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Inspection on 13/01/10 for Normanton Lodge Care Home

Also see our care home review for Normanton Lodge Care Home for more information

This is the latest available inspection report for this service, carried out on 13th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

People living in the home told us they were satisfied with the care and support they received. A relative of a person in the home told us "It is a pleasure to visit the Lodge where my Mum is and I come away with a peace of mind". Most people told us the staff were always available when needed. We received many positive comments about the staff, including: "The staff are very caring and helpful, they are always around looking after the needs of the people staying there", "friendly and caring staff", and, "nothing is too much trouble for the staff". 18 of the 21 care staff, (approximately 80%), had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the National Minimum Standard of 50% of care staff with the qualification.

What has improved since the last inspection?

A new format for care planning and review had been introduced in the home in December 2009. (This format was already in use in other homes owned by the same provider). A new system for communicating information at staff shift hand-overs had also been introduced. The information given at shift hand-overs was now recorded on audio tape as well as being written down. Staff said this system had improved communication and ensured they were up to date with the changing needs of people in the home. Most of the staff at the home had received training about the Mental Capacity Act 2005. The home had started to implement procedures to ensure compliance with the Mental Capacity Act 2005. Recruitment procedures had been improved to ensure that all required documents and information were obtained for staff employed at the home. This helped to ensure a more robust system that protected people in the home. Some areas of the home had been redecorated in a bright and contemporary style, making a more pleasant environment for people living there.

What the care home could do better:

Include in admission processes consideration of the person`s capacity to make decisions about their daily lives, care and treatment. This will ensure that people are protected and their rights are promoted. Provide staff with appropriate training to the work they perform, specifically about caring for people with mental health problems. This will ensure that staff have the knowledge and skills to enable them to meet the needs of all people in the home. Ensure that all cleaning chemicals, and any other substances hazardous to health, are stored securely in the home. This will help to ensure that people are not exposed to avoidable risks to their health and safety.

Key inspection report Care homes for older people Name: Address: Normanton Lodge Care Home 75 Mansfield Road South Normanton Alfreton Derbyshire DE55 2EF     The quality rating for this care home is:   two star good 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: Rose Moffatt     Date: 1 3 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Normanton Lodge Care Home 75 Mansfield Road South Normanton Alfreton Derbyshire DE55 2EF 01773811453 01773581754 info@my-care.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Normanton Lodge Limited care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Normanton Lodge Care Home is registered to provide personal care and accommodation for service users falling under the following categories: Older people (OP) 43 Dementia over 65 years of age (DE(E)) 43 The maximum number of service users that may be accommodated at Normanton Lodge Care Home is 43. Date of last inspection Brief description of the care home Normanton Lodge is situated in South Normanton, near to the M1 motorway at junction 28. The home is a large converted older building with several newer extensions. The home provides accommodation and personal care for up to 43 older people, including people with dementia. Most of the bedrooms are single with en-suite toilets. There are comfortable lounge and dining areas. There are accessible gardens, including a sensory garden, and a car park. Care Homes for Older People Page 4 of 29 Over 65 43 43 0 0 2 9 1 0 2 0 0 8 Brief description of the care home Information about the home, including CQC inspection reports, is available in the home or from the manager. The current fees range from £405 to £500 per week. The fees do not include private chiropody, hairdressing, individual newspapers/magazines, and personal toiletries. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 this service is 2 star. This means the people who use the service experience good quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we Care Homes for Older People Page 6 of 29 have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an annual service review (ASR) of the home in October 2009. The ASR looked at all the above information. The ASR showed us the home continued to provide good outcomes for people living there. We carried out an unannounced inspection visit that took place over 7 hours on 13/01/2010. We carried out this inspection because of safeguarding vulnerable adults procedures instigated in November 2009. The safeguarding procedures were instigated because of issues around the care of a person at the home. Subsequent reviews of other people in the home by social services and PCT staff raised further issues around personal care. Social services and the PCT were satisfied with the action taken to address the issues and to prevent re-occurrence. We sent out 10 surveys to people living in the home and received 9 completed responses, 6 of these completed with assistance from the persons relative. We sent out 10 surveys to staff employed at the home and received 8 completed responses. There were 30 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The manager was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 4 people were selected and the quality of the care they received was assessed by speaking to them, observation, reading their records, and talking to staff. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 29 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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process was sufficient to ensure that peoples needs could be met at the home. Evidence: People living in the home, and their relatives, told us they always received the care and support they needed. Two relatives commented on the improvement in the persons condition since admission to the home. One relative told us It is a pleasure to visit the Lodge where my Mum is and I come away with a peace of mind. We looked at the care records of four people in the home. Each person had an assessment of their needs carried out prior to their admission to the home. A new format for care records had been introduced in December 2009. This included space to record if the person had a Lasting or Enduring Power of Attorney and this had been completed in one of the records seen, (the manager told us it was not relevant Care Homes for Older People Page 11 of 29 Evidence: to the other records we looked at).The admission process did not include an assessment of the persons mental capacity to make decisions about their daily lives. Staff told us they always had up to date information about the needs of people in the home. They said they had received training to help them to understand and meet the needs of people in the home. However, we found that one person in the home had mental health needs and, although these needs appeared to be met, staff had not received relevant training. The AQAA said that, whenever possible, people had the opportunity to visit the home before deciding on admission. The AQAA told us that people and their families were involved in assessment of needs and care planning. The AQAA provided the statistical data we asked for. Standard 6 did not apply as there were no people receiving intermediate care in the home. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a purposeful and person centred approach to care planning so that people received care and support to meet their individual needs and preferences. Evidence: People told us they always received the care and support they needed, including medical care. They said they could see their GP when necessary and also the District Nurse, chiropodist and optician. People told us that staff usually listened to them and acted on what they said. A new format for care planning and review had been introduced in the home in December 2009. (This format was already in use in other homes owned by the same provider). A new system for communicating information at staff shift hand-overs had also been introduced. The information given at shift hand-overs was now recorded on audio tape as well as being written down. Staff said this system had improved communication and ensured they were up to date with the changing needs of people in the home. Care Homes for Older People Page 13 of 29 Evidence: Each of the four care records we looked at had an Individual Profile with details of the persons care needs and the action required by staff to meet those needs. There were details of the persons individual preferences, their likes and dislikes, with prompts to staff about maintaining the persons privacy and dignity. The individual profiles were part of the new assessment and care planning documentation started in December 2009. Each of those we looked at had been reviewed in January 2010 with further monthly reviews planned. One of the individual profiles lacked information about one aspect of the persons condition, and another had conflicting information about the persons manual handling needs. One individual profile had been updated with a change in the persons medication, but this was not signed or dated. The individual profiles were not routinely updated when there were changes in the persons condition. The manager said the individual profiles would be fully updated every 6 months as part of a full review of the persons care needs. Any information about changes in the persons condition and needs was included in the daily records, notes of the GP and District Nurse visits, and in the monthly review of the persons care needs. Staff spoken with knew where to find information about any changes in the persons conditions. They said they were alerted to any changes during shift handovers. Each of the four records we looked at had assessments of the persons manual handling needs, tissue viability and risk of developing pressure sores, risk of falls and nutritional needs. The assessments regarding tissue viability had been reviewed weekly since they commenced at the end of November 2009. Any equipment used for pressure relief was noted in the individual profile. We found that the equipment identified was in use for the people whose records we looked at. There were relevant risk assessments in place, such as the risk of falls for one person who used the stairs. The risk assessments included any limitations placed on the persons freedom. There were records of each persons weight, updated at least monthly - three of those seen had weekly updates from mid-December 2009. Each persons blood pressure and pulse was checked at least monthly and recorded. For one person, we found there were varied blood pressures recorded with no note of action taken. We were told that the GP had requested that the blood pressure of each person was monitored monthly and the results were given to the GP every month. Care Homes for Older People Page 14 of 29 Evidence: Medication was stored securely in the home. Staff who administered medication had received appropriate training. The medication administration records (MAR) were mostly fully and correctly completed. However, for one person we found one topical medication not recorded on a MAR and a discrepancy in the doses given for another medication. We found that where staff had hand-written instructions on the MAR these were not signed by the person who had written them or counter-signed by another member of staff who had checked the instructions were correct. The AQAA showed there were relevant policies and procedures in place that had been reviewed in the last 12 months. The AQAA said they had improved by introducing a palliative care policy and by comprehensive risk assessment that took into account the persons mental capacity. They planned to improve further by continuing to develop care plans. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples social, recreational and nutritional needs were generally met at the home and the lifestyle provided met their expectations. Evidence: Most people told us there were activities arranged that they could take part in. On the day of the inspection visit we observed people playing dominoes, watching television, reading newspapers, and enjoying a visiting entertainer in the afternoon. Photographs on display, the homes newsletter, and daily records gave information about recent and forthcoming events and activities. People told us they could get up and go to bed when they wanted to. We observed that people moved around the home as they wished and could use different lounges and dining areas if they wanted to. Most people told us they always enjoyed the meals at the home. There were several dining areas they could use, or they could choose to eat in their bedrooms. The menus showed a choice of food at each meal time. People were consulted about meals as part of the homes quality assurance system. Care Homes for Older People Page 16 of 29 Evidence: The AQAA said the home had improved by providing safe enclosure of part of the front garden, by providing regular chair based exercise sessions, and by providing gardening equipment so that people could help to maintain the garden. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there had been safeguarding issues, the management team had shown the capacity and commitment to improving the service and reducing the level of risk to people living in the home. Evidence: People told us they would speak to staff or the manager if they were unhappy with anything at the home. They were confident that appropriate action would be taken to address any concerns. Most people knew how to make a formal complaint and staff knew what to do if anyone had any concerns about the home. The complaints procedure was displayed in the main entrance area. We looked at the records kept of complaints made. The records included details of the complaint and the action taken, and, in most cases, the outcome. We had not received any complaints about the home since the last inspection. Staff had received relevant training about safeguarding vulnerable adults and were aware of the correct procedures to follow if abuse was suspected or alleged. In November 2009 safeguarding vulnerable adults procedures were instigated because of issues around the care of a person at the home. Subsequent reviews of other people in the home by social services and PCT staff raised further issues around personal care. Social services and the PCT were satisfied with the action taken to Care Homes for Older People Page 18 of 29 Evidence: address the issues and to prevent re-occurrence. In response to the safeguarding allegations, the provider had produced an action plan to address issues raised. This included the introduction of new care plans and improved staff shift hand-overs, as noted in the Health and Personal Care section of this report. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean, suitably equipped and mostly well maintained so that people lived in a pleasant and comfortable environment that met their needs. Evidence: People told us the home was always clean and fresh. They said they were satisfied with their bedrooms. They were able to bring in items from home to personalise their rooms. Some areas of the home had been redecorated and looked brighter with colourful, contemporary pictures hung on the walls. One person had recently chosen the new decor for their bedroom and they were pleased with the results. The lounges were warm, spacious, and comfortably furnished. The bathrooms appeared clean and bright, except for one that was awaiting refurbishment. The manager said this was not currently used for bathing people, though they did use the toilet in the bathroom. The flooring was pieced together and badly stained. There was a unlocked wall cupboard with personal toiletries, disposable razors and cleaning chemicals stored. The bin in this bathroom did not have a lid in place. The laundry appeared clean and tidy and was suitably equipped. We found that soiled Care Homes for Older People Page 20 of 29 Evidence: clothes were manually soaked/sluiced before placing in the washing machine. This does not comply with the Department of Health infection control guidance for care homes. There were no disposable paper towels in the laundry but this was rectified during the inspection visit. The home appeared clean in all the areas seen. The home was mostly free of offensive odours. There was a smell of urine in the en-suite toilet of one bedroom. Staff training records showed that they had received training about the control of infection. Staff spoken with confirmed this and were aware of good practice in infection control. The AQAA said the home provided a warm, friendly atmosphere with various communal living areas to suit individual preferences for social interaction or quiet areas. The home had improved by providing a safe area in the front garden for people to use and enjoy, by redecorating some areas, and by updating the laundry equipment and boiler. They planned to improve further by developing the seating area to the front garden. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were satisfactory recruitment practices, staff training and staffing levels so that peoples needs were met by competent staff. Evidence: Most people told us the staff were always available when needed. We received many positive comments about the staff, including: The staff are very caring and helpful, they are always around looking after the needs of the people staying there, friendly and caring staff, and, nothing is too much trouble for the staff. The staff rotas showed that there were always 3 care assistants on duty, day and night, and often 4 during the day. Care staff were supported by kitchen, domestic and laundry staff. Staff told us that the staffing levels were sufficient to meet the current needs of people in the home. Staff said that there was flexibility in staffing levels to allow for busy times. We looked at the records of 3 members of staff. All had the required documents and information, such as a Criminal Records Bureau disclosure and 2 written references. New staff followed an induction that met Skills For Care standards. Staff spoken with confirmed that they had a period of shadowing experienced members of staff when they first started at the home. Care Homes for Older People Page 22 of 29 Evidence: Staff training records showed that staff were up to date with required training, such as fire safety, manual handling, and safeguarding vulnerable adults. Most staff had received training about the care of people with dementia and about the Mental Capacity Act 2005. As noted in the Choice of Home section of this report, staff had not received training specifically to meet the mental health needs of a person in the home. Staff told us this is a good place to work, friendly, and, the staff work well together as a team. The AQAA showed a low turnover of staff and no use of agency staff. The AQAA said that 18 out of 21 care staff had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. The AQAA said the home had improved by changes implemented in recruitment procedures and in staff training. They planned to improve by further development of the staff training programme. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed with satisfactory systems in place to ensure that the health, safety and welfare of people was promoted and protected. Evidence: The manager was suitably experienced and qualified to run the home. People told us they had confidence in the manager to take appropriate action about any concerns raised. They said the manager was very efficient. Staff told us The management take time to listen to any concerns any member of staff may have. The quality assurance system included regular meetings for people in the home and their relatives/representatives, monthly audits by the manager, and surveys given out to people in the home, visitors and staff. The results of surveys and other quality assurance measures were made available in a report and a copy of this was in the main entrance area of the home. The area manager carried out monthly visits and produced reports in accordance with Regulation 26. A quarterly newsletter was produced for people in the home and their visitors. Care Homes for Older People Page 24 of 29 Evidence: The AQAA was completed in September 2009 by the manager. The AQAA was sent to us when we asked for it and contained clear, relevant information supported by a range of evidence. The data section of the AQAA was fully completed and showed that there were relevant policies and procedures in place that had been updated in the previous 12 months.The AQAA showed that the servicing and maintenance of equipment and systems in the home was up to date. We looked at accident records. These were satisfactory with details of any action taken. The manager carried out monthly audits of falls in the home to look at any trends and to ensure people were referred to their GPs if necessary. As referred to in the Complaints and Protection section of this report, safeguarding vulnerable adults procedures were instigated in November 2009 because of issues around the care of a person at the home. Subsequent reviews of other people in the home by social services and PCT staff raised further issues around personal care. Social services and the PCT were satisfied with the action taken to address the issues and to prevent re-occurrence. In response to the safeguarding allegations, the provider had produced an action plan to address issues raised. This included the introduction of new care plans and improved staff shift hand-overs, as noted in the Health and Personal Care section of this report. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Records of the administration of external medicines must be fully completed at all times. This will ensure that people receive medication as prescribed. 28/02/2010 2 26 13 There must be effective infection control systems operated that comply with recognised guidance, including the Department of Health guidance for care homes. This will help to ensure a more robust system of infection control that protects people in the home. 26/03/2010 3 30 18 Staff must have training 31/03/2010 appropriate to the work they perform, specifically, training about supporting people with mental health issues. Care Homes for Older People Page 27 of 29 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 will ensure that they have the knowledge and skills to enable them to meet the needs of people in the home. 4 38 13 All cleaning chemicals, and any other substances hazardous to health, must be stored securely in the home. This will help to ensure that people are not exposed to avoidable risks to their health and safety. 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 26/02/2010 1 3 The admission processes should include consideration of the persons capacity to make decisions about their daily lives, care and treatment. This will ensure that people are protected and their rights are promoted. Handwritten instructions on medication administration records should be signed by the person who has written them and counter signed by a member of staff who has checked they are correct. This will help to protect people and ensure that medication is given as prescribed. 2 9 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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