Inspection on 10/08/09 for Margaret`s Rest Home

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

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

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

Other inspections for this house

Margaret`s Rest Home 13/09/06

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 16/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Margaret`s Rest Home 30 32 Kingsley Road Kingsley Northampton Northants NN2 7BL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rajshree Mistry     Date: 1 0 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 42 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 42 Information about the care home Name of care home: Address: Margaret`s Rest Home 30 32 Kingsley Road Kingsley Northampton Northants NN2 7BL 01604710544 01604792789 carehome32@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hollyberry Care Limited care home 27 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: No further service users in the category of DE (E) may be admitted when there is already a total of 27 service users accommodated in this category. No further service users in the category of PD (E) may be admitted when there is already a total of 5 service users accommodated in this category. No service user in the category of OP may be admitted when there is already a total of 27 service users accommodated in this category. The number of service users accommodated must not exceed 27. Date of last inspection 0 0 0 Over 65 27 27 5 Care Homes for Older People Page 4 of 42 Brief description of the care home Margarets Rest Home is a care home providing personal care and accommodation for 27 older people who may have a physical disability or diagnosed with dementia. Margarets Rest Home is owned by Holllyberry Care Ltd, which also has a sister care home with nursing close by. Margarets Rest Home is a large Victorian house situated on the outskirts of Northampton. There are shops and other leisure amenities close by. There is limited parking in the road outside the home and at the rear of the home. There is good access to local transport facilities. The accommodation is on each floor, accessible via the passenger lift. The majority of the bedrooms are single rooms with en-suite facilities and there are two shared bedrooms without en-suite facilities. On the ground floor there is a lounge with a dining area. There is a pleasant garden to the rear of the property. The Responsible Individual provided us with the range of fees, starting at £381.00 to £430.00 per week. There are additional personal expenditure for private chiropody, hairdressing and personal toiletries. People considering using Margarets Rest Home should contact the home directly to discuss individual needs and requirements. Full details for Margarets Rest Home and any specific requirements can be obtained in the form of the Statement of Purpose and the Service User Guide. The latest Inspection Report from the Care Quality Commission is available at the home or accessible via our website: www.cqc.org.uk Care Homes for Older People Page 5 of 42 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for Margarets Rest Home is 2 star. This means the people who use this service experience good quality outcomes. We as it appears throughout this Inspection Report refers to the Care Quality Commission (CQC). Any reference to the Commission for Social Care Inspection (CSCI) should be taken as CQC, who hold the legal responsibilities previously held by CSCI as of 1st April 2009. This key inspection started with the review of the last key inspection dated 22nd August 2007 and the Annual Service Review dated 4th June 2008. We looked at the information we had about the management of Margarets Rest Home and the events that affects the well-being of the people who use the service, which included complaints or concerns we may have received. Care Homes for Older People Page 6 of 42 We received from the Registered Manager the completed Annual Quality Assurance Assessment (AQAA) document. This is the homes self-assessment of the standards within the home. We sent out 27 surveys to the people who use the service and surveys for their relatives. We received 14 surveys from the people who use the service and 8 from relatives. The responses and comments received indicated that people were generally satisfied with the quality of care, support from the staff, services and the facilities provided. The responses indicated people had the opportunity to live the lifestyle of their choice, participate in social events and activities arranged by the home including observing their religious beliefs and practice. The responses also indicated people were confident to complain and have had their complaints addressed promptly. The comments received are reflected in this Inspection Report and supports our findings. We sent out 5 surveys to the health and social care professionals who support the people that live at Margarets Rest Home. These included the General Practitioner, District Nurse and the Community Psychiatric Nurse. We received 4 surveys, all were positive with regards to the quality of care provided to the people who live at the home. The responses indicated that staff seek prompt advice and follow instructions given, support people with their medication safely and meet peoples health and personal care needs well. The comments received in the surveys indicated that there has been improvements made with regards to communication to benefit everyone involved in the care of the people who use the service. These comments are reflected throughout this Inspection Report. We sent out 28 surveys to staff, of which 20 were returned. The responses indicated staff recruitment was fair, staff receive supervision and training to meet the needs of people who use the service. The responses indicated that staff receive good information about how to support people. The responses also indicated that there has been improvements made with regards to communication and the quality of information staff receive. This was consistent with the comments received from health care professionals surveys. The comments received are included throughout this inspection report. We visited Margarets Rest Home on 10th August 2009 starting at 10am and lasted over 7 hours. The Registered Manager assisted us during the site visit to the home. The main method of inspecting we used was case tracking. This means looking at the range of health and personal care people receive that is met by the staff. We looked at how peoples rights, choice, dignity and independence is promoted by the staff at the home. We selected four people to case track, all having differing needs, level of independence, abilities and included a person that was new to the home. We spoke with those people and other people using the service. We read their care files containing information about the persons health and personal care needs, lifestyle and how these are met. We made observations of people how people were treated and supported by the staff with regards to meeting their needs and promoting their wellbeing. We spoke with the visiting District Nurse to gather their views about the quality of care provided by the staff at the home, their observations and experiences. We spoke with the staff at all levels, roles and responsibilities on the day to ascertain the recruitment process, training, staff skills and the management of the home. We looked at the staff files that demonstrated the staff recruitment, training and skill-mix. We looked at the accommodation offered to people using the service. This included the communal areas, bathrooms and individual bedrooms with permission. We also looked at the environmental improvements made to the home since the last key inspection of the service. We read the information people receive about Margarets Rest Home. We looked at how the policies and procedures are followed by the staff to ensure peoples health and safety. We looked at specific records that demonstrated the day-to-day management of the service and how people that use the service are informed and consulted about the quality of care they experience. The Care Quality Commission has a focus on Equality and Diversity and issues relating to these are included throughout the main body of this Inspection Report. Care Homes for Older People Page 8 of 42 What the care home does well: Margarets Rest Home is an established care home. It is a large Victorian property set overlooking the park across the main road. All areas of the home are clean and tidy. There is a welcoming atmosphere in the home that is warm and relaxed. People who are considering using the service and their relatives are encouraged to visit the home and are involved in the assessment process to find out what help they may need. People who use the service are involved in all aspects of their care planning to ensure their needs, requirements and wishes are know and can be met by the home. People are encouraged to maintain as much independence as practicable, whereby they continue to make decisions and choices. People are supported to maintain their personal care needs and benefit from having en-suite shower facilities. Peoples routine is promoted and are supported to take part in activities and social events arranged by the staff. People are able to receive visitors at any time and also go out with family. Margarets Rest Home manages and addresses complaints and concerns quickly and in line with the complaints procedures. This shows the management team is responsive. Staff recruitment and training is good. Staff receive regular training for their roles and responsibilities and have awareness training to support the people who use the service. This includes training in dementia awareness and understanding how dementia affects people differently. Staff are caring and patient. Staff interact with the people well, showing respect and awareness of peoples needs, routines and abilities. The comments received in the surveys from the people who use the service, relatives, health care professionals and staff were as follows: Allows me to lead a normal life They always look clean and well dressed Always polite to residents and usually very patient Food is good, bedroom is clean and answers my call bell Gives my father the help and support he requires to allow him to live as normal a life as possible The food is good quality and well cooked. It includes lots of old fashioned food like stews and toad-in-the hole that my mother enjoys The home is very welcoming. It is clean, tidy and well decorated. It has a calm relaxed feel Senior carers are professionals and dedicated and kind Care Homes for Older People Page 9 of 42 The home strives to do its best in all aspects of care. It ensures all service users needs are met and everything is always done to make them safe, comfortable and maintain their privacy, dignity and general well-being We work well as a team The home provides very good quality of care From a professional perspective - have always taken advice and willing to embrace change and consider alternative ways of meeting clients needs. Have taken clients that present some difficult behaviours and embrace need to change their perception/attitudes in striving to meet clients needs What has improved since the last inspection? Margarets Rest Home has addressed the recommendations made at the last key inspection of the service. Margarets Rest Home has increased the number of registered places from 23 to 27, providing more accommodation and a new larger lounge with a large television. A new passenger lift has been installed that provides access to all the floors. The access to the garden at the rear has been improved with the installation of a ramp, for people that may use walking aids such as zimmer frames or wheelchairs. The Registered Managers office is now located on the ground floor near the kitchen and a new staff station has been created at the end of the new lounge. This improves the access people have to the staff and the Registered Manager at all times. The communication with the health care professionals has improved. This has benefited the people who use the service with regards to the quality of health support they receive. The home has good support from the Community Psychiatric Nurse, as the service looks after some people diagnosed with dementia. Care plans have been improved with regards to the quality of information available to staff. There is clear guidance as to how to support people and promote their independence and well-being. The staffing structure has changed with the appointment of two Deputy Managers, a senior carer, care staff and an Activities Co-ordinator. There are clearer roles and responsibilities for all staff. The staff handover meetings are longer to enable staff to have good information and updates shared about the needs of the people who use the service. This benefits staff as they have improved the quality of care and service people receive. Staff have maintained their knowledge and receive regular updates to ensure staff follow the guidance in line with the current best practice. One of the Deputy Manager is a qualified moving and handling trainer and has already carried out training and refresher training with the staff. The Registered Manager has introduced weekly quality checks, which also looks at the Care Homes for Older People Page 10 of 42 medication and peoples money that is held in safe-keeping by 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 11 of 42 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 12 of 42 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good information about the service and are involved in the assessment process to make sure their needs will be met. Evidence: We wanted to find out what information people receive about Margarets Rest Home and peoples experience of moving into the home. The information we gathered from the self-assessment completed by the Registered Manager stated; people receive a brochure about the home, which includes the statement of purpose and have a preadmission assessment. We read the Statement of Purpose and the Service User Guide, which tells people what they can expect from the service. These were comprehensive and were recently updated when the service increased the number of registered places. It outlined the type of care, accommodation and services people can expect to receive if they choose to move to the home. It also sets out aims, objectives and the ethos of the service, Care Homes for Older People Page 13 of 42 Evidence: the key policies and procedures, by which, the service operates including the complaints procedures. There is information about how they support people with dementia and the skills and qualifications of the Registered Manager and the staff. We read the detailed report produced by the Registered Manager for Enhanced Dementia as the home looks after some people with dementia and complex needs. This report was detailed and demonstrated the level of care provided with the support from a dedicated Community Psychiatric Nurse. This showed the service is taking steps to offer people with dementia a quality lifestyle and support that maintains and promotes their well-being. The survey responses received from people who use the service and their relatives confirmed they and their relatives received information about the home. People who use the service that we spoke with said they or their relatives had visited the home before choosing to move in. This supported the information in the self-assessment. The information gathered from the self-assessment stated there is a pre-admission assessment and people can have a months trial stay, which can be extended. This process is known as the assessment of needs and looks at whether the home is able to meet the persons health and personal care needs. We spoke with three people, of which we case tracked two; they said they were seen by the Registered Manager and asked about what help they needed. The comments received from the people we spoke with included: My son arranged the placement and I was moved from Gloucester to here I wouldnt be here if I was able to live at home safely I like it here, I have my own routines We read the care files for the people we case tracked. All had a copy of the homes assessment of needs that was completed before they moved to the home. The assessment read showed information was gathered about the person, including their personal details and key people involved in their care such as family and the General Practitioner (GP). Other information gathered related to their medical history and illness, medication, physical and mental well-being, dietary needs, cultural needs and individual wishes and preferences. Where the person was unable to express their view due to their level of dementia, their relative advocated their needs, lifestyle and preferences. This showed that the assessment process was good to ensure peoples needs would be met by the staff at the home. Care Homes for Older People Page 14 of 42 Evidence: The information gathered from the self-assessment stated the home admits people in an emergency. The Registered Manager described the process that is the same as the planned admissions to the home although the person moves to the home quickly. They confirmed that whilst they may receive information about the person from the Care Management Team they will only consider accepting the person after they have visited and carried out their own assessment of needs. This demonstrates that there is an emergency admission procedure in place to ensure the persons needs can be met. We spoke with the Registered Manager and the Responsible Individual (representing the company and owner) regarding the new Mental Capacity Act and the Deprivation of Liberty. This means that a person cannot make a decision for themselves or might be able to make some decisions not others, which is called lacking capacity. They said they had attended training and have had discussions with the Care Management Team to ascertain the need to assess peoples capacity to make decisions. Therefore, the assessment of needs process should be revised to take into account the requirements of the Mental Capacity Act and the Deprivation of Liberty to ensure this is the right home for them. We wanted to find out what information staff receive about a new person that moves to the home. Staff we spoke with said they receive good quality information about the new person in the handover meetings, communication book, staff meetings and in the care files. Staff said there was a significant improvement with regards to communication at all levels, which has improved team work and benefits the people who live at the home. This supported the responses received in the staff surveys and included the following comments: Keeps us well informed of new residents .... keeps the staff up to date and work as a team The information gathered from the self-assessment completed by the Registered Manager stated signed contracts are in place on file and a copy is provided to each person. The Registered Person confirmed that everyone who chooses to move to the home are given a contract with the terms and conditions of their stay. The Responsible Individual said individual Care Management Teams assessment and individual placement agreements, where people are funded by the local authority, are kept with the contract, terms and conditions of stay. One person who we case tracked said they had signed a contract when they moved to the home. This supported the Care Homes for Older People Page 15 of 42 Evidence: information received in the self-assessment and surveys, confirming people have an agreement and contract in place for their stay. Margarets Rest Home does not provide intermediate care services. Care Homes for Older People Page 16 of 42 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. Peoples health and personal care needs are met through care planning and by trained staff that understand and promotes their independence and well-being . Evidence: We wanted to find out how peoples health and personal care needs are met. The information gathered from the self-assessment completed by the Registered Manager provided us with a summary of the systems such as the new care plans, risk assessments, management of medication, practice and procedures, key worker system and staff training. There was additional information with regards to the support from the health and social care professionals such as the District Nurse and the Community Psychiatric Nurse, including the provision of specialist equipment. The self-assessment described how people are involved and consulted about the quality of care they receive through the residents meetings and the quality assurance surveys. All the responses and comments received the surveys from people who live at the home and their relatives indicated they receive the care and support they need and have agreed. This was consistent with the comments received from our discussions Care Homes for Older People Page 17 of 42 Evidence: with people who use the service, which included: The girls tend to my needs, I just need to ask I do manage my own personal care and I enjoy having a bath Gives my father the help and support he requires to allow him to live as normal life as possible On the whole the care is good Provides a friendly service with the care and support needed We spoke with several people including people we case tracked. We found that people were involved in developing their care plans and where unable to do so, relatives have been consulted to ensure needs are met with consideration to their preferences and wishes. People gave us examples of their preferred routines and indicated the staff treated them well and with respect. This supported our observations with regards to how staff spoke with people and responded to requests. We read the new care plans that have been introduced. There are individual plans written with regards to the environment, group activities and individual activities, infection control, food and diet and elimination, which means how continence is managed. The information contained in the care plans, generally provided good guidance for staff to follow, ensuring peoples independence is maintained and promoted. We saw evidence of assessments of risks and the safety measures were detailed in the care plans. These included risk assessments for falls, nutrition and moving and handling. We saw evidence of care plans are reviewed monthly and were personalised, such as .... prefers to have a bath and how to support a person who has dementia by talking about something of interest to them. Staff we spoke with said they are key workers for individual people and are responsible for reviewing the care plans on a monthly basis or sooner if necessary. Staff demonstrated from our discussion that they know the people who live at the home, their needs, routines and what to do if the person is feeling down or becomes upset. Staff demonstrated their knowledge on dementia and how it affects people. This showed staff supports and understands the needs of the people that live at the home. Whilst the new care plans considered individual wishes and gave guidance for staff to Care Homes for Older People Page 18 of 42 Evidence: follow, it was difficult to establish how the persons health and personal care needs were met without reading through each care plan for the relevant information. For example supporting a person with washing and dressing, managing diabetes, actions to take in case of a seizure, personal care needs and pressure care management. We discussed our findings with the Registered Manager, recommending this is improved and suggested they use the knowledge of the dedicated Community Psychiatric Nurse who visits the home. The Registered Manager accepted our findings and suggestions and gave assurance that they would review the contents in the care plans. The care files read contained daily notes made by the staff on duty to reflect the wellbeing of the person and records of the activities people participated in and the visits made by the GP, District Nurse and the Community Psychiatric Nurse. Records were maintained of visits and treatments given by the health visitors, such as administering of insulin, pressure care management and changing wound dressings. This supported the responses received in the surveys stating people had timely medical support and from our discussion with the people who we case tracked. The comments received in the surveys included: Very quick to call the Dr when necessary Keeps relatives information of any medical problems or other needs The home communicates any concerns about my mothers health quickly to both me and the GP/Health visitors and follows the appropriate care decided on They allow me to get involved in some of my mothers care e.g. cutting nails, toileting and bathing, which I find very rewarding and special. It helps me to stay in touch with her declining health. We have regular reviews of her care I discovered at a review that my mother, ...... could no longer be bathed because of her increasing mobility problems. Being clean was always very important to her so I spoke with the manager about how my mother could be enabled to have a bath. The manager and owner acted very quickly to source and buy a new hoist. My mothers bath has now been re-introduced into her care plan and takes place weekly. This outcome means the world to me and the day I helped the carers bath her was one of the most special of my life. A big thank you The Deputy Managers told us the District Nurse visits daily, the GP visits the home every Wednesday and the visits from the Community Psychiatric Nurse. We spoke with the District Nurse who said they visit daily to administer insulin to people who are Care Homes for Older People Page 19 of 42 Evidence: diabetic. They said there had been significant improvements made with regards to communication and the quality of care provided. The District Nurse said they were confident to express concerns to the Registered Manager, which would be addressed. Some of the comments received from the District Nurse included: Very good, theres been significant improvements here at the home I know the Tissue Viability Nurse has given them training to help staff recognise the signs of a potential sore or skin breakdown and the types of dressing used Communication has significantly improved There is good recording and staff follow the instruction you have left It helps because we come to administer insulin to a resident twice a day and the GP has weekly surgeries here Staff definitely know the residents and do not hesitate to ask us for advice or if we can look at someone when we visit We concluded from the evidence we read and from what people who use the service told us, the staff and the visiting District Nurse that people had good access to health care support that meets their health care needs. We wanted to know whether the management system for medicines was safe. The Deputy Manager described and showed us the medication system and storage. All medicines are kept in a locked medication trolley. The Deputy Manager confirmed they and the senior carers are trained to administer medication and training records supported this. We observed the two Deputy Managers giving out the medication and signing the medication record sheet individually. We concluded that the management system and practice for giving out medication was good and the recording was good. People we spoke to confirmed they have their medicines on time, demonstrating peoples health and well-being is promoted. The controlled (very strong) medicines are kept locked in a secure cabinet, in line with the Pharmaceutical Regulations. We checked the number of controlled medicine remained in the cabinet for a person we case tracked and checked it against the medication records, which requires the signature of two staff. Whilst the numbers were correct, we found there was a missing signature. We brought this to the attention Deputy Manager who accepted the error and explained they were distracted Care Homes for Older People Page 20 of 42 Evidence: for a while and signed the records. Since the last inspection of the home, the Registered Manager conducts a weekly check on the controlled medicines. Whilst the checks demonstrated the number of dose/tablets in the cabinet, the Registered Manager should consider checking the records to ensure there are no gaps, errors or omissions that would place peoples health at risk. Throughout the site visit, we observed staff treating the people using the service and their visitors with respect at all times. Peoples privacy and dignity is maintained when staff were helping people be seated or being assisted with their meals. One person said, its good to have your own bathroom, I dont upset or disturb other people. Other comments received are mentioned earlier and throughout this Inspection Report demonstrates people are respected and treated with dignity. The majority of bedrooms have en-suite shower and toilet facilities or have bathrooms close by. There are two shared rooms and both have a privacy screen, which is used to maintain peoples dignity. This also demonstrated that the home environment also promotes peoples dignity and privacy. Care Homes for Older People Page 21 of 42 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. Peoples lifestyle and interests are promoted by maintaining social contact and events and offered good choice of meals that promotes their well-being. Evidence: We wanted to find out what social opportunities and activities are available to people using the service. The information gathered from the self-assessment stated there are strong links with the surrounding community who are involved in the home activities, there is a weekly activity programme and newsletter that gives advance notice of planned activities for the next month and a physiotherapist visits, music and movement and a motivation company visits. It told us the hairdresser visits and special days in the calendar are celebrated. The survey responses and comments received from the people who use the service and their relatives also demonstrated the home arranges activities and social events. We received comments with regards to how the service could improve, which related to appointing a dedicated Activities Co-ordinator. We shared the comments received with the Registered Manager and found that an Activities Co-ordinator had been appointed since the self-assessment was completed. Care Homes for Older People Page 22 of 42 Evidence: During our visit to the home, we found people were using various parts of the home, including the new lounge with the large television. The new lounge is light and spacious. We saw other people sitting in the dining area, the quiet room and in between the two lounges, allowing them to see what was happening in both areas. Some of the comments received from the people we spoke with included: I like it here, I have my own routines Weve had cheese tasting evening Often go to the shops or out onto the Common In the morning we saw people sitting with their visitors, spending time with staff or relaxing in the bedroom. There were a number of people joining in with the sing-along organised by the Activities Co-ordinator. They has printed song sheets for everyone and appeared to be enjoying the singing and brain teasers about the singers such as Gene Kelly. In the afternoon, we saw the Activities Co-ordinator out in the garden with a lady picking flowers to put into a vase. Later a number of people were sat at the dining table with the cake mixes and chocolate. The Activities Co-ordinator responded to people with dementia by engaging and encouraging them to take part in the flower picking and cake making. Staff throughout the day were seen supporting people in a sensitive and respectful manner, when they appeared to be confused or forgetful. Staff were seen offering people choices and allowing people to choose and respond without being hurried. The staff spoken with demonstrated an understanding of peoples needs and how they support people with dementia by talking about people, places and activities of interest to them. This showed the home appoints the right staff and trains staff to support the people who live at the home. We read the newsletter for August 2009. It had information about the activities and social events planned such as the hair dressing, Holy Communion, Piano playing and chiropodist; a resident focus; new people that had moved to the home and new staff, all welcomed; birthdays in August; historical events and the residents meeting. This supported the information we gathered from the self-assessment completed by the Registered Manager. We spoke with a number of people about their experience of the social life and entertainment at the home. A number of people told us their family do visit. One lady said she was looking forward celebrating her birthday with her family having planned Care Homes for Older People Page 23 of 42 Evidence: to go out for a meal and spend time with the grandchildren. People said they could choose what they do every day from taking part in the activities to choosing the meals. This was evident throughout the day as staff were seen supporting people. We wanted to find out what information staff received about peoples interests and choice of lifestyle. Staff said the care files have information about peoples life, interests and hobbies. Staff said, sometimes, its best to ask them or their family as well as reading the information in the file. Staff said there is a key-working system and staff get to know about people including the Activities Co-ordinator who shares information and updates the care file. The care files read for the people we case tracked had information about individual interests, what the person did in their earlier days such as family life and work. One care file stated the person likes to go out and often goes out from our conversation with them. This showed staff have access to good information and are able to support people to continue their interests and live the life of their choosing. We wanted to find out what the meals were like. The cook said they prepare meals that are suitable for people with diabetes and generally find out what peoples preferences are like. They told us that there are plans to re-locate the kitchen away from the office. At present staff have to walk through one side of the kitchen to get to the office. Several people told us they enjoyed the meals and were looking forward to the lunch of shepherds pie and vegetables. This supported the comments received directly from the people we spoke with during the site visit and the comments received in the surveys. One lady told us how staff ensure she maintains her independence by cutting the meal up and is then able to eat herself due to poor eyesight. We also received comments in the surveys with regards to improvements to the service, which we shared with the Registered Manager: Make sure there is always a hot milky drink at bedtime Menu that caters for elderly people Food is good on the whole but tea-time isnt very varied Staff have to cut up my meals, then I can manage The food is good quality and well cooked. It includes lots of old fashioned food like stew and toad-in the-hole that my mother enjoys Care Homes for Older People Page 24 of 42 Evidence: Provides a good menu ... We observed meal times were relaxed, some people sat at the dining table whilst others sat in the lounge. The meals were served individually, some having their meals served in a plate with raised sides to promote independence and dignity by not having to use plate-guards. The meals were well presented, looked appetising and nutritious. We saw some staff assisting people individually with their meals in a discreet and sensitive manner. Staff wore gloves and aprons when handling food or assisting people with their meals, which showed staff followed food hygiene practices. Throughout the day we observed people being offered drinks and snacks, whether they were in the lounge or in their bedroom. This showed peoples health and wellbeing was maintained and promoted. Care Homes for Older People Page 25 of 42 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident to complain, complaints are addressed promptly and are protected by trained staff that ensure their safety and protection from harm and abuse. Evidence: We wanted to find out whether people were aware of the homes complaints procedure, confident to complain and whether they feel safe and protected at Margarets Rest Home. The information we gathered from the self-assessment stated the homes complaints procedure is displayed in the home, complaints are recorded and action taken and the home can provide the contact details of Advocacy services. The complaints procedure was displayed at the entrance of the home and included in the homes information: service user guide and the statement of purpose. The complaints procedure was clear, detailing the timescale by when complaints would be addressed by and the contact details for Northamptonshire County Council, the Care Quality Commission and the local Advocacy service. This showed the service provided people with clear information in case they had a complaint about the service they or their relative received. The surveys responses and comments received from the people who use the service and their relatives all indicated they know how to make a complaint and have had complaints responded to promptly. The surveys responses and comments received Care Homes for Older People Page 26 of 42 Evidence: from the Health and Social Care Professionals also indicated that complaints are responded to promptly. This was consistent with the comments received from people that we spoke with, indicating they would speak with a member of staff or the manager. Some of the comments received from the people who use the service included: I dont like to complain but I would say something if it bothered me I would speak with .... or those two young ladies (referring to the deputy managers) I would talk to my daughter if there was a problem and she would sort it out From a professional perspective - have always taken advice and willing to embrace change and consider alternative ways of meeting clients needs They are aware of their limitations and act in a way to improve these The staff we spoke with and the staff surveys received received indicated staff were confident to receive concerns or complaints, which would be passed to the Deputy Manager or the Registered Manager. This supported the information gathered in the self-assessment, stating that staff are aware of their responsibility if people have a concern or a complaint. The information gathered from the self-assessment stated 5 complaints were received by the home, of which, 1 was substantiated. We read the complaints record, which demonstrated that investigation and actions taken to resolve the complaint. All complaints are now dated to show the time taken to resolve the complaint. The Care Quality Commission received no complaints about the Margarets Rest Home. We spoke with the Registered Manager confirmed that they have not referred any one to the local authority under the Deprivation of Liberty. This means that a person cannot make a decision for themselves or might be able to make some decisions not others, which is called lacking capacity. They said they had attended training and have had discussions with the Care Management Team to ascertain the need to assess peoples capacity to make decisions. The information gathered from the self-assessment stated there were 5 safeguarding referrals and investigations. We were notified of safeguarding referrals and investigations relating to individuals that live at the home or had lived at the home. Care Homes for Older People Page 27 of 42 Evidence: The local authority managed the investigations and the home assisted by being open and transparent. As a result of investigations, there has been improvements to the practice, recording and communication for the staff at the home and health care professionals. People who use the service now benefit from a regular team of District Nurses and the Community Psychiatric Nurse. We wanted to find out if staff knew what safeguarding issues meant and how to deal with any suspicions or allegations with regards to abuse. Safeguarding issues means promoting the well-being of people using the service from harm, risk and abuse. Staff we spoke with including the newest senior carer, demonstrated a good understanding of the types of abuse that could occur and were aware of their responsibilities with regard to following procedures by reporting it to the Deputy Managers or the Registered Manager. Staff confirmed they had received induction training that included training in safeguarding adults and the multi-agency procedure, training updates and through the National Vocational Qualification training. All the staff we spoke with said they had attended the Dementia Awareness training and received information about the Mental Capacity Act as the service cares for some people with mental health and dementia. Staff spoken with were confident to raise concerns with regards to poor care practices using the homes whistle-blowing procedures. This supported our findings that staff were aware of their responsibilities with regards to promoting and protecting peoples safety, health and well-being. The staff records viewed, staff surveys and from discussion with the staff all confirmed staff were recruited upon receipt of satisfactory pre-employment checks. These included two references and a criminal records bureau check. This is a check to assess the suitability of the applicant to work with vulnerable people. This demonstrated staff recruitment procedures were followed to ensure people are cared for by suitable staff, which promotes their health, safety and well-being. Care Homes for Older People Page 28 of 42 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 comfortable, clean and tidy home that promotes their health and wellbeing. Evidence: We wanted to find out what type of home and accommodation people live in. The information gathered from the self-assessment stated the home is well maintained and homely, there is a routine maintenance schedule, the home has passed the fire inspection, equipment is maintained, maintains reduced infection with infection control training given to all staff and there are internal quality checks conducted. It detailed the evidence in place to support the practice such as maintenance book, quality checks and specialist equipment certificates. The self-assessment also detailed the improvements made that include the new lounge, new furniture has been purchased, more en-suite rooms, improved access to the garden and new boundary wall and a lift. The office is now on the ground floor near the kitchen and a staff station has been created in the new lounge. The surveys responses and comments received from the people using the service and their relatives indicated majority of people were happy with the home environment. The range comments received about the home environment including areas for improvements were also shared with the Registered Manager, and included the following: Care Homes for Older People Page 29 of 42 Evidence: Keeps my room tidy Answer my call bell quicker The home is very welcoming. It is clean, tidy and well decorated. It has a calm and relaxed feel I discovered at a review that my mother .... could no longer be bathed because of her increasing mobility problems. Being clean was always very important to her so I spoke with the manager. The manager and owner acted very quickly to source and buy a new hoist. My mothers bath has now been re-introduced into her care plan and takes place weekly ..... A big thank you We spent time talking with some people in the lounge and in the dining room. People said they were happy with the layout of the home, their bedroom and the cleanliness of the home. The seating in the large lounge was against the walls and there was a new large television. People commented on the new lounge, which was light and spacious. Some people preferred to sit near the dining room or the quiet lounge, as they preferred smaller quieter areas. We saw staff were responding to call bells when they were rung. This showed people choose where they sit and staff do respond quickly to the call bells. All the bedrooms are located on all floors, accessible by the new passenger lift. The stair lift is still in place as a back-up in case the lift is undergoing routine maintenance. We discussed with the Registered Manager that an assessment of risk should be completed and steps should be taken to ensure people are safe as the rails for the stair lift extend out into the lounge, causing an obstruction and potential hazard. This was accepted by the Registered Manager and assurance was given that they would make the area safe for people using the service and the staff. We were invited to look at a number of bedrooms, the majority have en-suite shower and toilet facilities. There are two shared bedrooms and privacy screens are provided to maintain peoples dignity. The bedrooms were all individual in character, decorated with bedroom furniture, good lighting and personalised with pictures and family photographs. Some people said they were able to bring their own furniture such as an armchair or table. This showed the home supports people to personalise their bedrooms to make it feel more homely for them. We also saw the assisted bath, which is used by people who have limited mobility to Care Homes for Older People Page 30 of 42 Evidence: get into and out of the bath. Two people told us the liked having a bath and said I enjoy my baths now and you get on the seat, you go up and down into the bath. We found rubbish including tissue papers, a razor and bars of soap in the gap between the wall and the bath. We brought this to the attention of the Registered Manager, who ensured the rubbish was cleared. We discussed with the Registered Manager how they could make the area safe for people and to consider ways in which to ensure peoples safety and hygiene practices, where they prefer to use bars of soap. We saw staff using the hoist and the stand-aid to help people get up of the armchairs. We saw a number of equipment provided for individual people for the health such as pressure mattresses and their mobility. The laundry room is located away from the area where food is prepared. People told us they were satisfied with the laundry arrangements, having their clothes returned washed and ironed. The staff spoken with said they are responsible for keeping the home clean. There is a cleaner who is responsible for the cleanliness of the communal areas. This showed there are clear tasks carried out by the staff. The visiting District Nurse confirmed staff follow good infection control practices. We saw staff wearing protective clothing such as gloves and aprons when preparing to assist people with personal care tasks and assisting with food and meal times. Staff spoken with demonstrated a good understanding of infection control practices and the measures taken to prevent cross infection. The training records showed staff receive regular training and updates. This confirmed staff are trained and aware of the current best practice that promotes peoples safety and well-being. Care Homes for Older People Page 31 of 42 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 who live at the home are protected and supported by robust staff recruitment and training that promotes their health, well-being and independence. Evidence: We wanted to find out whether the staff recruitment process, the skill-mix and the staffing level, meets the needs of the people living at Margarets Rest Home. The information gathered from the self-assessment completed by the Registered Manager stated the recruitment is fair and open and all checks are carried out on prospective staff, references, pova and crb. This is a check to assess the suitability of the applicant to work with vulnerable people. It also stated the staff skills, training and qualification is maintained by providing 21 hours of paid training. There is regular staff supervision and appraisals. The home has also been awarded the investors in people award. The survey responses and comments received from the people who use the service and their relatives indicated that staff had the right skills and experience to look after the people who use the service. People that we spoke with told us they were happy with the staff with regards to how they are cared for and helped. Some of the comments received that further supported this included: Staff treats him with dignity Care Homes for Older People Page 32 of 42 Evidence: Senior carers are professional and dedicated and kind Always polite to residents and usually very patient Provides a friendly service with the care and support needed We observed staff interacting and engaging with the people using the service in a polite and courteous manner. Staff were not phased by some peoples comments and reaction, partially as a result of their dementia, by being patient and talking with them in tone that was friendly and respectful. This showed staff treated people with respect. We concluded that staff have the right skills to look at the people who use the service. We saw the staff rota displayed indicating the staffing levels, roles and responsibility. Staff told us that they now have longer handover time to ensure information about the people who use the service is passed onto the staff to ensure needs are met. Since the self-assessment was completed by the Registered Manager the staffing structure has changed. There are now two Deputy Managers and a new Activities Co-ordinator. The home has recently appointed a new senior carer and a number of carers. Staff surveys responses and comments received indicated there had been some improvements made with communication and information shared between the staff about the people who use the service. This was consistent with what staff all told us with regards to communication including the visiting District Nurse and the health care professionals surveys. The comments received with regards to the improvements included: Aware of the need to improve communication and have responded well and enthusiastically to the changes They have worked hard to improve in-house communication and external communication Communication and keep staff up to date and work as a team Keep us well informed of new residents The newest staff described to us the recruitment process they experienced and told us about the pre-employment checks carried out. We looked at the files for 5 staff that included the newest staff. All files contained evidence of the pre-employment checks Care Homes for Older People Page 33 of 42 Evidence: carried out such as two satisfactory references, criminal records bureau (crb) check and a protection of vulnerable adults (pova) check. This is to assess the suitability of the applicant to work with vulnerable people. We concluded that staff recruitment procedure was good and protects the people who use the service. Staff described to us the induction and training they completed, which is in-house using the Common Induction workbook. Staff told us they have had training in administering medication, dementia awareness, health and safety, manual handling, fire and infection control. Some staff demonstrated how they have used the information from the dementia awareness training and put it into practice, now having greater understanding of how dementia affects people in different ways. The home benefits from having one of the Deputy Managers qualified as a moving and handling trainer and is updating staff training. We discussed with the Registered Manager if they had considered the Skills for Care Induction Workbook and training opportunities available to them, which would ensure they maintain the staff training and skill-mix. The staff training records viewed and training matrix, which was being updated, showed staff had received training in moving and handling, fire, equality and diversity, infection control, dementia awareness, health and safety, safeguarding adults and administering medication for staff responsible for the medication. Some staff said they had received training from the District Nurse with regards to pressure care management, wound care and use of appropriate wound dressing. This was consistent with what the District Nurse had told us and demonstrated the home continues to improve the knowledge of staff to ensure people continue to receive better care and experience a better quality of life. One Deputy Manager has the responsibility of maintaining staff training. They confirmed that two staff including the Registered Manager have attained the National Vocational Qualification (NVQ) level 4 and a further member of staff is completing NVQ 4; 5 staff have attained NVQ 3 and 2 are completing NVQ 3 and 13 staff have attained NVQ 2 with 6 staff completing NVQ 2. This equates to 93 of staff that have attained or are in the process of completing the minimum of NVQ level 2 in care. We concluded that the staff are trained and skilled to meet the needs of the people who use the service. Care Homes for Older People Page 34 of 42 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. People benefit from a well-managed home, have opportunities to comment on the quality of the service that promotes their health, safety and well-being. Evidence: We wanted to find out whether the management of Margarets Rest Home protects and promotes the well-being of the people who use the service. The information gathered from the self-assessment completed by the Registered Manager stated their qualification, training completed and their experience. The Registered Manager has already attained NVQ level 4 and the Registered Managers award. They recently attended training in Mental Capacity Act training, the Deprivation of Libertys training and are due to complete the Institute of Leadership & Management level 5 coaching and mentoring course. This demonstrates they are keeping up to date with changes in the legislation. We were shown the Enhanced Dementia report that was produced by the Registered Manager for the local authority to demonstrate how they support people with Care Homes for Older People Page 35 of 42 Evidence: enhanced dementia at the home. This resulted in the support and input from a dedicated Community Psychiatric Nurse for the people who use the service. The Registered Manager told us there have been changes to the staffing structure since the self-assessment was sent to CQC. These includes two Deputy Managers, senior carer, new care staff and an Activities Co-ordinator. The staff described their roles and responsibilities and the improvements made with regards to information sharing, communication between the staff and the health care professionals and the new communication book. We saw that the staffing levels met the needs of the people who use the service. The visiting District Nurse also commented upon the new appointments, staffing levels and the quality of the information and communication now between the staff. This demonstrated that the changes in the staffing structure has positively benefited the staff , which improved the quality of care received by the people who use the service. We wanted to find out what quality assurance systems and checks are in place to ensure the service is safe. The representative of the Responsible Individual (owner) conducts the monthly visits, known as Regulation 26 visits. We read the latest monthly visit report demonstrating the quality checks that are carried out. In addition the Registered Manager showed us the weekly quality checks that are carried out in the home. The record of the quality checks showed checks are also carried out medication, peoples money held in safe-keeping and areas such as the quality of meals and the environment. This demonstrated internal quality monitoring systems are in place. We saw in the newsletter that there are regular Residents and Relatives meetings. The last meeting took place on 7th August 2009. The minutes of the meeting read showed the topics discussed included meals, activities and sherry evening. People using the service said they can choose to attend the meetings and often find it helpful especially when they were making improvements in the home. This demonstrated that people are informed and involved in what happens at home. Margarets Rest Home conducts two quality assurance surveys per year and the most recent was done in May 2009. We read some surveys as a report had not been compiled of the findings and how the service intends to make improvements in response to the surveys. We discussed with the Registered Manager and the Responsible Individual that some consideration should be made to making the report suitable for the people who use the service. We also suggested that consideration should be made to measuring the outcome of the quality assurance against the statement of purpose. This would show if peoples experiences and expectations of the Care Homes for Older People Page 36 of 42 Evidence: service are consistent with what the service had stated as the aims and objective. Following the site visit we received a report on the findings from the quality assurance. There were quotes from the people who use the service and their relatives and conclusions with regards to the quality of care people receive and areas where the service can improve. This showed the quality assurance process is robust and people are consulted and their views are sought. We wanted to find out how people are supported to manage their money. The majority of people who use the service have their relatives manage their financial affairs and have some money held in safe-keeping by the home. The Registered Manager described to us how peoples money is managed and records that reflect the account balance. They said there are a few relatives like to have copies of the financial transactions for their information. One person said that he just tells the manager when they want some money. This showed the home has a good system in place to manage peoples money safely, records are in place to support this and some people are aware what they need to do. The staff surveys responses indicated staff have regular team meetings and receive regular supervisions and appraisals. This was consistent with what the staff told us including the newest members of staff, who was on a probationary period. Staff files contained a record of the supervisions that had taken place, confirming a record is kept of the discussion from the meetings. We were unable to read the minutes of the last meeting as these had not been typed up but were able to read the minutes of the previous meeting held in March 2009. The topics discussed were uniforms, fluid charts and timesheets. The comments received from staff with regards to information and communication included; Communicating and keep the staff up to date and work as a team You gets lots of information about the residents, good handovers and good information is in the files We have longer handover meetings to make sure we have time to pass on the important information and to read the communication book The information gathered from the self-assessment completed by the Registered Manager stated all the policies and procedures are reviewed and kept up to date. Staff we spoke with said they know about the policies and procedures, kept in the office and in the new staff station in the lounge and have regular updates. Care Homes for Older People Page 37 of 42 Evidence: The Registered Manager confirmed the Environmental Health Officer inspected the home in May 2009, which was satisfactory. They also confirmed the Fire Officer was due in September 2009 to conduct a fire inspection. This demonstrated that the home ensures it complies with other health and safety regulations. The information gathered from the self-assessment tool completed by the Registered Manager, detailed the programme of routine maintenance, servicing and testing of equipment in the home. On the day of the site visit we saw an engineer servicing the stair lift. People who use the service told us they are told when the fire alarm is being tested. The fire tests records also demonstrated tests are carried out. In addition, the monthly visits carried out and the weekly quality checks also demonstrates regular checks are completed to ensure the home environment is safe for the people who use the service. The care files for the people we case tracked contained assessments of risks for moving and handling and falls. The care plans reflected the safety measures to be followed to ensure the persons health and safety. We concluded that the home environment is safe and well-maintained for the people living and the staff working at Margarets Rest Home. Care Homes for Older People Page 38 of 42 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 39 of 42 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 22 13 The registered person must 30/09/2009 assess the stair lift, including the rails that extend into the lounge and take steps to ensure, so far as practicable, it is free from avoidable risk or injury to the people who live at the home. This would ensure the health and safety of people who live at the home. 2 22 13 The registered person must 15/09/2009 take steps to secure the gap between the bath and the wall to prevent rubbish and other items being collected such as soap and razors. This would ensure people using the service are not at risk and their safety is protected. Care Homes for Older People Page 40 of 42 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 3 To consider reviewing and updating the assessment of needs format to take into account the requirement to assess the ability and capacity of people to make decisions in accordance with the deprivation of liberty and the Mental Capacity Act. To consider developing care plan that specifically provides clear needs and guidance as to how individual personal care and health needs should be met without having to read numerous care plans and risk assessments. To consider medication audits to include checking of the controlled medication records to ensure no errors or omissions. 2 7 3 9 Care Homes for Older People Page 41 of 42 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 42 of 42 - 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!