Inspection on 10/11/09 for Anchor Homes - Monarch Court

This is the latest available inspection report for this service, carried out on 10th November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Ashlong House

Henry Nihill House

Birchwood

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Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Anchor Homes - Monarch Court 30-50 Cadogan Terrace Hackney London E9 5EJ     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: Robert Sobotka     Date: 1 2 1 1 2 0 0 9 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 32 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 32 Information about the care home Name of care home: Address: Anchor Homes - Monarch Court 30-50 Cadogan Terrace Hackney London E9 5EJ Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Anchor Trust Type of registration: Number of places registered: care home 66 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: The maximum number of service users who can be accommodated is: 66 The Registered Person may provide the following categories of service only: Care home with Nursing - Code N 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 - Code OP Dementia - Code DE Physical Disability Code PD Date of last inspection Brief description of the care home Monarch Court is a purpose built home registered to provide nursing care and care and accommodation to people with dementia. The home is located in the London Borough of Hackney, overlooking Victoria Park. The home is close to public transport networks, Care Homes for Older People Page 4 of 32 Over 65 0 66 0 66 0 66 0 3 1 2 2 0 0 8 Brief description of the care home including bus routes and the London Overground service. The home is built over four floors, and all floors are accessible via a sevice lift. The home was first registered with the Commission for Social Care Inspection in June 2008. The home is privatley run, and owned by Anchor Homes. Care Homes for Older People Page 5 of 32 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: This inspection took place over three days and was unannounced. It was undertaken by four CQC staff: Robert Sobotka (Lead Regulatory Inspector), Sarah Greaves (Regulatory Inspector), Sharon Egan (Enforcement Team Leader) and Jane Shaw (Pharmacist Inspector). As part of our visit we spoke with the people who use the service, their relatives, staff working in the home, as well as the interim home manager. We undertook a tour of premises and viewed various records. The Pharmacist inspector spent some time checking the homes medication systems. In addition, we observed care staff as they carried out their duties. Prior to the visit to the home we asked the manager to complete the Annual Quality Assurance Assessment, information from which has been included in this inspection report. We would like to thank all service users, their relatives and staff who contributed to Care Homes for Older People Page 6 of 32 this inspection. Care Homes for Older People Page 7 of 32 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 32 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided sufficient information about the home to enable any prospective service users to make an informed choice as to whether to move in to the home or not. Improvements have been noted to the home admission systems. Evidence: The home had an up-to-date Statement of Purpose and the Service Users Guide in place. As part of our inspection we checked a random selection of files. There was evidence that appropriate pre-admission assessments were taking place and we were satisfied that the requirement issued at the last inspection that a comprehensive pre-admission assessment is carried out on all prospective service users before they are admitted to the home has now been met. The home does not provide intermediate care. Care Homes for Older People Page 11 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are required to the homes care planning and medication systems. Evidence: As part of our inspection we reviewed care plans of 7 service users, all of which were chosen at random. Although each person had a care plan in place, there was little evidence that these were prepared in consultation with the service user and where appropriate their relatives. Out of 6 care plans viewed only one was singed by the service user to confirm that they were in agreement with their care plans. During our discussion with some of the relatives of service users who resided on the floor for those with dementia, they (relatives) stated that they have not been involved in the process. The care plans viewed were generally well maintained, although there were some inconsistencies noted. For example a care plan of one of the service users stated that the person did not want to have hourly checks and has written a letter to that effect, however their care plan document stated that staff are to check on the service user every hour as required. Care Homes for Older People Page 12 of 32 Evidence: We also noted that in some cases there was a note on the file to state that a person should not be resuscitated in case of emergency and that this was requested by their relatives. When we discussed this issue with staff on duty, staff appeared unsure as to whether they should resuscitate a service user who had a DNR request on their file that is signed by their relative, should an emergency occur. Clarification is therefore needed to ensure that staff act within the law should an emergency situtation arise. Appropriate risk management systems were in place. Assessments identified possible risks and included strategies to manage and reduce those risks. They cover risks around skin care, use of bed rails, mobility and aggressive behavious, and they are subject to regular review. The home is registered to provide nursing care to service users, and as part of the case tracking process we checked records around the nursing care needs of a service users who had presssure sores. These appeared to be appropriately met. We carried out a specialist pharmacist inspection of medication.This was because of several concerns raised at a key inspection in 03/12/08 and subsequent safeguarding concerns. We looked at storage, the homes medication policy and records of receipts, administration and disposal for 25 residents in two units. We looked at the Monitored Dosage System (MDS) and the MAR (Medication Administration Records) and audited several samples of medication against the records. We noticed that the medicines policy was extensive and there were specimen signatures and initials for those nurses trained to administer medication and who understood the policies and procedures. The MAR were generally well completed with allergies stated and receipts and administration recorded. We noticed that simvastatin was not recorded as administered on the 9/11 but when we counted the tablets an audit confirmed that it was given but not signed as given. We counted 8 medicines supplied in their original packs on the ground floor and all those administered could be reconciled with the appropriate signatures. We looked at the recording of Warfarin for one resident and noticed that a dose had not been fully given as prescribed because there was no stock of one strength of the tablet on 9/11/09. We also noticed that this same resident had a blood test several Care Homes for Older People Page 13 of 32 Evidence: days previously and the home did not have the latest result and dosage schedule.The result was requested at the time of the inspection and an investigation was started to clarify the dosing error. We looked at records on the second floor and again overall there were no gaps in records of receipts and administration. We were concerned on this floor about the number of medicines out of stock. One residents multivitamin tablet had been recorded as out of stock for 12 days and there was an empty box for a heart tablet. We met the GP during the inspection and discussed the 24 hour turn around for prescriptions. There was a request in the diary to the GP for new supplies for one resident but this was dated 4/11 and the GP said that the prescription had not been collected from the surgery. Another resident prescribed antibiotics and a diuretic had run out on the day of the inspection and nothing had been ordered until we pointed it out. We were told that because of the residents medical condition the antibiotics should continue. We counted 6 packs of tablets and with the exception of two were able to reconcile against signatures on the MAR.There was an excess of two calcium tablets for one resident and we were told that the resident sometimes only wanted to take one rather than the two prescribed per day. For another resident there were two tablets left in the MDS blister but they had been signed as given. Several residents were diabetic and the home was using professional lancets to check blood glucose.The results were in the care plans and we noticed that there were schedules for testing and individual target levels of blood glucose to ensure stability of the diabetes. There were good records of visits by all healthcare professionals and we noticed that the dietitian frequently suggested sip feeds to improve nutrition and that these were recorded on the MAR when given. Storage was good in small secure clinical rooms.The drugs fridge was locked and the temperature was recorded daily.This record should be expanded so that both the minimum and maximum temperature is recorded. Waste medicines were recorded and the waste bins were held securely in the locked clinical areas whilst awaiting collection. We noticed on the MAR that there many medicines listed which had been discontinued. There was also a stock of Haloperidol in the trolley for one resident and it was not listed on the MAR. We were able to track this medicine to the residents doctors notes and noticed that it was to be used as Care Homes for Older People Page 14 of 32 Evidence: required. To summarise therefore we found some areas of good practice and many of the audits indicated that residents were receiving their medication as prescribed. However the error in administration of Warfarin and the poor systems to both monitor and ensure continuous supplies of medication can put residents health at risk. We were also concerned on the alteration of a signature on the MAR to A=refusal after the inspector pointed out a discrepancy. This resident had not refused this medicine at any time during the three plus weeks of the current medication cycle and had not refused any other medication the day of the error. We took copies of the MAR and INR results for Warfarin and issued a Code B notice to discuss further action. Care Homes for Older People Page 15 of 32 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. Although people who use the service are encouraged and supported to take part in social activities, these required some improvement. People who use the service enjoyed the food offered to them, however improvements are required to the way food products are stored. Evidence: As part of our inspection we look at what activities were on offer to the people who use the service. The home employs a full-time activities coordinator and there is a designated activities room located on the ground floor. This room was quite small and very warm and it backs onto main road so traffic noise was very noticeable. We noted a number of pictures on the walls and projects/themes that take place EGA was famous black persons theme at time of visit. We were told that activities were offered on a 1:1 basis and/or in a group. Group work takes place in this room, service users with dementia do not however access this room but activities on the floor. We spoke with the activities coordinator who stated that some of the activities on offer were: bingo, quizzes, skittles and hoopla, singing, listening to the music tapes (appropriate to the service users age), food tasting, herbal tea and jam tasting, playing giant dominoes, Care Homes for Older People Page 16 of 32 Evidence: as well as having newspaper discussions. There is a hairdresser that visits the service on a monthly basis and there is a hairdressing room located in the home. The home also has a sensory room.People who use the service are supported to practice their religion. We noted that at the time of this inspection, activities were only available during 5 days a week and there was little evidence to suggest as to what activities were on offer during the remaining two days of the week. This should be reviewed, so that activities are offered on a daily basis. Visitors are encouraged and welcomed in the home. Throughout our visit we saw and spoke with several relatives who were visiting people who used the service. Service users can see their visitors in their bedrooms or in communal areas. A visitors book was in place and it was being kept up-to-date. Visiting relatives told us that staff were welcoming. Following our discussion with the service users and their relatives, as well as staff working in the home, we were satisfied that people who use the service are helped to exercise choice and control over their lives for as long as they have capacity to do so. During our visit to the home we checked the homes kitchen premises, had a meal with the people who use the service and spoke with the homes chef about catering arrangements within the home. There was a good choice of food on offer and this included food for people who different ethnic backgrounds. On the day of our visit there service users were offered soup, two choices of the main course and a pudding. The majority of food is cooked on the premises and using mainly fresh ingredients. Service users who spoke with us told that the food was tasty and they generally enjoyed the food on offer. Special diets were also catered for. Two inspectors joined service users residing on the 2nd floor and shared lunch with them. Staff supporting service users with eating were courteous, however we noted that rather than sitting next to the service users, staff stood next to them and were helping them with their eating. This requires improvement. Whilst there were two choices of juice on offer, only orange juice was being poured into service users glasses. Kitchen premises are located on the ground floor. These were kept clean and there was a variety of food on offer. We noted that the homes labelling system of Care Homes for Older People Page 17 of 32 Evidence: perishable food was inconsistent. In some cases it appeared that some food was passed its use by date and some food was not labelled. We were told that the home was due for its food hygiene inspection from the Environmental Health team the following week and we advised the home chef to discuss the ways of appropriate food labelling with the Environmental Health Team. During our tour of the premises we visited a small kitchenette located on the ground floor, which was accessible to the people who use the service and visitors. There were several food products, such as ketchup and salad cream, sauces which were not labelled when opened, not refrigerated as required and/or passed its use by date. Additionally we found several food supplement drinks and powders prescribed to individual service users, which were left unsupervised in the kitchen. The registered person must ensure that all perishable food products are appropriately labelled, stored and used within its use by date, in order to prevent food poisoning. Care Homes for Older People Page 18 of 32 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. Improvements are required to the homes complaints systems and to the way the home monitors and reports any incidents that may adversely affect the wellbeing of the people who use the service. Evidence: As part of our visit we reviewed the homes complaints folder and accident/incident records. There have been several complaints made to the home since the last inspection. During the review of the complaints folder we found two complaints, which in our opinion should have been reported to the local Safeguarding Adults Team as a potential safeguarding adults case. One of the complaints was in relation to a staff nurse failing to take appropriate action following one of the service users complaining that they were in plain. The second complaint was about an unexplained bruise of one of the service users wrist. In addition, we found one written complaint made by one of the relatives, which was placed in the service users file and there was no evidence that it had been investigated. We brought this to the attention of the interim manager who dealt with the complaint immediately. We noted that all of the above complaints were made during the time when the Care Homes for Older People Page 19 of 32 Evidence: previous manager was in post and we received positive feedback about the interim home manager and his commitment to deal with any issues within the home. Records relating to accidents and incidents were generally appropriate maintained, however as previously stated it is required that any allegation of potential abuse and/or neglect are appropriately reported to the relevant authorities. We were informed that the staff working in the home were due to be offered adult protection training in the near future and this was to be offered by the London Borough of Hackney. Care Homes for Older People Page 20 of 32 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. Although the premises are generally well maintained, some areas required improvement, this included elimination of an offensive odour on the dementia unit. Evidence: The home is purpose built and was opened in the summer of 2008. It is built over four floors , all of which are accessible via a lift. At the time of this inspection only the ground floor and second floor were occupied. The home is located in the London Borough of Hackney, overlooking Victoria Park. It is close to transport networks and other local amenities. The home is generally well maintained and pleasantly decorated, however it has recently suffered from flooding, which affected the 2nd floor where service users with dementia reside. The 2nd floor had a strong offensive odour, which permeated most of the unit. This must be dealt with without delay. Communal areas include various lounges, dining areas, quiet rooms, an activities room, a sensory room and a hairdressing room, along with the outside courtyard. Service users were observed to be able to move around the communal areas. There are keypads in place located on the 2nd floor to protect people who use the service from leaving the unit unsupervised. Care Homes for Older People Page 21 of 32 Evidence: All the bedrooms are single rooms, and all have en-suite facilities. Bedrooms were pleasantly decorated and service users have been able to personalise them to their own tastes with personal possessions and family photographs. Bedrooms viewed by us contained adequate furniture, including a table, a chair, a wardrobe and a chest of draws. Although laundry facilities were appropriate in scale for the size of the home, we were told that there have been several issues with the service users laundry and these were being dealt with by the home manager. There were various adaptations in place to help make the home more accessible to the people who use the service. As previously mentioned, the home has a lift and several service users were using hoists. Bath showers and toilets have been adapted to make them more accessible to the current service user group. At the time of our visit, a bathroom opposite the dining room had a notice on saying out of order but not secured. The bathroom contained a toilet, sink and bath with hoist. Strong smell of damp plywood and long term dampness, the room felt very humid. There was water on the floor around the toilet, basin under cistern to catch water dripping. Also on the floor around the tap, no slip warning signs up. Water also collected in corner of the room behind the bath was slightly discoloured and smelt stale. the pipe boxing section around the room also had old water stains, suggested this had been subject to leaks before. Bathroom immediately below this one on floor 1 also had water ingress staining on the ceiling- also around base of pull cord. There was no water on the floor, though stain suggested that this was an old incident. Greater care is required to ensure that all areas of the home are safe from potential hazards, this includes ensuring that any areas that may pose a risk to vulnerable adults with dementia are kept locked. On the day of our inspection, we found a sluice room located on the dementia unit that was kept unlocked. Additionally, as previously stated we found an unlocked non-operational bathroom on the 2nd floor, as well as an unlocked cupboard which contained chemical products on the ground floor in the kitchenette area, which was accessible to the people who used the service and any visitors to the home. Care Homes for Older People Page 22 of 32 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. Although some improvements have been noted, further work is required to ensure that people who use the service are supported by a stable, well-trained and permanent staff team. Evidence: The home provides 24-hour support, including waking night staff. During our discussion with the relatives of the service users, some people commented that staff sometimes appeared to be rushed off their feet and some felt that staffing levels should be improved. This was mainly the case during busy times, such as mornings and mealtimes. This view was shared by some staff who spoke with us during this inspection. Following our last inspection, we made a requirement for the registered person to review its staffing levels, including the level of nursing staff provided, to determine how the home can meet all the assessed needs of service users at all times. At the time of this inspection, care staff consisted of permanent staff, bank staff and agency staff. The interim manager has informed us that since the last inspection new care staff have been recruited and the organisation was in the process of carrying their checks to ensure that they are suitable to work with vulnerable adults. New care Care Homes for Older People Page 23 of 32 Evidence: staff were due to start work within the next few weeks. We were told that once new staff have commenced working in the home, they would be provided with induction and mandatory training. Any existing care staff would also be provided with refresher training. As part of our inspection we checked a random selection of staff personnel files. These were generally well-maintained. Since the last inspection, the organisation has carried out an audit of staff personnel files and identified some shortcomings in the recruitment process. We were given a list of what action has been taken in respect of any incomplete files, for example where references did not have a previous employers stamp or clarification was required in relation to staff entitlement to work in the UK. This work was still ongoing at the time of our inspection. It was noted that since the interim manager has started working in the home, staff were being offered supervision sessions and there were plans to reintroduce annual appraisals. Staff who spoke with us told us that there has been an improvement in the way they were supported since the temporary manager commenced work in the home. Care Homes for Older People Page 24 of 32 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 are required to ensure that the home is conducted by a stable management team. Further work is required to ensure that the health and safety is promoted at all times. Evidence: Since the last inspection visit, both the registered manager and the deputy manager have left their post. At the time of this inspection, the home did not have a registered manager in place. As an interim measure, the managers role is currently covered by a Nurse Project Home Manager, whose role is to oversee the home until the new home manager has been confirmed in post. The interim manager informed us that a new home manager has now been appointed and it was anticipated that she would start working in the home in December 2009. We noted that the interim manager has brought in a lot of positive changes in the home and this was also confirmed by the service users, their relatives and staff working in the home. He has worked in a transparent and open way with us during our Care Homes for Older People Page 25 of 32 Evidence: inspection visit. The home receives monthly Regulation 26 visits and reports from these were available for inspection. The majority of health and safety checks were in place, however the homes fire alarm was last tested on 03/08/2009. This requires improvement. As previously mentioned, greater care must be taken to ensure that areas that may be deemed unsafe to vulnerable adults are kept locked when not in use. The home was adequately insured for its stated purpose. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 8 13 The registered person must ensure that any identified nursing care is carried out and recored as appropriate. To help promote the heath, safety and welfare of service users. 31/12/2008 Care Homes for Older People Page 27 of 32 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 7 15 The registered person must ensure that care plans are prepared in consultation with the service user, or their representative. This is to ensure that the person who uses the service has been involved in their care planning process. 23/12/2009 2 9 13 The registered person must ensure that the management of anticoagulants are reviewed in the home. There should be a local procedure to ensure that blood tests are received in a timely manner and residents receive the correct dose. This is to protect the health and welfare of the people who use the service. 09/12/2009 3 9 13 That medicines are administered and recorded as prescribed. 09/12/2009 Care Homes for Older People Page 28 of 32 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 This is to protect the health and welfare of the people who use the service. 4 9 12 That systems of ordering are 09/12/2009 reviewed to ensure that medicines do not run out. This is to maintain the health of the residents. 5 15 16 The registered person must ensure that all perishable food products are appropriately labelled, stored and used within its use by date. in order to prevent food poisoning. 6 16 22 The registered person must ensure that each complaint made to the home is investigated and resolved without delay. To ensure that effective complaints systems are in place. 7 18 13 The registered person must ensure that any potential abuse is promptly reported to the appropriate authorities. 09/12/2009 16/12/2009 09/12/2009 Care Homes for Older People Page 29 of 32 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 To ensure that people use the service are protected from any potential harm and/or abuse. 8 19 13 The registered person must 09/12/2009 ensure that all areas that may pose a risk to the service users are kept locked when not in use, this includes ensuring that any chemical products hazardous to health and kept out of reach. So that all parts of the home are free from hazards to the people who use the service, visitors and staff working in the home. 9 26 16 The registered person must ensure that the offensive odour on the dementia unit located on the 2 floor s eliminated. To provide a pleasant and hygienic environment. 10 38 23 The registered person must ensure that the homes fire alarm is tested on a weekly basis and records of these checks must be kept in the home. 11/12/2009 31/12/2009 Care Homes for Older People Page 30 of 32 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 To ensure that the health and safety is promoted at all times. 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 9 It is recommended that the home works with the supplying pharmacist to update the MAR and ensure that discontinued medicines are deleted. It is recommended that the minimum and maximum temperature be recorded for the fridge. It is recommended that the home reviews its systems in relation to any situation where service users express their wish not to be resuscitated. It is recommended that the activities timetable be reviewed to include activities on a daily basis, as opposed to only 5 days a week. 2 3 9 11 4 12 Care Homes for Older People Page 31 of 32 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. Copyright © (2009) Care Quality Commission (CQC). 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