Key inspection report
Care homes for older people
Name: Address: Allendale House Residential Care Home 11 Milehouse Lane Wolstanton Newcastle Staffordshire ST5 9JR The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter Dawson
Date: 0 2 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People
Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home
Name of care home: Address: Allendale House Residential Care Home 11 Milehouse Lane Wolstanton Newcastle Staffordshire ST5 9JR 01782627388 01782740466 allendalehouse@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Marcia Patricia Anderson Name of registered manager (if applicable) Provider in day to day control Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 5 PD in bedrooms 7,8 & 9 only. The maximum number of service users who can be accommodated is: 17 The registered person may provide the following category of service only: Care Home Only (Code 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) 17 Dementia (DE) 5 Physical disability (PD) 5 Date of last inspection 5 0 5 Over 65 0 17 0 Care Homes for Older People Page 4 of 29 Brief description of the care home Allendale House is a privately owned residential care home, located close to the villages of May Bank and Wolstanton. It is in close proximity to Newcastle-under-Lyme. Access to the village and main town is via a main bus route. The Home is registered to provide care for up to seventeen older people. There were 11 people resident at the time of this inspection. It is also registered to care for five people with dementia care needs and five people with a physical disability. The property is a large detached Victorian house that has been extended and provides spacious accommodation. There is a pleasant secluded garden area. The Home is owned by Mrs Marcia Anderson who is also the Registered Manager. The weekly fees for people at Allendale House are available in the homes Statement of Purpose or by contacting the home direct. Care Homes for Older People Page 5 of 29 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service as on 6th July 2009. In January 2010 a Safeguarding referral was made following concerns about care practices in the home. At the same time we also received anonymous complaints from ex staff members about poor levels of care. As a result of this we carried out two Random Inspections of the service on 20th January 2010 and 26th February 2010. In relation to the safeguarding referral the basic allegations about care practices were not substantiated, however we made a requirement in relation to inadequate heating in the home. When we revisited on 2th February this requirement had been met and the problems resolved. In relation to the complaints we looked at a range of personal care practices and Care Homes for Older People
Page 6 of 29 documentation in the home and found that the complaints were not substantiated. This unannounced key inspection on 2nd June 2010 was carried out by one inspector on one day. An Annual Quality Assurance Assessment (AQAA) was completed and returned to us prior to the inspection by the Registered Provider/Manager. The AQAA is a legally required self-assessment document containing information about what the service does well, what progress has been made over the past year, what they think they could do better and their plans for improving the service over the next 12 months. The AQAA was completed in sufficient detail and gave us the information we required. Some information from the AQAA is included in this report. We saw all 11 people living at Allendale House and spoke with most of them. We spoke to the 3 members of staff on duty and the two Managers who assisted with the inspection. We have received written feedback from 3 members of staff that was sent directly to us prior to the inspection and from 2 people living at Allendale House. We were able to speak with a visiting relative during the inspection. We inspected a range of records including care plans, risk assessments, medication records, daily records and logs, staff files and other documents relevant to the inspection process. The people we spoke with gave us positive feedback about the service and there were no complaints or concerns expressed. There was a good open atmosphere and people expressed their views readily. All spoke highly of the support from staff and with warm enthusiasm. Our observations during the inspection evidenced the views expressed by people. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The new care planning recording format introduced at the time of the last key inspection has been maintained and continues to provide the necessary detailed information that enables staff to meet peoples needs. Checks of the medication system by Managers introduced at the time of the last key inspection continue to be monitored daily, ensuring the system is safe and people have the medication necessary for their health and wellbeing. We recommended review of the method of recording for night time care. This has been done and there is now a 24 hour detailed record of care for each person. Night care plans have been established detailing peoples preferred choices and the necessary actions to make sure people are comfortable and safe at night. A recommendation to ensure peoples weights were accurately recorded has been actioned. Where there are concerns about weight people are weighed weekly and referrals made to GP/dietitian for further action/advice. Fluid intake charts are now totaled daily and monitored to ensure action is taken where there are shortfalls. Not all complaints had been previously recorded and a new system to record complaints concerns and grumbles has been put into place. Complaints are recorded either by the people making them or are recorded by staff, the record is available to all. Care Homes for Older People
Page 8 of 29 As recommended in the last report, training for staff has been provided in relation to The Mental Capacity Act and Deprivation of Liberty Standards (DOLS), although this has not been provided for all staff at this time. We made a recommendation to review the method of recording monies held for people and to provide a more robust system to ensure accuracy and accountability. We inspected monies held for people on this inspection and found that sample balances were correct. A new system of recording income and expenditure in greater detail has been introduced and two staff now sign for all expenditure. This ensures total accuracy and easy auditing of the system. This is a great improvement. Not all staff have received training in moving and handling and in specific use of the hoist in operation in the home. This was discussed and further identified at a Random Inspection but we found on this visit that all staff had been provided with moving and handling training from an external approved trainer and this included specific training for the hoist in use in the home. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 9 of 29 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 10 of 29 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 11 of 29 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. Pre admission information and assessments ensure that the home will meet individual needs, leading to successful placements. Evidence: There is a statement of purpose and service users guide giving required information about the service. These are regularly updated and provide sufficient information to allow people to make a judgment about the suitability of the home for them. People who have their care funded are provided with a contract with the local authority. Those funding their own care have contracts with the home. We saw a random sample contract between the home and person using the service. This contained detailed terms and conditions providing information and protection for the person. People are always assessed prior to admission and invited to the home before making
Care Homes for Older People Page 12 of 29 Evidence: a decision about suitability and the homes ability to meet the persons needs. We saw the assessment tool used. This covered all the information needed to ensure the home could meet the persons needs. We looked at assessments carried out in relation to a couple admitted 4 days prior to this inspection and we also spoke with them. This was an emergency admission out of hours but a manager had carried out an assessment in the home of the people considering admission. Relatives were invited to visit the home, but this had not been possible. Good comprehensive assessments on both people were completed and a care plan for respite care established at the point of admission based upon the preadmission assessment. A brief report by the social worker involved in the admission had also been obtained. This was positive and swift action - often assessments are not possible in relation to emergency admissions and homes are usually given 2 days to provide an assessment following admission. The assessment was detailed and good allowing staff to swiftly support, re-assure and settle them into the life of the home. Care Homes for Older People Page 13 of 29 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. Improvements made to recording and practice and actioning of health care issues including the medication medication system, ensure peoples health care needs are met. Evidence: At the time of the last key inspection we found that considerable improvements had been made in care planning information - a new care planning format had been introduced. This provided more comprehensive information about all aspects health and social care. As a result the outcomes in this area were then assessed as adequate rather than poor. On this visit we were keen to see if the positive changes introduced had been maintained. We found that they had. We looked at a sample of 4 care plans to assess this. We found that general health care information was readily available. In the records seen this included details of diagnosed medical conditions, nutritional assessments,
Care Homes for Older People Page 14 of 29 Evidence: dependency assessments, waterlow (risk of pressure damage) assessments together with completed risk assessments to reduce or minimise those risks. We looked at 4 food fluid intake charts established following nutritional risk assessments. These had been completed accurately and totaled daily to monitor any changes or shortfalls in nutritional intake. Where this was the case, referrals had been made to the GP and dietitians. We found that people had been weighed regularly to monitor general health. Where there was risk of pressure damage, people had been provided with propad mattresses/cushions for pressure relief. Early referrals had been made to the District Nursing Service where there were identified needs. For example, in relation to a person who recently had a reddened area, referral had been made to the District Nursing service who had provided a dressing and were monitoring the potential wound weekly. Record keeping had improved considerable over the preceding 12 months. We saw a care plan in place stating the person must not have more than 2 litres of fluid each day, must be weighed each morning and urgent referral made to specialist nurse of prescribed weights were exceeded. The records demonstrated that this care plan had been followed carefully on a daily basis. This was vital to ensure the health and wellbeing of the person. We saw two good care plans established for a couple admitted 4 days prior to the inspection. These were based upon detailed pre-admission assessments. Important information had been recorded providing staff with the detailed information they required to meet health and personal care needs and to support them in settling swiftly into the home. Prior to the last key inspection there had been serious concerns about the safety of the medication system in use. Statutory action had been taken together with requirements to ensure improvements were made to improve the safety of the system. This had been monitored closely and there had been compliance with all requirements at the time of the last inspection. It was important on this visit to ensure the improvements made at the time of the last inspection had continued. We looked at the medication system and found that regular daily checks by senior staff continued to be carried out to monitor correct administration of medicines. A record was kept of this. We also found that improvements in the receipt, storage and disposal of medication had continued. There was an ongoing count of medication allowing an audit of the system at any time. Medication returned to the pharmacy was Care Homes for Older People Page 15 of 29 Evidence: detailed and correct. We found that medication was now stored at correct temperatures with daily records of the temperature of the storage area and medication fridge. A recent review of the system had been carried out by the supplying pharmacy. We checked MAR (Medication Administration Records) sheets. They gave an accurate record of prescribed medication, including how it was administered and there were no gaps or omissions. The required improvements made at the time of the last key inspection had continued presenting a safe system of medication that ensured people had the prescribed medication needed to meet their health care needs. Care Homes for Older People Page 16 of 29 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. People have benefited from a wider range of activities that are developing. There is a high satisfaction level with food provision. Evidence: Since the last key inspection recommended improvements have been made in providing and recording activities for people. People now have social histories as an aid to care and a basis for providing activities. We saw some good examples of detailed histories. Activities are now recorded with individual care planning information and there is an activity file recording monthly ongoing activities. Photographs recorded some of the events. Regular entertainers are booked, we saw photographs relating to celebration parties and people involved in baking. There has been a theatre trip recently and shopping trip to nearby store. External activities are supported by staff often in their own time - demonstrating the commitment towards community involvement. The garden to the rear of the home is extremely pleasant and quite private. Garden seating and furniture provide a relaxed setting and several people, including visitors were taking advantage of this on the hot day of the inspection. The AQAA stated the home intended to Make greater use of the garden, including planting and bird trays
Care Homes for Older People Page 17 of 29 Evidence: etc We feel that positive progress is being made in extending the range and type of activities for people. A member of staff has recently completed a 4 day course on activities and will take a lead in this area of work. We saw and spoke with a visiting relative who visits his mother weekly and has been doing so for the past 8 years. His brother also visits weekly separately. He had no concerns or complaints about the home and said his mother has excellent care at Allendale House. He said this was also the view of his brother. In written feedback from a relative, provided directly to us prior to the inspection, stated that staff were readily available and supportive. Asked what the home does well the reply was good caring staff. Asked what the home could do better the reply was More activities and challenges for the slightly more able - both physically and mentally, would be welcomed. This person commented upon the high turnover of staff in the past year, although this has been addressed by employing staff on a full time basis rather than part-time. We saw the menus for the day and also planned menus. Staff and people confirmed they were consulted about food choices. We found that there was a choice of main dish for the mid-day meal and also choice of sweet. Hot alternatives were also provided at teatime. People told us they liked the food and had no complaints about choice, quantity or quality. Care Homes for Older People Page 18 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff knowledge of safeguarding procedures will ensure appropriate referrals are made where people may be at risk of harm. Mental Capacity Act assessments will ensure peoples rights and interests are protected. Evidence: Since the last key inspection 3 Safeguarding referrals have been made. These have all been made in 2010. The first related to concerns about alleged intimidation and concerning care practices in the home. Investigations did not provide evidence to support the allegations, although a complaint about inadequate heating in the home in January was evidenced and resolved following a requirement under regulations. The second allegation referred and investigated under Safeguarding procedures related to removal of medication to highlight poor staff practice. This is not appropriate action to deal with this situation. The third safeguarding referral relating to a person admitted to hospital has not been completed. In addition to the safeguarding referrals ex members of staff made three complaints about poor care and practice and lack of checks upon staff working in the home. We looked at these complaints during our 2 Random Inspections to the home since January and found that they were not substantiated. We found that 4 staff have not had training in Safeguarding Vulnerable Adults. This training is needed for all staff and is to be arranged.
Care Homes for Older People Page 19 of 29 Evidence: We found that days prior to this inspection one person using the service had hit another person. There were no apparent injuries but we advised that a referral should be made to the Safeguarding team about this. The complaints procedure is displayed in the reception area and also available in individual bedrooms. A complaints and grumbles book is also available in the reception area. We saw that 3 domestic type complaints/suggestions had been made and all had been acted upon. There is a facility for people to make anonymous complaints, concerns or compliments also in the reception area. Some staff have had training since the last inspection relating to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). It is important to provide this for all staff. Following this training we were surprised to find that no assessments of capacity had been made in relation to people using the service. It is important to provide assessments for both new and existing residents. We saw some DNAR (Do Not Attempt Resuscitation) declarations in care plans. These had been correctly assessed and recorded by the GP in partnership with the person, relatives and others. They were in the correct format and the home were reminding GPs to review them regularly. Care Homes for Older People Page 20 of 29 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 live in a well maintained, safe and pleasant environment. Evidence: There is ongoing maintanence, decoration and replacements to the environment that provide a well-presented, comfortable place to live. Standards of hygiene and safety throughout the home were observed to be high. The AQAA summarises actions in these areas: We follow the health and safety guidelines and this has been borne out by Environmental Health and Safety Officer visits that have not generated requirements. The home is kept clean, pleasant and free from odours. We have quality commercial laundry equipment. We have a sluice room. An infection control policy is in place. We have a development plan with timescales that we are following. We protect people from cross contamination via the laundry system. We remedy faults quickly. This statement was evidenced from observations during the inspection. We inspected the communal areas and a sample of bedrooms showed good standards being maintained. Some empty bedrooms had been completely redecorated and refurbished with new furniture and equipment. Some double bedrooms are being offered as single rooms,
Care Homes for Older People Page 21 of 29 Evidence: providing spacious options. People had been consulted when occupied rooms had been redecorated/refurbished, allowing choice of colour and type. The excellent small but pleasant, well maintained and private garden area is referred to elsewhere in this report; its use is being maximised and enjoyed by people during the summer months. There is a large central lounge area that has recessed areas where people can choose to watch TV or to have a quiet area to sit. Someone who likes to read and enjoy a quiet area told us that she enjoyed this and that TV was used selectively for this small group, only in the evenings. Care Homes for Older People Page 22 of 29 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. Further staff training in areas identified will ensure people are supported by staff who are fully trained and competent to do their jobs. Evidence: At the time of this unannounced inspection there were 11 people in residence at Allendale House. Two carers were on duty, plus a trainee carer completing her first day and induction. The Registered Manager was also on duty and we were later joined by a former Acting Manager who still provides additional cover and support when needed. At weekends there is usually a third person in addition to the 2 usual carers. At night time there is one waking night carer and a person sleeping-in and on call. The Provider/Manager is usually on call at all times to support and give advice. We spoke with all staff on duty and separately to a carer who had been employed for the past 6 months. She showed detailed knowledge of the needs of people using the service, has completed induction and is involved in NVQ training. She confirmed she has receive important statutory training including moving and handling and use of the hoist. She has regular supervision and said that she feels well supported by senior staff. She felt that there was a good atmosphere in the home and a cohesive and friendly staff group.
Care Homes for Older People Page 23 of 29 Evidence: These opinions were endorsed in 3 written staff surveys provided to us privately prior to the inspection. Comments made included: I have worked in a number of care homes and now been at Allendale for over 3 years. I think it is one of the better homes regarding the standards of care that the service users receive. We looked at a sample of 2 staff records both showed that all checks and references had been obtained prior to employment. This included the necessary police and protection checks. In relation to person employed as a bank member of staff we found that training records had not been completed. We were unable to ascertain, for instance, if the person had received first aid training - she had been on duty the previous night with another carer who had not completed first aid training. The Manager will confirm the training completed by this person by fax following this inspection. We saw evidence of regular staff meetings. Staff felt they had the opportunity to raise any areas of concern. We looked at staff training and identified some areas of shortfall. We found that 4 people had not had training in Safeguarding Vulnerable Adults, only 2 had undertaken training in dementia care needs. Half the staff had received training in infection control and a further 5 places being booked to complete training for all. All staff have completed Fire Training and some staff had completed training in Diabetic Care, Hydration and Challenging Behaviours. Care Homes for Older People Page 24 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in some aspects of safety will ensure people are safe from harm at all times. Evidence: Improvements in the management and operation of the home identified in the last key inspection report have continued. There have been complaints and concerns expressed in the interim period and we have carried out 2 Random Inspections of the service during that time to focus upon and improve some areas identified. Requirements and recommendations made have been acted upon and we feel that progress continues to be made in the general management and operation of the home and areas of care and practice identified as having shortfalls. We will continue to look for this sustained progress in those areas. There are shortfalls in some areas of staff training identified in this report. The home are attempting to arrange courses to cover this. A plan to further improve most of the outcome areas has been commissioned and completed and is a target plan for the
Care Homes for Older People Page 25 of 29 Evidence: future. At the time of the last inspection we were concerned about inadequate recording where monies were being held for people using the service. We felt that a more robust and clear system would protect both staff and people whose finances were being held for them. This has been changed and improved. All transactions are witnessed, providing 2 signatures, the method and detail of recording has been made clearer. There was never any question of monies being handled incorrectly but that improved systems would provide total clarity. We saw the new system in place and checked balances for 3-4 people. These were correct with clearer supporting documentation. We noticed during the inspection that the door to the laundry was propped open. This practice must cease. The laundry is a high risk area for potential fire. The home has registration to meet the needs of people with dementia. We found that a recently admitted person who was totally ambulant and had expressed a wish to leave, had not attempted to do so, but we found that some external doors were not alarmed. Contact alarms must be provided for all external doors to alert staff when someone leaves the building. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 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 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 18 All staff should have training relating to the Mental Capacity Act and DOLS. This will ensure peoples rights and interests are protected. Assessments of capacity must be made under the Mental Capacity Act. This will ensure peoples rights and interests are known and protected. Referrals must be made under Safeguarding procedures where people are assaulted or suffer harm. Training for staff is required in relation to Safeguarding, dementia care and infection control. Some further training is also needed in the Mental Capacity Act and DOLS. The laundry door must not be propped open. This is a high risk area for fire and compromises fire safety. All external doors must be alarmed to alert staff when people may leave the building. This will ensure that people are safe at all times. 2 18 3 4 18 30 5 6 38 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
