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Inspection on 30/04/09 for Allambie Court

Also see our care home review for Allambie Court for more information

This is the latest available inspection report for this service, carried out on 30th April 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. People living in the home are treated respectfully. Care plans are available for each of the identified needs of residents and staff recognise and respond to changes in the health and well being of people living in the home. This means that people living in the home can be confident their health and personal care needs will be met. Staff have access to information about people`s preferences and planned activities reflect residents` interests. Visitors are made welcome, which supports people to maintain important relationships. People living in the home can be confident that their concerns will be listened to and acted upon. The home is generally well maintained providing a safe, homely and clean place for people to live in and enjoy.

What has improved since the last inspection?

The way the service manages people`s medicines has improved, which minimises the risk of harm from medicine errors. Staff have received training in recognising and responding to abuse and there are systems in place to make sure people living in the home are safeguarded from harm. Action has been taken to eliminate unpleasant odours so people can enjoy a pleasant environment where their dignity is upheld. The provider has reviewed working practices in the home and developed an action plan to make improvements.

What the care home could do better:

The support available for people during meal times needs to be reviewed so that people receive sensitive assistance and discreet monitoring when eating htier meals. Recruitment procedures need to be improved to safeguard residents.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Allambie Court 55 Hinckley Road Nuneaton Warwickshire CV11 6LG     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: Michelle McCarthy     Date: 3 0 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: Allambie Court 55 Hinckley Road Nuneaton Warwickshire CV11 6LG 02476383501 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) : allambiect@btinternet.com ADL Plc care home 30 Number of places (if applicable): Under 65 Over 65 30 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 0 30 1 6 1 0 2 0 0 8 Allambie Court Nursing Home is situated in Nuneaton approximately 1 mile from the town centre, and is easily reached by a local bus service. The home is an Edwardian building converted into a nursing home and has had an extension built to accommodate 30 people who have a diagnosis of dementia and mental health problems. There is a small secure garden to the rear of the property and sufficient parking to the front. The home has a mixture of single and shared occupancy and all bedrooms are fitted with a hand washbasin. The fee structure published in the service users guide states weekly fees range between £424.56 and £570 per week. There is an additional tariff for additional services such as toiletries, hairdressing, escorts and chiropody. Care Homes for Older People Page 4 of 31 Brief description of the care home 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: Before the inspection, we looked at all the information we have about this service, such as information about concerns, complaints or allegations, incidents and previous inspection reports. We do this to see how well the service has performed in the past and how it has improved. The manager completed an improvement plan and sent it to us after the last inspection. The manager completed and returned an Annual Quality Assurance Assessment in November 2008. We did not ask for another one before this inspection. Care Homes for Older People Page 6 of 31 A specialist pharmacist inspector undertook a random inspection on 29th Decemebr 2008 which found improvements in the way the service managed peoples medicines. We have included evidence from this inspection in this report. We sent questionnaires to staff and residents before the inspection but we did not receive any responses. We visited the home on Thursday 30th Apri 2009 between 9.30am and 4.30pm. We did not tell the home we were coming on that day. There were 22 people were living in the home during our visit. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. We talked to people who use the service and observed their interaction with staff. We looked at the environment and facilities provided and checked records such as care plans and risk assessments. We talked to the manager, the administrator and care staff. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. We chatted informally with about half of the people living in the home. At the end of the visit we discussed our preliminary findings with the home manager. 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. 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 Care Homes for Older People Page 8 of 31 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. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: We looked at the care files of two people who were admitted to the home since our last inspection. The manager said that it was usual practice for a senior member of staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Both files contained a pre admission assessment of each persons needs and abilities. This means that sufficient information was available so that the home could confirm they could meet each persons needs and develop care plans. Care Homes for Older People Page 11 of 31 Evidence: For example, staff identified that a person had previous history of aggression and anxiety and a care plan was developed to offer to take her away from the stimulus or to her room, offer support and reassurance or alternative stimulation to divert. During our visit we observed that staff supported the person to choose activities so her time was spent meaningfully. 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. People living in the home are treated respectfully and are protected from harm by the safe management of medicines. Care plans are available for each of the identified needs of residents and staff recognise and respond to changes in the health and well being of people living in the home. This means that people living in the home can be confident their health and personal care needs will be met. Evidence: We observed that people living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. It was evident from observation that the personal care needs of people living in the home are met. We looked at the care files for three people identified for case tracking. Care files were standardised, well organised and easy to follow. This should mean that staff have good access to information about the needs of people living in the home and the actions they need to take to meet those needs. Care Homes for Older People Page 13 of 31 Evidence: Care plans and daily records were available for each person. Care plans contained information to tell staff what they need to do to meet peoples needs. There was evidence that peoples care plans are updated when there is a change in their needs. This should mean people get the care they need. For example, one resident sustained a laceration to their leg following an accidental injury; a care plan was developed for wound treatment and there was evidence of review and evaluation of the treatment prescribed. These actions should promote effective wound healing for this person. The care file of another person admitted to the home with an urinary catheter contained a care plan with detailed instructions about catheter care and information about the symptoms staff should look for that might indicate an obstruction. This should promote the health and well being of this person. We spoke to three staff. They were familiar with residents needs and abilities, and knew what care they needed. The service uses risk assessments for falls, nutrition and pressure sores, which are reviewed at least monthly. When the outcome of the assessment identifies an increased risk, action is implemented to minimise the risk. For example, one person was identified as having an increased risk of developing pressure sores; a care plan was developed to minimise the risk and included the use of a pressure relieving mattress. We saw this in use for the person. The condition of the persons skin was recorded in daily records and care plan evaluation sheets. This should promote the health and well being of this person. Peoples records show they are supported to access other health and social care professionals such as GP, optician, dentist, chiropodist and the community mental health team. This should mean that peoples healthcare needs are met. For example, staff referred one person to the GP when they complained of feeling unwell. The GP diagnosed a chest infection and prescribed antibiotics. This promoted this persons health. Individual blood letting devices and monitors were available for each person who required them. This should minimize the risk of cross infection and complies with the requirement we made at our last key inspection. Nursing staff received training in the use of pen type devices for the administration of insulin in January 2009. This should mean people receive the correctly prescribed dose of insulin and complies with the requirement we made at our last key inspection. The pharmacist inspection on 29th December 2008 found evidence of improvements in Care Homes for Older People Page 14 of 31 Evidence: the safe management of medicines. Medicines and controlled drugs were stored safely. The manager had addressed some of the issues raised at the last inspection, was proactive throughout the inspection and keen to address the two remaining requirements. We looked at the systems for management of medicines in the home. The service uses a monitored dosage (blister packed) system. Medicines are secured in locked trolleys and stored in locked rooms. A medicines fridge is available and daily records are maintained to demonstrate the temperature is within recommended limits. Daily room temperature records are maintained for the clinical room demonstrating that medicines are stored within recommended limits to retain their stability. The arrangements for storing controlled drugs comply with legislation. The medicine contents of the controlled drug cupboard corresponded with the numbers recorded in the controlled drugs register. We looked at medicine administration records for one person prescribed a fentanyl patch (strong painkiller) every 72 hours. Records show this was administered regularly as prescribed. We audited the medicines of people involved in case tracking by comparing the quantity in stock against the signatures on the medicine administration records (MAR). The audits indicated that the medicines had been administered correctly. Evidence was available to confirm that changes in residents prescribed medicines are detected by staff and the MAR is updated. For example, one resident was recently discharged back to the home following a stay in hospital. The discharge letter from the hospital recorded several changes in prescribed medication which we saw recorded on the MAR sheet. This should ensure this resident receives their prescribed medication at the correct dose and frequency to promote their health and complies with the requirement we made at our last key inspection. People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and residents were spoken to respectfully. We observed safe practice was when staff assisted people to move using a hoist. During observation of working practice it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. We observed several incidents when residents became agitated. Staff used calm and sensitive attitudes and techniques to divert the behaviours, which should minimise the agitation and distress for people using the service. Care Homes for Older People Page 15 of 31 Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have access to information about peoples preferences and planned activities reflect residents interests. Visitors are made welcome which supports people to maintain important relationships. A nutritious and varied diet is provided, but there are not always enough staff available to provide sensitive support to people at meal times. Evidence: A support worker is employed for 16 hours each week to support the recreational needs of residents. A weekly programme of activities is planned and displayed in the reception area of the home. Activities include aromatherapy, trips out (both in groups and individual), art therapy and music. A musician entertained residents during the afternoon of our visit. The support worker maintains detailed records of peoples participation and their reaction to the activities provided, which should mean that the planned activity programme reflects peoples preferences. Some residents are offered one to one assistance to meet their needs to participate or escorts for trips out. The time available to support recreational needs is limited Care Homes for Older People Page 17 of 31 Evidence: because care staff are busy undertaking personal care and the support worker has time limited resources. The support worker has developed and maintained lifestyle diaries recording peoples past employment, hobbies and important relationships. This should mean that staff have access to information about peoples preferences. The home has an open visiting policy which means residents can receive visitors when they want. We saw evidence of a review of residents dining experiences in the home; management are in the process of developing and implementing an action plan for improvement. We observed the midday meal service in both the ground and first floor areas during our visit. Most of the residents were encouraged to use the dining room. Some residents remained in their rooms and a few people stayed in the lounges. This is improved from our last inspection when most residents remained in the lounges which meant people did not have access to a proper dining table to eat their meals from. Lunch was served at 12.30pm. Residents were offered a choice of lamb or pork stew, jacket or mashed potatoes and seasonal vegetables followed by ground rice pudding and jam. Staff told us that the majority of people need to be supervised or monitored at meal times and several people need full physical assistance to eat their meals. There are 2 care staff available to assist at meal times on each floor; staff said it could be difficult to feed people in their rooms and keep an eye on the people in the dining room at the same time. We visited the kitchen and spoke with the cook, who was able to describe the individual dietary requirements of people living in the home; for example, those people who required a soft texture diet. There was sufficient stock of fresh, frozen and dry goods in the kitchen for meals and snacks. 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 living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. Evidence: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager. Residents were observed to be familiar with the senior staff on duty and felt confident to make requests. This suggests residents would be confident in raising concerns with staff. We looked at the record of complaints and concerns received by the home, which included the action taken by the home regarding each issue raised. They have recorded two complaints since the last inspection. A complaint from a resident raising concerns about being left on a commode for too long was investigated with social worker and family involved. A second complaint from the Health and Safety Executive stated they had information shared with them that the hoists in the home were broken. Evidence was available to confirm the manager and provider makes a timely and objective response to concerns raised and the outcome is recorded. Care Homes for Older People Page 19 of 31 Evidence: There has been no other information shared with us since the last key inspection that raised any concerns about the service. Since the last key inspection, the manager has worked collaboratively with Warwickshire County Councils lead safeguarding practitioner to make sure staff are familiar with their responsibilities for recognising and responding to abuse. A copy of the local joint agency (Police and Social Services) guidelines is available in the home for reference. Senior staff (nurses) have attended advanced training sessions and care staff are given information about abuse in their induction workbooks. This complies with requirements made during the last inspection to safeguard people living in the home. Social Services told us about an alert they received alleging the service failed to safeguard a resident who sustained injuries after falling in the garden of the home. Following a review at the home, risk assessments were undertaken and care plans were developed and implemented to minimise the risk to this person. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well maintained providing a safe, homely and clean place for people to live in and enjoy. Evidence: Communal areas are traditionally and comfortably decorated; they were warm, bright and clean. Communal areas were tidy but looked quite sparse. We saw evidence of a review of the environment identifying areas for improvement and development of an action plan to achieve the improvements. Some improvements were immediately evident. For example, new furniture has been provided in the homes large reception hall to create a comfortable seating area for residents. We observed several residents making use of this area during our visit. There were no unpleasant odours in the home, all areas smelt fresh and clean. The front door and doors to stair well are secured, but residents who can mobilise indpependently were observed pottering around freely in corridors and in and out of their own rooms. Care Homes for Older People Page 21 of 31 Evidence: We looked at several bedrooms, including those belonging to the people involved in case tracking. All the rooms we looked at were clean, homely and personalised with some of the residents own possessions so it looked like it belonged to them. The quality of the furnishings and fittings in residents rooms varied. Some rooms have hard vinyl flooring as an alternative to fitted carpet. Some rooms have new, matching wardrobes and chests of drawers while other rooms have worn, mismatched furniture. Staff have sustained the improvements seen at the last inspection by adding cushions, throws and wall art in individual bedrooms to create a more cosy atmosphere. The handbasin vanity units in some of the rooms are still chipped and worn. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattresses is available for people who have an identified need for them. Dining areas continue to look sparse and functional, but this has been identified for improvement in the homes action plan. The home has systems in place for the management of dirty laundry and the disposal of waste. Residents personal clothing is washed in the homes own laundry and an outside contractor is used for bedlinen and towels. Systems are in place to manage the control of infection, for example, we saw staff using plastic aprons and gloves and there are handwashing facilities in public areas. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient competent staff on duty to meet the physical needs of people using the service. Recruitment procedures are not robust enough to safeguard residents. Evidence: The manager told us the current staff complement for the 22 people living in the home is: One registered nurse and 4 or 5 care staff on duty between 8am and 2pm One registered nurse and 3 or 4 care staff on duty between 2pm and 8pm One registered nurse and 2 care staff on duty between 8pm and 8am Staffing levels have recently been reduced to reflect the reduced number of people living in the home. We looked at 3 weeks duty rota between 13th April and 3rd May 2009, which confirmed that this staffing complement is mostly achieved. Care Homes for Older People Page 23 of 31 Evidence: The manager relies on staff working overtime to cover any absence and maintain the staff complement. It was evident from the appearance of residents and information recorded that the numbers of staff on duty were sufficient to meet their physical personal care needs. We observed that there are short periods of time when residents are left unsupervised in communal areas because care staff are attending to the needs of people in their room, who require the assistance of two carers. The home does not have a system or tool to decide the number of staff required to meet the identified needs of residents in the home; this is monitored informally by the manager. Training records show that nine out of the 17 care staff currently employed in the home have achieved a National Vocational Qualification (NVQ) in Care at level 2 or above which, at 53 , meets the National Minimum Standard for 50 of staff to be qualified. A further three staff members are working towards the award, which should mean that people living in the home are cared for by competent staff. We looked at the personnel files of two recently recruited staff. Each file contained evidence of pre-employment checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA), and references. Records showed that both staff started work with a satisfactory PoVA check before a CRB was obtained. There was no evidence of formal mentoring for these staff. Two references for one staff member were from family friends, although the staff member was recently employed as a carer. Professional references should be sought from a previous employer. One staff member declared a criminal conviction on their application form. The service has a procedure for making a risk assessment for employing people with convictions, but there was no evidence that the procedure had been followed on this occasion. The failure to maintain robust recruitment procedures leaves vulnerable people using the service at risk from harm. The staff training matrix shows that staff have access to mandatory training in fire safety, moving and handling and abuse awareness. The training is available annually and the most recent updates were in October 2008. Each staff member had an individual record showing a programme of development identifying the training they Care Homes for Older People Page 24 of 31 Evidence: need for their role. We saw evidence confirming new staff receive induction training that meets the Skills for Care Common Induction Standards. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of residents. People can be confident their health and safety are promoted. Evidence: The manager is a Registered Mental Nurse (RMN) with experience of caring for older people with dementia and has attained the Registered Managers Award (RMA NVQ Level 4). He has been in post since August 2006. After the last inspection we sent a warning letter to the manager, requiring him to submit an application to register with us. The manager initiated the process by applying for a CRB through us. He told us he has completed the registration forms after receiving his CRB. The manager has a variable amount of supernumerary time each week to enable him to fulfil his managerial responsibilities. He works the floor as a nurse for at least 3 Care Homes for Older People Page 26 of 31 Evidence: shifts each week. He is supported by an administrator who works 25 hours each week. An improvement plan was developed and returned to us to address the requirements we made at our last inspection in October 2008. The service has complied with the requirements we made. Evidence from this inspection and our random inspection in December 2008 shows that the service has sustained the improvements in managing peoples medication safely. Since the last inspection, the provider has reviewed working practices in the home by assessing the outcomes experienced by the people living in the home, measured against National Minimum Standards. The assessment was available for examination and accurately reflected outcomes for residents. This good practice should assist the service to identify areas where the home is providing good outcomes and where improvements could be made. Evidence was available to demonstrate that action plans are developed to address areas requiring improvement and the progress is reviewed. Records show Regulation 26 visits have been made by a representative of the provider organisation every month since our last inspection. The home does not hold personal monies for residents. Residents are invoiced for any expenditure such as chiropody, toiletries or newspapers. We looked at staff supervision records, which showed that staff are receiving regular supervision. Incidents and accidents that happen in the home are recorded and were available for examination. The manager completes a monthly accident audit to analyse any patterns that occur. Records sampled during our last inspection demonstrate the home has effective systems for maintaining equipment and services to the home to promote the safety of people in the home. 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 29 19 Satisfactory pre15/06/2009 employment checks must be obtained before staff start working in the home. This is to safeguard people using the service. 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 The provider should make arrangements to increase the opportunities for people to participate in meaningful activities to enhance their quality of life, with consideration for the level of their physical and pyschological abilities. The arrangements for supporting people to eat their meals should be reviewed to make sure residents have enough support to enjoy their meals, retain their skills and their nutritional intake monitored. Arrangements should be made for the formal mentoring and supervision of staff who are employed with a satisfactory PoVA check, before their CRB is obtained. This should safeguard people using the service. The service should be able to demonstrate that staff declaring criminal convictions have been risk assessed Page 29 of 31 2 15 3 29 4 29 Care Homes for Older People before working with vulnerable people. This should safeguard people using the service. 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). 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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