Care Home: White Hill House

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well Propspective users of the service are provided with information about the home and the services it can offer, along with an assessment of their needs and visits to the home to meet with fellow service users, staff members and to gain a `feel` of the home to ensure that they can make an informed choice as to whether the home suits their needs. The food provided in the home is of good quality, freshly prepared and cooked on the premises, offers choice and meets the dietary needs of those using the service. There is a complaints procedure in place, which is discussed with service users and their representatives when they first come into the home to ensure that they know how to make a complaint and who to speak to if they are unhappy with any aspect of the care and support or the service. Details of the procedure is also provided in the service users guide which is provided to all users of the service. The home is clean, homely, well maintained and decorated, promoting a positive environment for the people who live there. What has improved since the last inspection? Since the last inspection the home has made improvements to ensure good outcomes for those using the service, which include: Updating the service user`s guide and providing it in large print format for those who require. Reviewing, updating and formalising the induction programme for all newly appointed staff and ensuring evidence of the training is held on staff personnel files. The home has provided training to staff to update their skills and knowledge in the majority of the mandatory subjects and dates have been booked to ensure that all staff are up to date in such training within the next few weeks of this visit. Whilst there are no service users who are prescribed any controlled drugs, the home has purchase a controlled drugs cabinet to store any future prescribed controlled drugs. However, this does need to be fixed securely in line with the Misuse of Drugs (Safe Custody) Regulations 1973 (see section below headed `what the service could do better). The frayed carpet on the stairs has been replaced to prevent people from tripping and harming themselves. The paving area outside the coach house has been repointed to ensure any risk to people using the area is minimised. Radiators in all bedrooms have been fitted with radiator covers to prevent people from scalding themselves on the hot surface. What the care home could do better: The recently purchased Controlled Drugs cupboard must be fixed to a solid wall or a wall that has a steel plate mounted behind it and it is to be fitted with either Rawl or Rag bolts complying with the Misuse of Drugs (Safe Custody) Regulations 1973. The registered person must gain verification of any references supplied without a company stamp or on headed paper and a full employment history for each member of staff and ensure to obtain the information and documentation in respect of those persons specified in the Care Homes Regulations 2001. The registered person must ensure that the two staff members whose files were viewed are on the delgate list for the upcoming training to ensure their health and safety training and food hygiene training is updated. Establish a system which ensures that care staff receive formal supervision, at least six times a year, and an annual appraisal of their work. It is reccommended that the registered manager ensures that all users of the service have in place both a risk assessment and a medication agreement, both of which are signed by the service user or their representative, detailing whether they are self medicating or that they give their consent to staff administering their medication. . Inspecting for better lives Key inspection report Care homes for older people Name: Address: White Hill House 128 White Hill Chesham Bucks HP5 1AR     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: Jane Handscombe     Date: 0 8 0 4 2 0 0 9 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 31 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: White Hill House 128 White Hill Chesham Bucks HP5 1AR 01494782992 01494772420 jnalarkin@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Anita Larkin,Mr Julian Larkin care home 8 Number of places (if applicable): Under 65 Over 65 0 8 dementia old age, not falling within any other category Additional conditions: 8 0 The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home White Hill House is a small, privately owned and family run care home registered to care for eight older people. It is situated a short distance from Chesham. It is an Edwardian building set back from the main road. There are pleasant sloping gardens to the rear. Seven rooms are single and one is double. There is one waking staff during the night and the proprietor who also manages the home is available and on the premises when required. Care Homes for Older People Page 4 of 31 Brief description of the care home The fees range from 595 pounds to 625 pounds per week. Additional charges are made for hairdressing, chiropody and newspapers. Information about the home can be obtained by contacting or visiting the home directly. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day by Jane Handscombe and covered all of the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the home for completion and comment cards were sent to a selection of people living at the home, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with people using the service, the manager, staff, visitors, an examination of some of the homes required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the Care Homes for Older People Page 6 of 31 service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. We would like to thank all those involved for the co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? Since the last inspection the home has made improvements to ensure good outcomes for those using the service, which include: Updating the service users guide and providing it in large print format for those who require. Reviewing, updating and formalising the induction programme for all newly appointed staff and ensuring evidence of the training is held on staff personnel files. The home has provided training to staff to update their skills and knowledge in the majority of the mandatory subjects and dates have been booked to ensure that all staff are up to date in such training within the next few weeks of this visit. Whilst there are no service users who are prescribed any controlled drugs, the home has purchase a controlled drugs cabinet to store any future prescribed controlled drugs. However, this does need to be fixed securely in line with the Misuse of Drugs (Safe Custody) Regulations 1973 (see section below headed what the service could do better). The frayed carpet on the stairs has been replaced to prevent people from tripping and harming themselves. The paving area outside the coach house has been repointed to ensure any risk to people using the area is minimised. Radiators in all bedrooms have been fitted with radiator covers to prevent people from scalding themselves on the hot surface. Care Homes for Older People Page 8 of 31 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of the service are provided with information about the home and the services they can offer in various formats to suit their needs. Prior to moving into the home an assessment of peoples personal, social and healthcare needs are assessed to ensure that both parties are confident that their needs can be met appropriately. Evidence: The home provides prospective service users and/or their representatives comprehensive information about the home and the services it offers. The service users guide was updated in September 2008 and is available in large print for those who require. Prior to a person moving into the home, the registered manager or care leader, who are both qualified to undertake such a task, undertake an assessment of the individuals health, personal and social care needs to ensure that their needs can be met appropriately. The assessment process is undertaken in consultation with the Care Homes for Older People Page 11 of 31 Evidence: prospective user of the service and relevant family members and health and social care professionals who have an input into the persons health and social care needs. Each prospective user of the service is invited to visit the home and spend a day with fellow service users and staff members to gain a feel of the home prior to a service being offered. This ensures that prospective service users are able to make an informed choice when deciding upon a home suitable to meet their needs. From evidence seen, it is considered that this service is able to meet the needs of individuals of various religious, racial or cultural needs. 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. All service users have an individualised personal plan of care detailing their needs and how these are to be addressed in order to meet these needs fully. Within a risk management process, service users are enabled to maintain responsibility for their own medication should the need be required. Service users are treated with dignity and respect at all times Evidence: As part of the inspection process we casetracked two service users care and found them to be comprehensive and clearly detail their individual health, social and personal care needs. The service users files viewed were found to be individualised, comprehensive and up to date. Equality and diversity was addressed throughout the care plans. All those viewed gave a good all round view of their needs and how these were being addressed. Care Homes for Older People Page 13 of 31 Evidence: Monthly reviews of the care plans were documented within the plans and where issues arise these were documented detailing the interventions being undertaken to address the issue. Both plans viewed contained nutritional assessments along with evidence of regular weights being undertaken. Pressure area care assessments were also evident within the files, however one of the files viewed contained a skin inspection chart informing that the individual had developed a new sore although this was not detailed to provide information such as the size, whether the skin was broken/unbroken, colour and size. This was discussed and fedback to the provider and a reccommendation made to ensure that detailed information on any developing pressure sores and any changes be documented appropriately. Any accidents or incidents that occur and which may affect the health, safety or welfare of service users are contained within the relevant users files, the appropriate accidents/incidents forms are completed and the relevant authorities are notified as is required. Details of health professionals visits and interventions were clearly noted in each file, as were eye tests and any visits to the hospital or referrals. The service endeavours to work in the best interests of all those using the service and where service users have no family involvement and little or no capacity, we are informed that the home will seek the services of an independent advocate to work alongside that particular service user to ensure their best interests. As part of the inspection process we looked at the medication systems within the home. People are enabled to maintain responsibility for their medication within a risk management process and are provided with secure facilities in which to store them. One of the files viewed highlighted that the service user maintained responsibility for self medicating although there was no medication agreement form in place or a risk assessment that had been signed by the individual agreeing to taking responsibility. It is reccommended that the registered manager ensures that all users of the service/their representatives sign both the risk assessment and a medication agreement, detailing their consent to self medicating or that they give their consent to staff administering their medication. We discussed the systems in place for checking in medication received into the home from the pharmacist and the systems in place for returning medication, all of which were appropriate. All staff who administer medication have undergone training to ensure they have the knowledge, skills and competencies to undertake such a task safely. The home has copies of signatures for those staff who are responsible for the administration of medication to ensure that if an error is made the signature on the medication administration records can traced to highlight the staff member responsible. Since the last inspection, the home has purchased a controlled drugs cabinet, however Care Homes for Older People Page 14 of 31 Evidence: this was not affixed to a solid wall or a wall that has a steel plate mounted behind it and a requirement has been made within this report to ensure that the cabinet is fixed securely to complying with the Misuse of Drugs (Safe Custody) Regulations 1973. At the time of this visit no service user was prescribed any controlled drugs and therefore non were at this time being stored in the home. All those who completed questionnaires tell us that they receive the care and medical support that they need and those spoken to on the day reiterated this. A visiting GP told us that the home always act on any reccommendations that he/she makes, that peoples privacy and dignity is respected by the staff at all times and arrangements are made for her/him to see service users in their own rooms. He/she told us that the home does call in situations where they require advice and tells us Id like to come and stay and I would place my parents here its like home from home. 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. Discussions with service users was positive acknowledging that the lifestyle experienced at White Hill House matches their expectations and enables them to exercise choice and control over their lives Evidence: Contact with families, friends and the wider community is supported enabling those using the service to maintain social links. Service users are able to receive visitors at the home and there are no restrictions imposed on visiting unless requested by the service user themselves. Service users are able to entertain them in their own bedrooms or in the communal lounges. Both the residents and those visiting said that staff always make visitors feel very welcome. One family member, who was visiting at the time, told us that the home dont have visiting hours, that he is always welcomed and said Ive been invited many times to join mum for meals. People using the service are able to take part in activities suited to their needs and abilities, which are undertaken in house and also at the sister home to provide for variety and stimulation. Service users also have access to a hairdresser, who visits the Care Homes for Older People Page 16 of 31 Evidence: home on a fortnightly basis, a beautician who provides manicures and massage and a chiropodist who visits every six to eight weeks. A local vicar visits the home on a regular basis to visit people on a one to one basis and a monthly service is provided at the sister home to which residents are supported to attend if required. The home will make arrangements to enable residents to visit their own church or for someone from their church to visit. The food provided in the home is of good quality, freshly prepared and cooked on the premises, offers choice and meets the dietary needs of those using the service. The home provides a varied menu. Cereal and toast are served at breakfast although the staff said that a cooked breakfast could be provided if a resident wanted one. The main meal is served at lunchtime and a light cooked supper or sandwiches are served at suppertime. The service users spoken to, during the inspection, said that they enjoyed the meals provided, one told us the food here is very good, whilst another told us breakfast is brought to us in our rooms on trays....we always get enough the portions are of a good size Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are able to express their concerns and have access to an effective complaints procedure. The home has effective policies and procedures in place to ensure that those using the service are safeguarded from harm. Evidence: People using the service tell us that they know how to make a complaint and are confident that any concerns that they may have would be dealt with appropriately. The homes complaints procedure is clearly set out in the Statement of Purpose and Service Users Guide. All complaints are taken seriously and logged in a complaints book detailing any actions taken and the resulting outcome. There are policies and procedures in place to guide the manager and staff on how to respond to any suspicion of abuse, these are in line with the Buckinghamshire multi agency policies and procedures. Training is provided to all members of staff to assist them in becoming aware of their own care practices, to recognise signs and symptoms of abuse and to emphasise each staff members responsibility to whistle blow on any poor practice or concerns that come to their attention. Information provided to us in the completed Annual Quality Assurance Assessment (AQAA), provided to us before this visit, informs us that there have been no Care Homes for Older People Page 18 of 31 Evidence: safeguarding referrals or investigation undertaken during the last 12 months. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users of the service live in a well maintained environment which suits their needs and presents a high standard of cleanliness at all times. Evidence: The home is centrally located within the village of Chesham and is not distinguishable as a care home, except for the sign alerting of its presence. The building is well maintained and provides a clean, homely environment for the people living there. We toured the premises and found that the home was cleaned to a good standard with no offensive odours present. All of the bedrooms are single and have been decorated and arranged to peoples individual tastes. Each room has an en-suite shower and toilet and adaptations such as grab rails, raised toilet seats and a bath hoist are in place. People using the service need to have fairly good mobility to be able to manage some small steps around the home and in the garden area. At the previous inspection undertaken in April 2008, three requirements were made to ensure the health, safety and welfare of those using the service. It was noted during Care Homes for Older People Page 20 of 31 Evidence: this vist that actions had been taken to address the requirements and remove the risks that were found; the frayed carpet on the stairs has been replaced, the uneven paving area outside the coach room has been re-pointed and all bedrooms have now been provided with radiator guards to prevent users of the service scalding themselves. Further improvements to the environment include recarpeting three rooms, raising the vegetable patch to make it more accessible to those service users who enjoy helping in the garden, installing window blinds to provide protection and comfort to those using the service from the sunshine when it is strong during the summer months. The garden area is safe for service users and their visitors to enjoy, the side gate has now been fitted with a lock, new furniture for the garden has been provided to add comfort for service users and their visitors and bird feeders have been placed around the garden to encourage the birds. The gardens were observed to be well kept and stocked with flowers, shrubs and garden ornaments to provide a pleasant outdoor environment during the warmer summer months for those who require. Whilst touring the home there was evidence of hazardous substances being stored inappropriately in an unlocked cupboard in the kitchen. Insect killer and bleach was being stored in a cupboard under the sink and a further unlocked cupboard contained medication which we were informed belonged to the proprietor of the home who lives on the premises. A member of staff immediately undertook the necessary precautions in removing the items to ensure the health and safety of those using the service. Discussions with service users informs us that they are happy with their bedrooms and their surroundings, that the home is kept to a high standard of cleanliness at all times and that they were encouraged to bring personal possessions with them, many of which were seen to be on view in their bedrooms. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there is a robust recruitment policy in place, there are poor procedures taking place in verifying references to ensure their authenticity and gaining a full employment history which could compromise the health, safety and welfare of those using the service. Staff are provided with appropriate training to enable them to undertake their roles competently although the updating of these skills are not undertaken in a timely manner Evidence: During the inspection process, two staff members personnel files were examined to ascertain the procedures that are undertaken when recruiting and selecting staff, that appropriate training is provided for staff to ensure they have the skills knowledge and competencies to undertake their roles safely. Both files viewed contained a relevant application form, evidence that suitable Criminal Record Bureau Disclosures had been gained and a statement by the person as to his/her mental and physical health. However there were some shortcomings; whilst two references were found on both files each file contained one reference that had been supplied without a company stamp or compliments slip and had not been followed up and their authenticity verified and neither of the files viewed contained a full employment history. These shortfalls Care Homes for Older People Page 22 of 31 Evidence: were discussed with the manager who informed us that she would follow up on the references retrospectively and gain each of the said staff members full employment history and place them in their respective personnel files. During the last inspection undertaken in April 2008, a requirement was made to ensure that the staff induction be formalised and recorded. Improvements around the staff induction have been made; the service have updated their induction programme to ensure that all newly recruited members of staff are provided with a structured induction training including shadowing more experienced carers until both parties feel confident and comfortable to undertake their role competently. Staff are provided with mandatory training in core subject areas and training records viewed highlighted that the service have, since the last inspection, been providing staff with relevant updates to their mandatory training, although the two files viewed highlighted that one member of staff required an update to her health and safety training whilst the other needed an update to her food hygiene training which had just expired. Training provided since the last key inspection covered infection control, medication awareness, risk assessment training, fire training, COSSH, food hygiene, first aid, safeguarding and supervision and appraisal training. It was noted that there were gaps in the provision of manual handling training, however, during this visit the manager acted promptly on the deficit; she contacted a training organisation to provide the training at the home for all staff two weeks from the date of this inspection; confirmation of the booking for this training was provided to us. The home is part of a cluster of homes in Buckinghamshire that share their expertise, skills, knowledge and training. The manager informs us that staff are encouraged to request further training in chosen areas and wherever possible they will source such training to meet the staffs requests in their chosen field. Staff are notified and encouraged to undertake training provided by the local council either through the cluster group or independent courses which are outside of the mandatory subjects, such as Challenging Behaviour training and training in Bereavement and Loss. Information provided to us in the completed AQAA informs us that all staff are encouraged to undertake the National Vocational Qualification (NVQ) at level 2 or above in care and of the six permanent care staff one has gained the NVQ in care at level 2. The manager informed us that staff members were undertaking their NVQ in care, although they are experiencing problems in finishing the qualification as the assessors have left the training company that the home were using. The manager assures us that the said members of staff will finish their NVQs and that she will change to a different training company if the company that they have been using does not resolve the issue in the coming weeks. Care Homes for Older People Page 23 of 31 Evidence: All those who completed surveys tell us that the staff are always available when they need them and tell us that they listen and act on what they say. 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. There is effective management at the home which is generally run in the best interests of service users, and safeguards are in place to protect their health, safety and welfare. Quality assurance measures have been put into place to monitor standards of care and procedures to ensure that service users receive the support they require. Staff files do not evidence that they are provided with regular formal supervision from their line manager or have their standard of work appraised on an annual basis. Evidence: The registered manager is experienced, knowledgeable, and is competent to manage the home. She displays a good sound knowledge of matters related to the management and running of the care home for older people and is presently undertaking the registered managers award as is one of the senior members ofcare staff although this is on hold at present until a replacement assessor can be found (see section on staffing). Care Homes for Older People Page 25 of 31 Evidence: Residents, staff and visitors to the home spoke in complimentary terms about her management ability and the support she gives. The management approach of the home creates an open, positive, transparent and inclusive atmosphere. We discussed health and safety issues and saw appropriate maintenance records relating to maintaining a safe environment for residents. Regular safety checks are undertaken relating to fire safety and infectious diseases and regular servicing and maintenance of equipment, all of which were seen to be documented appropriately. However, there was one shortfall in that the certificate of Legionella analysis was out of date and needs updating. The registered manager assured us that this would be undertaken. Information provided to us in the completed AQAA informed us that the service had a health and safety inspection in August 2008, for which two requirements were made; during this visit we viewed the inspection report and found that the service had not infact actioned one of the requirements within the given timescale. The home does not act as agent or manage monies on behalf of service users, all expenditures made on their behalf is invoiced to them or their representative who deals with their finances. There were shortfalls around the level of formal supervision that staff are provided with although actions have been taken to address the shortfall. We are assured that staff are provided with supervision on an informal basis regularly and feel well supported, but the registered manager needs to record formal supervisions appropriately. Both staff files viewed during this visit highlighted that one file failed to evidence that any formal supervision had been provided since they were appointed and the second file that we viewed evidenced that the last formal supervision was undertaken in October 2007. Neither of the two files evidenced that the said staff members had been provided with an annual appraisal of their work. We are informed that a senior member of staff has, since the last inspection, undertaken training in Supervision and Appraisal and following the training documentation has been produced to record such supervisions and appraisals., for which we saw evidence. We are informed that since this training informs work has begun on providing staff with formal supervisions. There was evidence of staff records being kept in the home which were not stored securely, for which an immediate requirement was made to ensure staff personnel files clearly meet any requirements set out in legislation such as the Data Protection Act 1998 within 48 hours of the inspection. We received confirmation from the service, Care Homes for Older People Page 26 of 31 Evidence: within the timescale set, that actions had been taken and the said files were now stored securely in locked filing cabinets for which two delegated members of staff had access to, thereby maintaining their confidentiality. The home completed the AQAA well which contained information about changes they have made and where they still need to make improvements. It tells us of their plans as to how they are going to do this and the data section of the AQAA was fully completed. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The recently purchased 15/07/2009 Controlled Drugs cupboard must be fixed to a solid wall or a wall that has a steel plate mounted behind it and it is to be fitted with either Rawl or Rag bolts complying with the Misuse of Drugs (Safe Custody) Regulations 1973. Regulation 13(2) of the Care Homes Regulations 2001 requires that; The registered person shall make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 31 1 9 It is reccommended that the registered manager ensures that all users of the service/their representatives sign both the risk assessment and a medication agreement, detailing their consent to self medicating or that they give their consent to staff administering their medication. To establish a system which ensures that care staff receive formal supervision, at least six times a year, and an annual appraisal of their work. 2 36 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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