Inspection on 24/03/10 for Andrin House

This is the latest available inspection report for this service, carried out on 24th March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Andrin House 01/04/08

Andrin House 02/04/07

Andrin House 19/04/06

Andrin House 05/09/05

Andrin House 18/04/05

Andrin House 27/09/04

Andrin House 05/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Andrin House 43 Belper Road Derby DE1 3EP     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: Angela Kennedy     Date: 2 4 0 3 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 31 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 31 Information about the care home Name of care home: Address: Andrin House 43 Belper Road Derby DE1 3EP 01332346812 F/P01332346812 enquiries@andrinhouse.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rosecare Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 1 place for named service user (MH) in category PD under 65 years of age.. 1 place for named service user (DG) under 65 years of age. Date of last inspection Brief description of the care home Andrin House is a 37 bedded care home with nursing for older people, situated in a residential area close to the city centre of Derby. The property was originally a private dwelling, which has been extended and converted into a care home. Bedrooms are located on the ground floor and first floor, and are accessed by lift and staircase. Three bedrooms have en suite facilities and there are four communal rooms for the people who use the service, including a room for people living at the home who smoke. Support services are in place with a choice of GPs, chiropodist, dentist and optician. Information provided by the service stated that people funded by the local authority paid the current rate and privately funded fees ranged from £320 a week for residential care to £371 for nursing care. Further information regarding the fees is Care Homes for Older People Page 4 of 31 Over 65 37 0 2 2 0 4 2 0 0 9 Brief description of the care home available by contacting the 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: 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 key inspection was unannounced. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people using the service and their views on the service provided. This process considers the providers and registered managers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. An Annual Quality Assurance Assessment (AQAA) had been completed by the service. This is a self-assessment for providers, which is a legal requirement. This assessment gives the provider and registered manager an opportunity to let us know about their Care Homes for Older People Page 6 of 31 service and how well they think they are performing. The information provided in the AQAA is reflected within this report. At this inspection visit two people were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at care plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. One of the people case tracked was able to express their views of the service and the support it provided. However the views of several people living at the home and their relatives are included within this report. This information was gathered by talking to people and through information that was provided in surveys that were returned prior to this visit. The views of several members of staff are reflected within this report. This information was gathered by talking to staff on duty and through the staff surveys returned prior to this inspection visit. The acting manager was available at this inspection to provide any information and documents requested. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The service should now undertake an assessment of each persons capacity to consent to care and treatment and this should be recorded in each persons plan of care. The medication practices were not robust to ensure that any errors were identified. At the time of this visit the medications for two people had not been signed for on the medication administration records for the previous day at 5pm. it was established that both people had received their prescribed medication but this was not done through auditing the quantities of medication left as the quantities held did not correspond with the stock balance recorded on the medication administration record. This further demonstrated an urgent need for all medication to be audited to ensure they had been Care Homes for Older People Page 8 of 31 given as prescribed, signed for on administration and balances of medicines recorded correctly. 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were assessed before admission was agreed to ensure the home was right for them. Evidence: The pre inspection self assessment told us that the needs of individuals were assessed prior to admission. The two care files looked at had information about the person taken at the time of admission, this included an assessment of their care needs that had been undertaken by a senior member of staff from the home. As both of the people case tracked were funded, records were also in place that demonstrated that assessments had been undertaken by the Local Authority. In the surveys received from the people using the service, it was confirmed that they had received enough information about the home to enable them to decide if it was Care Homes for Older People Page 11 of 31 Evidence: right for them One person case tracked said that they were too ill at the time of their admission to make a decision about the home. They said that they had little memory of the time they were admitted, but now felt that the home had been suitable to meet their needs. Both of the people case tracked had information within their care files regarding their interests and the activities that they enjoyed. A Map of Life was also in the files seen describing both individuals past history. This enabled social care plans to be developed based on the individuals needs and preferences. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in their planned care and in general this is delivered in a safe and consistent way, but could be compromised if safe medication practices are not maintained. Evidence: The pre inspection self assessment told us that the people living at the home were provided with holistic care which was reviewed each month by the persons link nurse. Improvements were seen in the care plans that were looked at. Care plans provided more detail. Both people case tracked had care plans in place that instructed staff on the level of support the individual required. However some care plans could have provided more detail. For example, medication care plans should include the prescribed medication and information on why this medication is taken and any common side effects. Improvements were seen in the information provided regarding peoples social interests. Both people case tracked had a care plan in place that addressed their social Care Homes for Older People Page 13 of 31 Evidence: interests. As stated in the previous section of this report a Map of Life that described the individuals past history, had been completed and this enabled social care plans to be developed, based on individual needs and preferences. All of the care plans seen were reviewed on a monthly basis. There was evidence in the files seen to demonstrate that peoples relatives were involved in the development and reviews of care. Both of the people case tracked had information in their care plans that reflected their capacity to consent to treatment and care, however there was no care plan in place regarding their capacity to make decisions. Risk assessments were in place in the files seen and these generally linked well with the care plans. Two new risk assessments tools had been put in place since the last inspection. This was a nutritional risk assessment and a falls risk assessment. Both of these assessments were illogical in their scoring system. For example the nutritional risk assessment had a scoring system that scored a healthy person, who was able to eat a full diet with no difficulties in swallowing, as someone who was at risk and requiring nutritional investigation. The falls assessment score for a person in a coma was the same as for a fully orientated person. This was discussed with the acting manager who acknowledged these errors and stated that she was aware of them and planned to put new assessments in place within the near future. Evidence was seen within the records looked at that showed us that peoples health care needs were supported and met. One person case tracked had information within their care file that gave clear and detailed information on the specialist equipment that was used to support that person. This ensured that the staff were able to support this person appropriately. Other records included visits by General Practitioners and chiropodists, as well records of hospital appointments. In the surveys received from the people using the service they told us that they received the care and support they needed. People that were spoken to on the day of the inspection visit told us the care here is very good and they look after us very well. One visitor that was spoken with said, Im happy with the care my mum gets, they ring if anything happens, the staff are a nice bunch. The medication practices were looked at for the two people case tracked. The Care Homes for Older People Page 14 of 31 Evidence: administration records for one person had been signed in accordance with their prescribed instructions. One person administered there own medication and a risk assessment had been undertaken that showed us that their capacity to retain and administer their medication had been undertaken. The storage and recording of controlled drugs was looked at and was satisfactory. The balance of one controlled drug held was checked against the records held and corresponded. The medication record for the other person case tracked, had not been signed for medication that was prescribed at 5pm the day prior to this inspection visit. We were not able to confirm by checking the balance of this persons medication that this medication had been given. This was because the balance of medication did not correspond with the balance of medication recorded on their medication administration record (MAR) sheet. The nurse that had administered the 5pm medication the previous day had recorded in this persons daily notes, that they had received their medication at 5pm. Other MAR sheets were then looked at and one other persons medication for 5pm the previous day had not been signed for. Again we were unable to confirm by checking the balance of this persons medication that this medication had been given. As the balance did not correspond with the balance recorded on the MAR sheet. The nurse responsible for this medication round was contacted by the acting manager and came into the home to confirm they had administered the medication and signed the MAR sheets to confirm this. An immediate requirement was left for the acting manager to audit all medications. This has been undertaken and the acting manager has taken the appropriate actions to address these errors and put actions in place to ensure that the likely hood of this occurring is reduced. The acting manager has said that she will undertake weekly reviews of medication in the future to ensure any errors are identified, investigated and actions taken as required to maintain safe practice. Care plans reflected how individuals privacy and dignity was to be maintained. Observations of staff with people living at the home were positive and demonstrate a relaxed atmosphere with a good rapport between the staff and the people using the service. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social and recreational needs of the people using the service were met. People were supported to maintain contact with family and friends and the quality and variety of meals provided was enjoyed. Evidence: The pre inspection self assessment stated that different types of activities were available at the home. It said that since the last inspection they have had eight entertainers and three pantomimes, which the people living at the home have enjoyed. This included clothing companies who bring clothes to display for people to purchase if they wish. The pre inspection self assessment stated that the home buys monthly magazines for the use of the people living there and a company bringing books and gifts for purchase. People are also able to purchase daily newspapers Structured activities continue at the home throughout the week. The activities coordinator who was employed for five mornings a week confirmed that she had undertaken two training courses since the last inspection visit. One was a relating to activities for older people and the other was specifically focused on activities for Care Homes for Older People Page 16 of 31 Evidence: people with Dementia. The records seen demonstrated that activities were planned in consultation with people at the home such as through residents meetings. Records were kept for individuals on the activities they had participated in. As well as group activities the activities coordinator confirmed that she spent time with people on an individual basis on activities such as trips into town, trips to cafes and craft work. The acting manager and records seen confirmed that on Saturdays music and movement was provided by an external body for the people using the service and care staff had the responsibility of undertaking the planned activity on Sundays. On the day of this inspection visit a group of ladies were seen making bracelets and making cakes. People that were spoken to regarding the activities available said that they enjoyed the activities that were provided. Surveys received also confirmed that entertainment and activities were provided. Information regarding the activities was on display on the notice board. The pre inspection self assessment stated that the local priest visited people at the home to provide Holy Communion as required. A hairdresser was available each week on a Monday and a salon was provided in the home. Visitors confirmed that they were welcomed by staff and were usually offered a drink. Observations throughout the day demonstrated that the rapport between visitors and staff was warm and friendly. The acting manager confirmed that no one living at the home used advocacy services and none were advertised within the home. The pre inspection self assessment stated that some people preferred to take their meals in their rooms. It said that there was a variety of meals and snacks available. We looked at the menus the records showed us that there was two options each day. It was confirmed by people living at the home that if neither options were liked an alternative would be prepared. Care Homes for Older People Page 17 of 31 Evidence: People that were spoken to were complimentary about the quality of the meals. One person when asked abut the quality of the meals said, theyre surprisingly good, I really enjoy them. Information within the surveys received indicated that the meals were enjoyed. 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. Peoples concerns are fully addressed and the practices in place ensured people using the service were protected from abuse. Evidence: The pre inspection self assessment stated that the complaints policy was displayed in the home and that any complaints received were recorded, including the outcome of the complaint. The acting manager had told us in the pre inspection self assessment that the home had received two complaints since the last inspection and that both had been resolved within the 28 day timescale. Neither of these complaints had been upheld. We looked at the information held about these complaints and found that they had been recorded clearly. The information recorded told us what actions had been taken to investigate these complaints and the outcome of these complaints. In the surveys received from the people using the service all eleven surveys told us that they had someone to speak to informally if they were not happy. Nine people confirmed that they knew how to make a formal complaint and the other two people said they did not know how to make a formal complaint. People using the service that were spoken with on the day of this inspection visit said they would speak to the acting manager if they had any concerns. Care Homes for Older People Page 19 of 31 Evidence: One visitor that was spoken with said that if they had any concerns they would speak with the acting manager. They felt that any issues they had would be addressed. The staff training records were looked at and showed us that some staff were due for refresher training in safeguarding adults in February 2010. The acting manager was able to demonstrate that this training was booked and that she was awaiting a start date. She confirmed that all staff would be attending this over the coming months. The staff surveys received told us that staff knew what to do if someone had concerns about the home. The home has the Local Authority procedure on Safeguarding Adults and the company policy, plus report cards that can be used for recording any evidence of abuse. All of this information was accessible to staff as it was held in the duty office. Staff that were spoken with were aware of the policy and procedure to follow. There have been no safeguarding referrals or investigations undertaken regarding the home since the last inspection visit. 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 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 well maintained for the people using the service and the practices in place ensure their safety is not compromised. Evidence: The pre inspection self assessment stated that the improvements to the home since the last inspection visit included, new carpets in some of the bedrooms and improvements to the garden, such as garden chairs and tables and a decked area with flowers and plants added. A partial tour of the building was undertaken and several areas of the home had been redecorated since the lat inspection visit. This included communal areas and corridors. A maintenance person was employed for five days a week to undertake general maintenance and redecoration. Staff were observed supporting people with specialist equipment as required ensuring their safety was maintained. This support was provided in a dignified way that respected the individual. The general appearance of the home was clean and tidy and the standards of cleanliness and hygiene appeared satisfactory. Staff were observed wearing protective clothing, such as disposable aprons when supporting people with personal care. Care Homes for Older People Page 21 of 31 Evidence: The staff rotas showed us that one or two housekeeping staff were on duty each day. People that were spoken with and information in surveys told us that people felt the home was well maintained. Two surveys received from people living at the home told us that the home could take better care of clothing. As no further information was provided in these surveys regarding this, it was discussed with the acting manager. The acting manager confirmed that there had been some issues with the laundry as some items of clothing had been washed accidentally with bed linen by care staff. This has now been resolved as only laundry staff now wash individuals clothing. It was stated that care staff support laundry staff by assisting with the laundering of bed linen as required. The laundry room housed sufficient equipment to launder clothing and appeared clean and tidy. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty at all times. Appropriate staff checks ensure individuals safety is maintained. Evidence: The pre inspection self assessment stated that there was a low staff turn over, with a good skill mix of staff. The staff rotas demonstrated that staffing levels and skill mix were appropriate to meet the needs of the people using the service. A key worker system was in place with defined roles and senior carers assigned specific tasks for staff so that they knew what tasks they were responsible for when on shift. Staff comments told us that staff felt there was enough staff on duty to meet the needs of the people using the service. Comments included, we provide a high standard of care and work well as a team and we meet all needs and goals to promote independence. Comments from people using the service and their representatives told us that they felt there was enough staff on duty and that the staff had the skills and knowledge to support them. Comments included, the care here is very good and I am very happy with the care my mum gets, they look after her very well. Care Homes for Older People Page 23 of 31 Evidence: The pre inspection self assessment stated that ninety eight percent of the care staff have a National Vocational Qualification (NVQ). It told us that seven percent were working towards NVQ at level 2 in health and social care and that fourteen percent had an NVQ 3 and thirteen percent were working towards an NVQ 3. This was confirmed at this inspection visit with the acting manager, who told us that a further seven staff have commenced this training, four at level 3 and three at level two. This demonstrates that the staff team have the relevant qualification to enable them to enhance the support and care they provide to the people living at the home. The recruitment records for two members of staff were looked at and both had the required documents in place to demonstrate that a thorough recruitment practice was in place at the home. All of the checks and records required by law were in place to ensure the staff employed were safe to care for the people living at the home. The training records seen showed that training in some mandatory areas was due for refresher updates for some staff. The acting manager was able to demonstrate to us that she had audited all of the training undertaken and from that had booked training in all mandatory areas for all of the staff. This training was to be provided by a training company and all mandatory training was to be covered in five consecutive days. Plans were in place for three staff to attend this training at a time, until all staff had completed this training. The acting manager had calculated that this would take approximately ten weeks. Other training that was specific to the needs of the people using the service had also been undertaken such as wound care, dementia care, and continence care. Staff comments told us that they were provided with training that was relevant to their role to enable them to support the people using the service effectively. The induction provided to staff was based on skills for care induction standards. A member of staffs completed work book was seen. This demonstrated that new staff were supported appropriately and assessed throughout their induction to ensure they were competent within their role. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples opinions are sought and acted upon to develop the service in their best interests. The maintenance of equipment and safety checks in place, ensures that peoples health, safety and welfare are met. Evidence: The pre inspection self assessment stated that the acting manager works closely with the directors and said that management meetings were held. The acting manager confirmed that she was in the process of applying for registration and was undertaking a management qualification. The acting manager was allocated supernumerary time to undertake administration work. In the pre inspection self assessment she said this was for care plans and medication audits and staff supervisions. As stated earlier in this report there were errors found with the recording of medication balances and administration. However the acting manager did take prompt action to address these issues and has put control Care Homes for Older People Page 25 of 31 Evidence: measures in place to reduce the likelihood of any re occurrence of these errors. As stated in the pre inspection self assessment, meetings are held for staff, people using the service and relatives of people using the service. Minutes of these meetings were looked at and demonstrated that peoples views were actively sought to further develop the service provided. The meetings held for the people using the service and the meetings held for their family and friends was undertaken every three months. The minutes of these meetings demonstrated that there was a good attendance. The minutes showed us that the views and opinions of the people at these meetings were acted upon to further improve the service. A variety of staff meetings were held on a three monthly basis, this included nurses meetings, senior carers meetings, laundry staff meetings, kitchen staff meetings, night staff meetings, maintenance meetings and full staff meetings. This ensured that everyone employed had an opportunity to express their opinions and discuss any issues or changes in practice. It also ensured that all staff were kept up to date with any service changes. At the last inspection visit it was identified that monthly provider reports needed to be further developed to include routine sampling of the opinions of people living at the home and their relatives or representatives. This is now being undertaken and evidence of this was seen in the reports looked at. The majority of people living at the home had some money that was held in safe keeping for them. The system used has been in place for several years. Although records were kept of all transactions and these were seen, the money that was held securely by the provider could not be checked against the transaction records in place, as it was confirmed by the acting manager that the monies were held collectively in an interest free account. The acting manager confirmed that if anyone wanted access to their money when the provider was not available a petty cash float was kept and this was used. Following this inspection we have now been informed that the home intend to change the system that was in place at the time of this inspection visit. We have been informed that this new system should be in place by the 9th April 2010. The new system will hold small amounts of monies securely at the home for any person who wishes for their money to be held in safe keeping. These monies will be held separately and this will enable a more transparent audit system to take place, as the Care Homes for Older People Page 26 of 31 Evidence: actual monies held for each person can be checked against their financial transaction records.We have been informed that these monies will be accessible to the acting manager, provider and administrator only. Supervision sessions were provided at frequent intervals and records were seen to demonstrate this. This ensured that the staff team were provided with the support and guidance required to undertake their duties and support people effectively. Comments from staff confirmed they received regular supervision and staff said that the acting manager was supportive and always available to talk to. The pre inspection self assessment confirmed that the maintenance of equipment was undertaken as required to ensure that the environment remains safe for the people living at the home, staff and visitors. 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 1 9 13 The medication prescribed for all of the people living at the home must be audited against their medication administration records. This is to ensure that the correct procedures for recording, handling, safekeeping and safe administration and disposal of medicines are undertaken. 26/03/2010 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 12 Risk assessments regarding nutrition and falls must ensure they clearly assess the persons strengths and identify any risks and how these risks are to be managed and monitored. This is to ensure that each persons health and welfare is maintained and promoted 23/06/2010 2 9 13 The medication prescribed for all of the people living at the home must be audited against their medication administration records on a regular ongoing basis. 28/04/2010 Care Homes for Older People Page 29 of 31 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 ensure that the correct procedures for recording, handling, safekeeping and safe administration and disposal of medicines are undertaken. 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 7 Each persons capacity to make decisions in their every day life should be assessed and a care plan developed to instruct staff on how to support people to make decisions. Independent Advocacy services should be advertised, to ensure they are accessible to the people using the service. 2 14 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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