manager and observation of the residents during their stay at the Beeches. Discussion with the residents in question evidenced that the staff Care Homes for Older People Page 13 of 31 Evidence: perception of their needs was accurate, as was the case with other residents we spoke to. Despite concerns it was pleasing to see that the acting manager has taken on board our comments on the 1st day of the visit and prepared fairly detailed and accurate care plans that reflected individuals needs prior to completion of our fieldwork. In discussion the acting manager did share with us her ideas for developing care plans so that they were more person centered and understandable for residents. There was some evidence of residents involvement in care planning, this as the plans reflected what they told us about their needs and preferences. In some cases the plans were signed to show agreement, this by the residents representative. We saw that the home has risk assessments in place in respect of nutrition, falls, tissue viability and movement/handling for residents. These are generally reviewed monthly and tracking of these evidenced that these are followed in practice, this based on our observations, comments from residents/relatives and other documentation. Residents weights are compared against a recognized guidance tool (MUST) and there was clear evidence that when there are concerns advice was sought through contact with health professionals. Documentation, supported by comments from residents and relatives evidenced that individuals have access to health care services as needed, records of this contact showing that referral is appropriate and timely. They have a choice of their own GP (within catchment areas). The home has arranged better access to a dentist for residents since the time of the last inspection. The home was seen to have a medication policy, this reviewed in the last 12 months although still basic in content. This would benefit from expansion as raised by the homes contracted pharmacist at the point of their last medication audit in June 2008. There was clear evidence that issues identified at the time of the last inspection in respect of the handling of medication had been addressed, although there were still some areas where improvement is needed including the need to ensure staff do not leave gaps in administration records, as we found was the case on a limited number of occasions. There are also prescribed creams kept in some bedrooms that are not in locked storage. Records of medication regimes were clear and we saw no reference to as directed medication. With the exception of the aforementioned creams, medicines are stored appropriately. None of the residents currently self medicate, this stated by the acting manager due to risk although consent to medication on a risk assessment basis needs to be considered. Discussion with some of the staff evidenced that they think in a person centered way when considering an individuals personal care needs, this further evidenced by Care Homes for Older People Page 14 of 31 Evidence: comments we heard from residents. Staff are aware of the need to, and in practice were seen to (during the time of our visits), treat individuals with respect and to consider dignity when delivering personal care. 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. Individuals are able to make choices about their lifestyle and are supported to maintain their independence. Social and recreational activities meets individuals expectations, although some areas in regard to documentation and presentation of information could be improved. Evidence: Based on comments from residents and relatives people who live at the home have access to and involvement in meaningful daytime activities of their choice, these based on their individual interests and abilities. Examples cited, and in some cases observed include music to movement, trips out, reflexology, parties and holidays to Ross on Wye (the latter at additional cost). Some of these choices we saw to be reflected in records. People we spoke to stated that they were able to make choices as to their daily routines and the home was flexible with such as extended breakfast times this allowing residents that did not rise early to have breakfast at a time convenient to them. Documentation of the activities residents are involved in has improved since the time of the last inspection although is still not maintained daily and does not always reflect day to day activity and stimulation residents maybe involved in whether as a group or on an individual basis. Care Homes for Older People Page 16 of 31 Evidence: We saw that residents are able to move freely around the home and that staff involved them in what was happening so as to provide stimulation and reduce frustration. The home encourages and supports the maintenance of important personal and family relationships. The homes visiting policy was seen to be accessible to visitors and told us that there are no restrictions on visiting, although there is a request to avoid mealtimes. The practices of staff promote good relationships between the home and residents, relatives or friends through ensuring they are welcomed into the home and offered hospitality. The staff are conscious of residents security and access to the home is through a member of staff at all times. The homes policies and what individuals told us evidenced that residents are encouraged to maintain independence within the remit of their capabilities. We discussed with the acting manager the extent to which residents maybe able to have full and active involvement in informed decision making without the support of representatives, and we judged that there is a need to ensure this is formally recognized within assessments in respect of individuals capacity to do so (in accordance with the Mental Capacity Act 2005). The acting manager and staff have received some training in respect of the Mental Capacity Act , although a copy of the guidelines for care homes was not available. The homes menu is varied with a number of available choices, these based on consultation with residents on a day to day basis as well as through meetings. Staff ask the residents as to their daily meal choices, this as we observed. The same was also confirmed by written records. Discussion with the cook showed that she had a real enthusiasm for her job and was knowledgeable as to the need to be vigilant in respect of residents with poor appetites. Records showed us that there are robust nutritional assessments that made use of recognized tools to reflect residents weights against set criteria; this highlighting any cause for concern. We saw examples of where such concerns had been identified and there was clear recording to show the referral of these to external health professionals. Where residents had difficulty digesting foods, these are pureed, although it was noted that different foods are presented as one, rather than separate ( i.e vegetables, meat and potatoes as separate pureed portions) this to assist identification of foods by look and taste. Care staff are sensitive to the needs of those residents who find it difficult to eat and were seen to give appropriate assistance with feeding. The menus are not currently on display due to improvements underway in the dining room, although residents are made aware of the available choices. It was suggested to the home that the use of a pictorial menu may assist residents to make easier meal Care Homes for Older People Page 17 of 31 Evidence: choices, as they could be shown the meals on offer by presentation of photos of meals cooked on site. Care Homes for Older People Page 18 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. People who use the service are able to express their concerns, and have access to a robust effective complaints procedure. The service is aware of how to protect people from abuse with staff knowledge improving through the provision of training. Evidence: Residents and others involved with the service say that they are satisfied with the service provided and are well supported by staff and management . All those we spoke to were aware of the homes complaints procedure and commented that staff listen to them and they felt they would address concerns if they had any. The service has a complaints procedure that is easy to understand, this on display in the reception area of the home and now supported by complaint/comment sheet that can be taken by visitors for completion. The complaints procedure is also available in information packs within each residents bedroom. The addition of the local social services telephone number on all these procedures would be helpful to assist people to contact their social worker although it was noted that the information packs in the bedrooms held the mobile phone numbers for the acting manager and provider, meaning individuals could contact them without recourse to staff. We saw the homes records of complaints this showing that none have been received in the last twelve months in respect of the service currently provided. Care Homes for Older People Page 19 of 31 Evidence: We saw that the homes policies and procedures for safeguarding adults are available, these supplemented by the local social services safeguarding procedures as well as Department of Health guidance. The combination of all these documents gives clear and specific guidance to staff, that they told us they were aware of. Discussion with staff evidenced that they were well aware of the indicators of potential and actual abuse and what action to take should they have concerns. When not sure of the external body to refer these concerns to they were aware of the availability of the homes procedures and the contact numbers within these. The home trains staff in respect of safeguarding and there are plans to update staff in this area as needed, although the provision of refresher training to ensure they are fully aware of local authority procedures would be beneficial, this so that they are clear as to which agencies carry the responsibility for investigation of safeguarding matters, and should be notified of any such concerns. Staff we spoke to have a good general understanding of what may trigger physical and verbal aggression and were able to highlight strategies to avoid this, such as avoiding placing restrictions and involving residents within what is happening in the home. Many staff have or are currently undertaking distance learning in dementia care, which should assist with their insight into care for those residents that have dementia. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a generally safe, well maintained and comfortable environment, which allows independence. Further development of the homes approach to risk assessment will further improve safety of the environment. Evidence: The Beeches provides a comfortable and interesting environment with the presence of period features enhancing the living areas presentation. There is on going work to improve the environment with the main lounge and dining room undergoing extension, recent refurbishment of toilets and bathrooms and the fitting of new upvc windows at the back of the home. Routine maintenance and redecoration is assisted by the home employing a handyman who takes care of routine maintenance issues. A member of staff has also been appointed to carry out safety checks in the home once a week and discussion with this staff member evidenced that this assists with the identification of potential hazards. We saw that the checks carried out are fully documented. We saw that risk assessments in respect of the environment have been expanded since the time of our last inspection and safety checks on wheelchairs are now undertaken monthly. Care Homes for Older People Page 21 of 31 Evidence: The homes has set itself standards for the checks on the environment to ensure safety and the checks carried out by these staff do partly evidence that these standards are met. We saw certificates that evidenced the home is up to date with the servicing of equipment and safety checks on fixtures within the home. The Fire Prevention Officers last visit was in 2005 and issues raised at this time have seemingly been addressed with the exception of the need to review the homes fire risk assessment, with particular attention paid on night time evacuation. The fire risk assessment we saw was reviewed in 2005. All the homes bedrooms have an en-suite facility available which assists with the promotion of privacy and dignity, although it is important that all residents are offered the opportunity to hold bedroom and drawer keys. Choices should be documented and where residents are unable to hold keys a risk assessment completed to validate this decision. We were told by some residents we spoke to that they did not wish to hold keys, although there maybe residents that do. The equipment and aids available at the home we saw are appropriate for the needs of the residents accommodated. Consideration of aids for visually impaired residents should be considered however, with provision of such as talking clocks and such like dependent on the views of any residents concerned. The home is well lit, clean and tidy and was found to smell fresh, this assisted by regular cleaning of areas by dedicated cleaning staff. Records of cleaning around the home we saw are documented in each bedroom. The management has health and safety policies developed by a consultancy and there is reference within some of these to infection control, although there is scope to expand the homes risk assessments in respect of this area in accordance with Department of Health guidance (essential steps) including reference to such as safer handling of laundry. Personal protective wear was seen to be readily available to staff although the gloves we saw in use are the thinner plastic type and not latex, which would offer a better level of protection. We were told that these type of gloves are used for tasks that did not involve high risk of infection as would be the case if a resident had such as MRSA, Clostridium etc. The majority of staff have now received infection control training . It was pleasing to see that a sink for hand washing is now available by the laundry , allowing better hand washing facilities for staff. Care Homes for Older People Page 22 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. Staff in the home present as skilled, knowledgeable as to the care of vulnerable people and are available in sufficient numbers to support residents. Training inputs reflect staff knowledge. Documentation of the safeguards the home takes when recruiting new staff could be better in some instances. Evidence: People who use the service offered by the home expressed confidence in the staff team. From discussion with residents we heard no concerns as to the staffing levels or staff availability when needed. Staffing at present consists of a senior and two care staff during day time hours with a cook and domestic usually available during the morning and afternoon. There is also a handyman available two days a week and two waking night staff . The numbers of staff on duty agreed with the staffing rotas we saw and we judge these sufficient to meet the number and dependency of the residents accommodated at the time of our visits to the home. The service has an recruitment procedure that defines the process to be followed. We looked at the records of two recently recruited staff members and found these showed suitable arrangements were usually in place for the vetting of staff, although there are some areas that need consideration by the management. A very recently recruited staff member was employed following a suitable POVA check, but not an enhanced Care Homes for Older People Page 23 of 31 Evidence: disclosure. Whilst the acting manager was able to demonstrate that this person was working under the supervision of named staff (including herself) there was no documented risk assessment in place to show how this was planned, and no daily log of supervision that would remain in place until the home received the persons disclosure. The statement as to this persons mental/physical health was still outstanding, and according to the acting manager was yet to be returned. Copies of these health statements were available in other staff files we saw. On a more positive note all other recruitment checks we saw were present which indicates an improvement in recruitment practice since the time of the last inspection. These records included interview notes, a record of the staff members full working history and references from their last employer. We heard positive views as to the staff from residents. The homes own quality assurance monitoring also reflected this view. Staff we spoke to were very positive as to the training input provided to them by the home and although the training plan we saw needed updating the acting manager was able to evidence that staff are well trained and had received training in those areas highlighted as needed at the time of our last inspection (namely dementia care and infection control). Nearly all staff have achieved a vocational qualification in care. we saw evidence that new staff are involved in induction training although ways in which this can be improved we discussed with the acting manager, for example the use of written question sheets to evidence staff understanding of key practice issues that may later assist with the staff members training in such as NVQ. The staff we spoke to are knowledgeable as to the residents and what was important in respect of their individual care. We saw that staff meetings take place and that the frequency of one to one supervision sessions for staff has improved with clear recording of these sessions in those staff files we saw. Care Homes for Older People Page 24 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 management and administration of the home is open and accessible with feedback from residents and relatives indicating it is well run, although there are some areas in respect of record keeping that could be better. Evidence: The home has an acting manager who has numerous years of management experience of a care home, is appropriately qualified, and based on what we have been told in the process of preparing her application for registration. The acting manager is aware of the need to keep up to date with practice and continue to develop her management skills and told us that she was well supported by the registered provider, as was demonstrated by copies of reports completed by the latter related to her official monthly visits to the home. There are systems in place for monitoring of the homes performance including regular resident and staff meetings. Annual questionnaires to residents and relatives are Care Homes for Older People Page 25 of 31 Evidence: employed to gain their views on how well they think the home is performing. These have been used to inform the homes AQAA (annual quality assurance assessment) prior to its submission to us although it was noted that this document could have been more thorough. This was the first time the acting manager had completed an AQAA and we suggested that she may benefit from viewing the guidance available on our website.The self assessment did however show clear objectives the acting manager had set for the home over the next twelve months, this identifying some of those areas for improvement identified within this report. It was however pleasing to see that the home has responded to the requirements from the last inspection to the point that we have not had to repeat any of these. Comments have been made earlier in the report to specific issues in respect of record keeping and whilst some records we saw were well maintained others showed gaps, the most notable the lack of care plans for very recently admitted residents as noted on the 1st day of our visit to the home. Records relating to residents monies in safekeeping are well recorded and accurate although the storage of receipts was a little haphazard and could be improved to assist with auditing. We also noted that inventories of residents property in their rooms are not recorded, this an omission that needs addressing so as to ensure there is no doubt what property the individual has in the home. It would also be advisable that the provider undertakes checks of residents monies in safe keeping as an additional safeguard as part of her official monthly visits. The acting manager is aware of the need to promote safeguarding and there has been use made of an external consultant to develop a robust health and safety policy that meets health and safety requirements and legislation. There is still a need to develop generic risk assessments in respect of safe working practices in some areas ( see earlier comments under the environment section), although it has been noted that there has been some improvement in this area. Staff have an awareness of their responsibilities in respect of safe working practices as they told us in discussion, and as we saw from observing practice during the course of our visits ( for example safe use of equipment, safe assistance given to residents etc). Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered provider must ensure that the home has a robust assessment framework in place for prospective residents, that includes use of social services assessments and care plans . This is to allow confirmation of the homes ability to comfortably meet assessed needs and ensure that the service is fully aware of all an individuals requirements. 28/11/2008 2 9 13 The registered provider 28/11/2008 must ensure that medication records are completed at the point medication is administered This is to ensure that there is a clear record of residents receiving prescribed medication. Care Homes for Older People Page 28 of 31 3 35 17 The registered provider must ensure that all residents property is fully documented. This is to ensure that it is easily established what property each resident has in the home. 31/12/2008 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 1 The registered provider should ensure that there is a scale of charges for residency available to prospective users rather than a from this amount figure. The registered provider should confirm in writing the homes ability to meet a prospective residents needs prior to admission. The registered provider should ensure that a care plan is available for residents at the point they are admitted to the home so that individual care instructions are clear. The registered provider should ensure that prescribed creams are consistently locked up when not in use. The registered provider should ensure that the homes medication policy and procedures are reviewed to reflect best practice. The registered provider should ensure that assessments are carried out in respect of residents capacity to make decisions in accordance with the Mental Capacity Act 2005, this so that their right to any individual decision making is fully protected. The registered provider should provide menus in a format that is based on pictures or similar, this to supplement the written menu and assist the presentation of meal choices for individuals with dementia. The registered provider should include the telephone number for the local social services department in all the homes complaint procedures, this to facilitate individuals contact with them. The registered provider should ensure that staff are aware 2 3 3 7 4 5 9 9 6 14 7 15 8 16 9 18 Care Homes for Older People Page 29 of 31 of local authority safeguarding procedures and who carries responsibility for investigation of safeguarding issues. 10 11 19 24 The registered provider should review the homes fire risk assessment, with regard to night time evacuation. The registered provider should ensure that keyholding of bedroom door and lockable areas in bedrooms is explored through a risk assessment process for all residents. The registered provider should developed risk assessment in respect of the homes practices to control infection in accordance with department of health guidance essential steps. The registered provider should ensure that the steps the home takes to ensure that new staff employed with a POVA check, but not an enhanced disclosure are full documented in the form of a risk assessment. In addition questionnaires relating to the new employees mental and physical fitness to carry out their duties should be completed prior to employment. That the registered provider includes auditing residents monies in safekeeping as part of her monthly (regulation 26) visits to the home. That the receipts relating to any expenditure from residents monies in safekeeping are better referenced. 12 26 13 29 14 35 15 35 Care Homes for Older People Page 30 of 31 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 © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!