Care Home: The Pines Nursing Home

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What the care home does well There were good arrangements in place for admitting new people to the service. These included a pre-admission assessment to identify people`s individual needs, and this gave the manager the opportunity to make sure the service would be suitable for the person. The provision of personal and health care was good, and people told us they felt well looked after. The staff worked closely with other agencies and health care services to offer people a good standard of general and specialised health care. The management of medicines was safe and promoted people`s health and well being. One person told us, "The Pines is like a cross between a hospital and a luxury hotel and should be nominated for an award". People told us the food was very good, and we saw that all meals were homemade to a high standard, although there were some issues around choice. The service managed complaints well and had a clearly advertised complaints procedure. People had been reminded of this during residents and relatives meetings and there were stamped addressed postcards available for people to post direct to the home owner. People told us that staff listened to them and said they felt safe living in the home. Staffing arrangements were good, and people spoke fondly of the staff team. One person said that "all the nurses, cleaners and carers are friendly, open, and really care". There were sufficient staff on duty to meet care people`s needs, and to manage the domestic tasks and catering. The service supported care staff to do National Vocational Qualifications and 40 percent of staff had achieved this, with a further 30 percent working towards it. The home was clean, fresh and tidy throughout, and the general standard of decor was good. People told us the environment was pleasant and they were very comfortable, and "the home is always spotless and smells nice". There were good management systems in place and the manager was focused on meeting peoples needs and wishes in a person centred way. What has improved since the last inspection? The new manager had introduced a number of changes and re-introduced some systems that had slipped prior to her coming into post. Care plans were being updated and made more person centred, to include people`s wishes and choices as well as details about their physical care needs. The medicines system had been strengthened and the process for destroying unwanted controlled drugs had been improved to make them safe before they left the premises. The breakfast routine had been altered to make sure people got their breakfast at a reasonable time, and were not left too long overnight without food. People who wished to be up and have breakfast in the dining room could still do so, while other people had their breakfast served in their bedroom. Regular residents, relatives and staff meetings had taken place. The minutes of these showed that people had been able to ask questions and make suggestions about howthe service should be run, and this demonstrated the managers willingness to consult with people. A new extension had been built accommodating additional bedrooms, a bathroom and a lounge. Some decoration had taken place in the older part of the building and new dining room furniture had been provided. People`s moving and handling needs had been re-assessed and a new hoist and several slings had been purchased to accommodate peoples needs. One carer was training to become a moving and handling trainer. The majority of beds had been replaced with electric profiling nursing beds, and the remaining six were on order. New hand washing facilities for staff had been provided in people`s en suites. The manager was booked onto a management course. What the care home could do better: To comply with the law, the new manager must apply for registration with the commission to become the registered manager for this service. Staff fire training was out of date and staff need an update to make sure they understand how to prevent fires, and how to keep people safe if there is a fire in the home. We made a number of good practice recommendations that the manager should give consideration to. People should be consulted about the provision of activities and entertainment in the home, so they can experience a fulfilling lifestyle. There should be a choice of menu, so people can choose in advance what they would like to eat. Staff would benefit from some safeguarding training so they can be confident about what to do if someone makes an allegation of mis treatment or neglect. In some areas of the home the lighting should be improved so it is bright enough for people to read by. The bathing facilities should be reviewed as one bathroom is not fit for use. The manager should continue her work to introduce formal staff supervision and set up a quality monitoring system. This will help to make sure that staff are working in accordance with the homes policies and procedures and help the manager ensure people are happy with the service they receive. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Pines Nursing Home Bongate Appleby-in-westmorland Cumbria CA16 6HN     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: Jenny Donnelly     Date: 1 8 1 1 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 28 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 28 Information about the care home Name of care home: Address: The Pines Nursing Home Bongate Appleby-in-westmorland Cumbria CA16 6HN 01768351503 01768352827 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) J.L.Robson and R.M.Johnson Partnership Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing: Code N, to people 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 Physical disability: Code PD The maximum number of people who can be accommodated is: 27 Date of last inspection Brief description of the care home The Pines Nursing Home is situated in the town of Appleby. It is a converted house with new extensions added. Accommodation is on the ground floor only, with the first floor used as office and staff space. All bedrooms are single with an en-suite toilet and hand basin. There are comfortable lounges, dining rooms and a conservatory. The Pines has mature gardens, with a paved area for seating. There is ramped access and a small car park. The Robson and Johnson Partnership own the home. There was a new Care Homes for Older People Page 4 of 28 0 27 Over 65 27 0 Brief description of the care home manager in post, Delphine Benson, who was applying for registration with the commission. Written information about the home and copies of inspection reports can be gained directly from The Pines. At the time of this visit the weekly fees ranged from £535 to £545. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the key inspection of this service for the year. Jenny Donnelly made an unannounced visit to the service between the hours of 09.20 and 15.45 on the 18th November 2008. During this visit we, the Commission for Social Care Inspection, toured the building, spoke with people who live in the home, the staff and the manager. We looked at care, staffing and management records. We saw how people were spending their day and saw lunch being served. Prior to our visit the manager had completed and returned an Annual Quality Assessment Audit, AQAA, that we had requested. The AQAA is a self assessment document that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information. We sent surveys to some of the Care Homes for Older People Page 6 of 28 people living in the care home and to staff, and the information received is included in this report. The manager and one of the home owners, Mr Johnson, was present during the inspection. What the care home does well: What has improved since the last inspection? The new manager had introduced a number of changes and re-introduced some systems that had slipped prior to her coming into post. Care plans were being updated and made more person centred, to include peoples wishes and choices as well as details about their physical care needs. The medicines system had been strengthened and the process for destroying unwanted controlled drugs had been improved to make them safe before they left the premises. The breakfast routine had been altered to make sure people got their breakfast at a reasonable time, and were not left too long overnight without food. People who wished to be up and have breakfast in the dining room could still do so, while other people had their breakfast served in their bedroom. Regular residents, relatives and staff meetings had taken place. The minutes of these showed that people had been able to ask questions and make suggestions about how Care Homes for Older People Page 8 of 28 the service should be run, and this demonstrated the managers willingness to consult with people. A new extension had been built accommodating additional bedrooms, a bathroom and a lounge. Some decoration had taken place in the older part of the building and new dining room furniture had been provided. Peoples moving and handling needs had been re-assessed and a new hoist and several slings had been purchased to accommodate peoples needs. One carer was training to become a moving and handling trainer. The majority of beds had been replaced with electric profiling nursing beds, and the remaining six were on order. New hand washing facilities for staff had been provided in peoples en suites. The manager was booked onto a management course. 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 28 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 28 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 care home provided good written information for people about the services and facilities offered. The admission arrangements helped people to know if the home would be able to meet their needs before they decided to move in. Evidence: The service had produced a statement of purpose that provided good written information for people about the home and the services and facilities they provided. The new manager was in the process of updating the management structure in this to include herself. She then intended to provide each person with their own copy. The service only admitted new people after an assessment of their care needs had been carried out. We looked at the admission process for two people, one person with complex needs and another person new to the home. Both had a basic assessment completed by the manager or senior nurse. In addition to this the service had gathered information from other relevant professionals such as social workers and hospital staff. Care Homes for Older People Page 11 of 28 Evidence: Some people had nursing care assessments carried out by the local health service to determine the level of health care funding they were entitled to. The assessment process helped people to know if the care home would adequately meet their needs, and enabled staff to be prepared for their arrival. The surveys we received told us, people had a very welcoming and reassuring introductory visit, and The Pines is like a cross between a hospital and a luxury hotel. Care Homes for Older People Page 12 of 28 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. People were receiving a good standard of health and personal care and the proposed new care planning system will help staff move towards a more person centred approach. Evidence: Each person was allocated a primary nurse and a key worker, who were responsible for their care when on duty. The primary nurse was responsible for developing and updating the persons care plan. The manager had been providing some training on person centred planning and intended to introduce a new style of care plans that incorporated this philosophy. The intention was to keep each persons care plan in their bedroom so the content could be discussed and agreed with them. We looked a some of the existing care records, and they were detailed about peoples nursing needs, but did not tell us very much about the individual person and what they would like. Where people required specific interventions such as tube feeds into their stomach or special precautions against infection, these were clearly documented and Care Homes for Older People Page 13 of 28 Evidence: guided staff in what to do. There was also evidence that people had good access to general health care such as their doctor, chiropodist and optician. Some people with specialist needs also received input from speech and language therapists and dietitians. Risk assessments had been completed for peoples moving and handling, nutritional and skin care needs. Specialist nursing beds and pressure reducing mattresses were provided for people assessed as needing them. One care plan was not so detailed and did not include the fact that the person had a short term illness that was affecting their well being and meant they needed extra care at this time. It was clear from discussions with staff this person was receiving the extra care needed, but it had not been documented. The manager said the new care plan system would include a section for short term care plans to cover temporary illness, and would include more information about peoples wishes and choices. We look forward to seeing these developed. People we spoke with told us they felt well looked after and thought the staff were very caring. We saw that staff were polite and addressed people in an appropriate manner. People said they were cared for in private and staff helped to make them feel comfortable during this, and that staff knocked on doors before entering bedrooms. We received the following comments in our surveys, The care is first rate, all staff nurses, cleaners and carers are friendly open and really care, and my relatives overall state of health despite her condition is a testament to the kind and excellent staff. The overall level of care is very good. We looked at the way the home managed peoples medicines. Records were kept of every medicine received into the home, those administered and those disposed of. We were able to follow this audit trail for a number of peoples medicines and found the records and stock to be correct. Where medicines were prescribed at periodic intervals, such as three times a week, or in alternating doses, these were being well managed. There was good information for staff about the administration of medicines via feeding tubes, and discussion with nurses confirmed they were aware of the instructions and were doing this correctly. The home used a licensed contractor to remove any unwanted medicines and these were properly recorded. The home had not been provided with kits to make safe any wasted controlled drugs and the manager agreed to check this with the contractor. We later confirmed by telephone, that these kits had now been supplied to the home for the safe disposal of controlled drugs. Care Homes for Older People Page 14 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were minimal activities and entertainment provided for people, and although the standard of food was very good, there was little choice for people in what to eat. Evidence: The new manager had altered the structure of the morning routine to make sure that everyone got their breakfast at a reasonable hour. Previously some people had not been getting their breakfast until near to lunch time. Those people who wanted to be up and dressed early and have their breakfast in dining room were still assisted to do so. Other people were served breakfast in their bedroom, and helped to wash and dress later as they preferred. This meant that people were no longer left for a long period between meals, but still had the option to stay in bed later if they wished. We saw that people chose how and where to spend their day. Some people preferred to stay in the privacy of their bedrooms whilst others chose to use the lounges. The provision of regular activities in the home was minimal, with no forthcoming events advertised. People did tell us that they had enjoyed visits from birds of prey and a miniature Shetland pony, as well as a musical event. The manager said activities had been discussed at a residents meeting and people had asked for more musical events. Care Homes for Older People Page 15 of 28 Evidence: Our surveys told us, I have seen very positive interaction with people, they were highly stimulated and interested in animal visits, it was brilliant to see peoples faces light up and their eyes sparkling. Another person wrote, I need more social stimulation as I am bed bound. The manager said one carer occasionally did craft activities with people when she was on duty. The hairdresser visited every week and a minister visited every three weeks. People should be offered more opportunities for activities and social stimulation. All meals and baking were homemade on the premises. The cook had recently surveyed people to update their likes and dislikes in preparation for updating the menus. There was a four week menu in operation with the days menu displayed by the front door. The menu showed the main meal, with no advertised alternative. The cook said alternatives were available if she knew some one did not like what was on offer, or if people asked. People we spoke with had not seen the menu, and did not know what was for lunch until it was put down in front of them. Although the meal looked and smelt very good, one person told us, I do not like meat loaf, I always just eat the vegetables and send it back. We saw that this person was not offered any alternative, so just had vegetables and dessert. People should be offered a choice of meals. Special dietary needs such as soft or liquidised food and diabetic meals were being catered for. Drinks and snacks of homemade cakes and biscuits were served during the morning and afternoon. One survey told us there were some very nice meals, the cook is making an effort to give people food of their choice. Care Homes for Older People Page 16 of 28 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 felt safe at The Pines, knew how to make complaints and felt confident they would be listened to. Evidence: There was a complaints procedure on display in the entrance hall, along with stamped addressed postcards for people to complete and post directly to the home owner asking him to contact them. The minutes of the residents and relatives meetings, showed that the manager had discussed the complaints procedure with people and explained if she was not available there was a book for recording any issues for her attention. People we spoke with said they felt safe, and knew how to complain if necessary. One complaint had been made since the new manager came into post, and we saw evidence that this had been looked into and responded to appropriately. No complaints had been made to the commission, and there were numerous compliment cards on display in the home. Staff told us they were aware of the companies whistle blowing procedures, and knew they must speak up about any concerns about how people were treated. Most staff had done some form of training on safeguarding people from abuse, either as part of a National Vocational Qualification, or through in house DVD training. There was some confusion however about the reporting procedures and refresher training would be beneficial, to make sure any allegations are correctly reported and investigated by the Care Homes for Older People Page 17 of 28 Evidence: proper authorities. Care Homes for Older People Page 18 of 28 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. People lived in a clean, comfortable and pleasant environment. Evidence: The Pines is an older property that has been extended and modernised into a care home. Since the last inspection a further extension with additional bedrooms, lounge and bathroom had been added. All accommodation is provided on the ground floor, with the upper floors being used for staff and office space. There were a number of lounge and dining areas which were all very pleasant. The older rooms had been decorated and new dining furniture and armchairs had been provided since the last inspection. All bedrooms were single and had en suite toilet and hand basin. Some people had personalised their rooms and made them very homely. The newer bedrooms were nicely decorated and equipped, and the manager had completed an audit of the older bedrooms with plans to upgrade the decor and furniture. In some rooms the lighting was not bright enough for people to read by and this should be remedied. Hand washing facilities for staff were being put into the en suite bathrooms. There were three baths and two showers in the home, but not all of these functioned, as one bath did not have the right hoist seat for that model, and the shower leaked into the corridor. This should be addressed, so there are sufficient suitable bathing facilities to Care Homes for Older People Page 19 of 28 Evidence: meet peoples needs. The home was generally well equipped and they had purchased an additional hoist and a number of hoist slings. The majority of beds were electric profiling nursing beds, with the remainder to be replaced with the same. There were pressure reducing mattresses for people assessed as needing them. The manager was hoping to purchase a hoist with a weighing function, as not everyone could manage the sit on weighing scales. This would be helpful as some people were tube fed and need their weight checked regularly. The home was fresh and clean throughout, and the arrangements for managing the laundry and reducing the risk of infection were good. People told us, the home always smells fresh and clean, but sometimes dropped food is left on the floor, the place is spotless and always smells nice, and there are good levels of hygiene. Care Homes for Older People Page 20 of 28 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. People were cared for by a competent and caring team of staff. Evidence: The home was adequately staffed on the day we inspected. On duty were the manager, one nurse, five carers, two housekeepers, two kitchen staff and an administrator. They also employed a part time handy man. The staffing arrangements on the day were satisfactory to meet peoples care needs. There were plans to change the shift pattern in the new year, to provide a more consistent service to people. This had caused some concern among staff and visitors, but had been discussed in residents and relatives meetings, and individually with staff. We received some very positive comments about the staff team in our surveys, including, I regard the staff very highly, the carers are very high quality, the cleaners are fantastic. On the day people told us the staff are wonderful, and they are all very caring. The service continues to support care staff to undertake a National Vocational Qualification, NVQ, in care and 40 percent of staff have completed this, with another 30 percent working towards it. The NVQ assessor visited the home on the day of our inspection, to support staff with their studies, and one carer showed us her file and told us about the progress she was making, and the good support she had. Care Homes for Older People Page 21 of 28 Evidence: There had been other training in the home during the last year including moving and handling training, skills for care induction course for new staff, infection control training, and training in person centred care. Some staff were due to attend training days about end of life care and skin care. One of the staff was undertaking a course to be a moving and handling trainer, and once completed, would provide updates to all staff. Staff said there had been a number of fire drills, but there was no record of recent fire training, which is discussed under the management and administration section of this report. We looked at four staff files to check the homes recruitment procedures. We found that the recruitment checks had been thorough and protected people from having unsuitable persons working in the home. But there was some confusion in the way records were kept, and although everyone had a criminal records bureau disclosure, these were not recorded in a consistent manner. The recruitment procedures should be tightened up. Care Homes for Older People Page 22 of 28 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 new manager was listening to people and was working hard to promote their health, safety and well being. Evidence: A new manager, Delphine Benson, had been in post for three months, and was in the process of applying for registration with the commission. She was supported by an administrator and one of the home owners visited the service most weeks. The manager had booked a place on a management training course with the Care Sector Alliance. We received these comments in our surveys about management arrangements. The new management is very much better, the atmosphere is upbeat and, The manager is warm hearted, kind, approachable and generous of her time and thought. Staff told us the new manager will be excellent for the home. The manager had been working a lot as the nurse on duty, but was now expecting to have more managerial time. We believe this will be important so she can put back in place some of the management systems that lapsed before she came into post. Care Homes for Older People Page 23 of 28 Evidence: The manager had held meetings with residents, relatives and staff, and the notes of these meetings showed that people had been able to ask questions and make suggestions about the way the home is run. A staff forum had also been set up for staff to talk about how changes in the home affected them. A quality audit file had been set up and the manager hoped to spend some time developing this. An audit of the building had been completed to identify any repairs and renewals needed. A full quality assurance system needs to be developed that includes self monitoring and regularly seeks the views of residents and other stakeholders. These should feed into the homes annual development plan. The service holds spending money on behalf of some people for safekeeping. We looked at the way this was handled and checked the records and money of three people. The system was secure and each person had their own record and own money kept separately from the others. Supervision had lapsed prior to the new manager came into post, and she was looking into supervision training for the senior staff and had set up supervision files and discussed the process with staff. Staff should be supervised to make sure they are working in accordance with the homes policies and procedures, to maintain standards and identify training needs. The new manager had done a lot of work bringing health and safety systems up to standard. Every residents moving and handling needs had been re assessed and consequently some new equipment had been purchased. One staff member was training to become a handling trainer. The fire log showed that regular checks of the fire alarms and equipment had been carried out, but the last fire safety training for staff was in May 2007, and this needs to be updated. Staff said there had been a number of fire drills. The kitchen had been inspected by the environmental health officer in May 2008 and had been awarded four stars (very good) for food safety. The new manager had made good progress in becoming familiar with the service, and with peoples needs. She demonstrated a clear vision for the future and was focused on delivering person centred care. Care Homes for Older People Page 24 of 28 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 25 of 28 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 31 9 The home manager must apply to be registered with the commission. To check they are suitably qualified and experienced to run the service, and understand the responsibilities of the role. 01/03/2009 2 38 23 Staff must receive fire safety 01/02/2009 training. So they understand how to prevent fires and know how to keep people safe should a fire occur. 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 12 People should be asked about their interests and hobbies, so that opportunities for activities and entertainment can be provided in accordance with their wishes and preferences. People should be offered a choice of meals, so they can make a positive decision about what they wish to eat. Page 26 of 28 2 15 Care Homes for Older People 3 18 Staff should receive refresher training on safeguarding procedures, to make sure people are protected and any allegations are dealt with through the proper channels. There should be sufficient suitable bathing facilities to meet peoples needs. Lighting should be sufficiently bright enough for people to read by. Staff files should be monitored to ensure records of all recruitment checks are complete and in order. A full quality assurance system that takes peoples views into account and feeds into a development plan for the home should be implemented. Staff should receive regular formal supervision to make sure they are working in accordance with the homes policies and procedures and so that training needs can be identified. 4 5 6 7 22 25 29 33 8 36 Care Homes for Older People Page 27 of 28 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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