Inspection on 06/11/09 for Orchard Views

This is the latest available inspection report for this service, carried out on 6th November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard Views 26/11/07

Orchard Views 17/10/06

Orchard Views 25/10/05

Orchard Views 13/05/05

Orchard Views 17/11/04

Orchard Views 10/08/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Orchard Views 39 Gawber Road Barnsley South Yorkshire S75 2AN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jayne White     Date: 0 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: Orchard Views 39 Gawber Road Barnsley South Yorkshire S75 2AN 01226284151 01226284151 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): None Mr Mohammed Sharif,Mrs Wendy Sharif Name of registered manager (if applicable) Mrs Tina Brammer Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Three service users may be accommodated at the home age 60 years and above. Date of last inspection Brief description of the care home Orchard Views is a purpose built care home registered to provide personal care and accommodation to 40 older people. The accommodation and facilities are all ground floor level and there are 38 single and one double bedroom. There is a small car park at the front of the building. The home has a garden area. The home is situated on the outskirts of Barnsley town centre within easy reach of local amenities including a main bus route, post office, shops, pubs, clubs, churches Care Homes for Older People Page 4 of 30 Over 65 40 0 1 0 1 1 2 0 0 8 Brief description of the care home and Barnsley Foundation Trust. Information about the home, including the service user guide is available in the entrance hall. This includes the most current Care Quality Commission (CQC) report about the service. The manager said the fees were £356.77 per week. Additional charges were made for hairdressing, private chiropody, dentist and individual toiletries. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection. We visited without giving the service any notice from 09:15 until 17:15. Ms Tina Brammer, manager was present during the visit. The manager completed an Annual Quality Assurance Assessment before the site visit. This gives the service the opportunity to tell the CQC how well they think they are meeting the needs of people using the service and what they are working on to improve. Various aspects of the service were checked during the site visit including inspection of parts of the environment, records relating to the running of the home, observing care practices and inspecting a sample of policies and procedures. We sent ten surveys to people living at the home, asking them about their experiences of living there, ten to the representatives of people living at the home (this included Care Homes for Older People Page 6 of 30 family and friends), asking them about the experiences of their contact with the home, six to health professionals and five to care managers, asking them about their experiences of working with the home and five to staff, of their experience of working at the home. Five surveys were returned by people that lived there (50 ), two from their representatives (20 ) and four from staff (80 ). The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received, as were some of their representatives. The care provided for four people was checked against their records to determine if their individual needs identified in their plan of care were being met. We also spoke with staff and the manager about their knowledge, skills and experiences of working at the home and three health care professionals. We checked all the key standards and previous requirements. The manager was provided with initial feedback from the inspection during and at the end of the visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Both the owner and manager need to make sure they fulfil all of their responsibilities in meeting the legislative requirements and National Minimum Standards of a registered care home to ensure the health, safety and welfare of people and staff. For example, implementing what has been identified below as what the service could do better. A comprehensive full needs assessment must be completed before people are admitted. This would mean the person will not be placed at risk or not have their wishes adhered to, by the service having insufficient information. Transfer to the plan of care the action to be taken by staff to reduce risks to people as identified in a risk assessment. This would tell staff what they need to do to meet peoples needs in a safe way. Understand the importance of making a second signature on records and that it means they are verifying the information recorded is correct. Care Homes for Older People Page 8 of 30 Record peoples allergies to medication on the actual medication administration record to reduce the risk of people being given medication they are allergic to. Improve medication records, so that all quantities of medication received into the home and returned to the pharmacy are recorded, controlled drugs have a witness signature and there is a record authorising changes to peoples prescribed medication. Follow a more robust recruitment procedure so that people living at the service can be assured they are sufficiently protected. A warning letter has been sent to the provider to achieve compliance with this, because a requirement was made in respect of this at the last inspection. Make the environment a better quality for people. A number of the fixtures and fittings need replacing and some of the decor requires upgrading. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service did not always have full written information about peoples assessed needs before they moved into the home. This meant the person may be placed at risk or not having their wishes adhered to, by the service not having sufficient information about them. Evidence: The manager in the AQAA told us new admissions were only admitted on the basis of a full assessment which is carried out by the home manager before they come into the home. Four people had been admitted in last twelve months. Generally, when we spoke to people they said their family had taken the responsibility for making the decision about the choice of home. They reflected what the manager had told us in their AQAA. However, one person was able to describe in detail their admission to the home and it didnt reflect what the manager had told us in their AQAA. They didnt want to be at the home. When we looked at their file there was no Care Homes for Older People Page 11 of 30 Evidence: information from the placing authority to confirm why the person was staying there. When we spoke with the manager she told us the person had been an emergency admission, which told us why the pre-admission assessment and asssessment had taken place on the day of admission. Had an assessment taken place and all information obtained prior to their admission, the situation could have been avoided. On all the three files we looked at the pre-admission assessment was carried out and an assessment took place, but on the day of admission. We discussed again with the manager that these needed to contain greater detail. Also, it is essential that where the service do not conduct their own assessment before admission, they receive a summary assessment from the placing authority, as this was in place on only one of the files. This suggests that until the person was admitted they knew no information about the person. A plan of care had been put together from the information. When we looked at peoples surveys it told us that they all thought they were given enough information to decide if the home was the right place for them before they moved in. Three stated theyd been given a contract, two that they hadnt. Care Homes for Older People Page 12 of 30 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. On the whole, the health and personal care that people received reflected what assistance they needed. People were treated with respect, dignity and privacy. Evidence: All the surveys that were returned by people told us they always received the care and support they needed. Three stated they always received the medical care they needed, two that they usually did. One commented, they try hard to keep me comfortable and are kind and supportive towards my emotional needs. This was reflected when we spoke to people about the care they were given. Both the relatives surveys that were returned told us they usually get enough information about the care service to help them make decisions, the service always meets the needs of their relative, they are usually kept up to date with important issues affecting their relative and the care service usually gives the care they expected to their relative. They commented, provides personal care people expect for a relative and looks after my relative as an individual. They treat him with respect and he is able to maintain his dignity and quality of life. Care Homes for Older People Page 13 of 30 Evidence: All the staff surveys told us they were always given up to date information about the needs of the people they cared for. Three stated the way information was shared about people they cared for with other carers and the manager always works well, one that it usually did. When we spoke to staff about peoples needs they were knowledgable with what this was and how they preferred this to be given. We looked at four care plans. On the whole, the plans contained good information that was sufficient to inform staff of the action they needed to take to meet peoples needs. The daily report identified that staff acted on this information. In the main, risk assessments were in place to identify any risks that might be presented by people, for example, mobility, nutrition, pressure areas and falls. The assessment identified the action required by staff to reduce the potential risks to people, which promoted and maintained their independence. However, where a risk had been identified in the risk assessment, action to be taken to reduce the risk wasnt always transferred to the plan of care. Records of healthcare visits that were undertaken were maintained and demonstrated people did receive visits from healthcare professionals. People confirmed this when we spoke with them. When we observed staff working there was clear and respectful communication between people and staff and staff treated people in a kind manner. On the whole, people were well dressed and their hair and nails were clean. This indicated respect and dignity by staff when caring for people. Senior care staff administered medication. Medicines were securely stored and the service had storage for controlled drugs that met the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. There was also suitable storage for medication that required refrigeration. This meant medication was stored at the correct temperature. We saw that when people were given their medication it was done in a respectful and dignified way. A drink was available to assist people in taking their medication. People were prompted and encouraged to take their medication where this was necessary. We looked at the recording, administration and storage of medication on a sample basis. On the whole, medication received was clearly recorded on the persons medication administration record and medication administered signed for. However, Care Homes for Older People Page 14 of 30 Evidence: for one controlled medication record that was checked, there had been an error in the record for two days. This meant the member of staff who was the second signatory was not checking what they were signing for. We noted that although there was information about peoples allergies to medication it was not on the actual medication administration record. This could lead to people being given medication they are allergic to. We spoke with staff who had responsibilities for dealing with medication. They told us they received medication training, but competency assessments did not take place to confirm their competency to administer medication. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were assisted to make choices and decisions about their daily life and social activities met peoples expectations. Evidence: When we entered the home there was a pleasant ambience in the communal areas. Since the last inspection there had been some improvement in the provision of a fulfilling quality of life for people. This was because the service had employed an activities co-ordinator. When we spoke to the activity co-ordinator they said they worked four hours a day at different times. They had commenced about two months ago. They told us both group and individual activities take place, with individual activities taking place in peoples own rooms. This had already made a difference to the quality of life for people. This is shown in the surveys returned to us. Two stated the home always arranged activities they could take part in if they wanted to, three that they usually did. They commented, an old complaint has been not enough been done about activities to occupy time. This has recently been solved by the appointment of a lady therapist and her activities classes are well attended and I cannot praise the home and staff enough. Occasionally I read of homes that are rubbish but not Orchard Views. We saw that the activity co-odinator organised a Care Homes for Older People Page 16 of 30 Evidence: game of beetle and ten people participated in this. Our observations during the visit and discussions with people identified people could spend their day as they wished following their preferred routines. People told us their family and friends could visit at any time and that they were made to feel welcome by being offered a drink and staff being friendly. This means they were able to maintain important personal and family relationships. The surveys returned by peoples representatives told us that one of them felt the person they represented was always supported to live the life they chose, another that they usually were. The surveys returned by people told us four of them always liked their meals at the home, the other that they usually did. The dining room was welcoming, being bright and clean. The menu for the day was written on a board in the dining room so people knew what their meals would be. Meals were served at two sittings. This was so that there was enough staff available to serve people without them having to wait for long periods and provide one to one support for people who needed assistance to eat. Where people needed assistance with eating staff helped the person at their pace, making them feel comfortable and unhurried. We saw the breakfast and lunchtime meal being served. There was no rush to the mealtime and people were given sufficient time to eat. Staff were patient and helpful and allowed people time to finish their meal. We saw that some people maintained their independence by laying tables for meals and clearing items away when the meal had finished. Care Homes for Older People Page 17 of 30 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 were able to express their concerns and had access to a complaints procedure. There were adult safeguarding policies and procedures in place that promoted the protection of people from harm. Evidence: On the whole, people were satisfied with the care they received and felt safe. They said they would speak up if there was something they werent happy about. This indicated there was an open culture that allowed people to express their views and concerns in a safe and understanding environment. On the whole, people knew who they would talk to if they were unhappy about any aspect of their care and when I spoke with them the majority said they had no complaints. Both of the surveys returned by representatives of people told us they knew how to make a complaint if they needed to and that the service always responded appropriately if they had raised any concerns. The staff surveys that were returned told us they knew what to do if people or their representatives raised any concerns. This was confirmed when we spoke with them. People could access the complaints procedure because it was displayed in the foyer and clearly described the procedure for people should they have any concerns. It was clearly written, easy to understand and explained what the procedure was and how Care Homes for Older People Page 18 of 30 Evidence: long the process would take. A record was maintained of complaints that had been made. No complaints had been recorded since the last inspection. The manager demonstrated good knowledge in the procedures to be used if allegations of abuse were made and followed these when necessary. She had attended further training on the local adult safeguarding policy and procedure for South Yorkshire. She was to commence training on the deprivation of liberty safeguards. The AQAA told us all senior care staff had undertaken in-house training in adult safeguarding. One adult safeguarding referral alleging verbal abuse was made. Appropriate action was taken to safeguard both the person making the allegation and the member of staff that was implicated. Safeguarding meetings were held and the home conducted their own investigation. Recommendations were made in order to safeguard people better. The service had acted on those recommendations. These included documentation and report writing training and improving some aspects of care planning for the person. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The living environment was clean but improvements were still required to make all living areas a well maintained and comfortable environment for people to live and enjoy. Evidence: When we spoke to people they said they were satisfied with their living environment. They said their bedrooms were comfortable and some people had personalised these with pieces of their own furniture and possessions. The surveys that they returned told us four of them felt the home was always fresh and clean, one that it usually was. In the services own quality assurance surveys that were returned by people, one of them commented, I like the room, but it needs decorating. The AQAA told us the main entrance and conservatory had been redecorated and a bathroom refurbished. It stated the home required updating with furniture and chairs in communal areas, but didnt give any timescales when this might take place. The person conducting regulation 26 visits on behalf of the owner had identified that the corridors needed decorating, but again a date when this will take place was not identified. In the staff survey, they stated in what the home could do better, more decorating and more updating furniture etc. When we spoke with staff one of them commented, Care Homes for Older People Page 20 of 30 Evidence: building could do with some work. When we looked round the home it told us it had not been well maintained on a regular basis. A number of the fixtures and fittings needed replacing and some of the decor required upgrading. People were not able to use some of the furniture properly and this could pose a risk of potential injury to them. For example, in lounges, some occasional tables stained and chipped and some chairs had very little padding in them where people sat, which could be uncomfortable, in bedrooms the furniture was chipped and tired, handles were missing from drawers and the bed linen was thin and worn, in corridor areas, paper was peeling from the ceiling and in the hairdressers room there was furniture being stored there that was not fit for purpose and needed to be disposed of. The bathroom areas, despite a requirement to improve them at the last inspection had not improved sufficiently. Some were still stark and bare. There was still one where the handle was missing on the inside, wallpaper was peeling off in a number, a painted floor was peeling and there was a light switch that was unable to be used because there was no string. Where repairs had been made they were not all to a good standard as they did not match the existing decor. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was an experienced, trained and stable staff team in sufficient numbers to support people and the smooth running of the service. However, the recruitment of staff was insufficient to ensure people using the service were protected. Evidence: Everyones surveys that were returned told us the staff were always available when they needed them and that the staff always listened and acted on what they said. They commented, friendly and supportive staff, but have more staff in busy periods. This was reflected when we spoke with people on the visit. Two of the staff surveys stated they felt there was always enough staff to meet the needs of people, one that there usually was and one didnt answer. We observed how staff worked during the visit. This told us there were good relationships between staff and people and they responded in a timely way when people needed assistance. Staff were clear of their roles and what was expected of them. The AQAA told us training opportunities were provided. It stated all new staff undertake a basic induction and all new staff that are not qualified are mentored by a senior staff member until they feel competent they can work alone. It told us all staff Care Homes for Older People Page 22 of 30 Evidence: had completed NVQ Level 2 in Care and completed induction training in accordance with Skills for Care. It also stated staff have attended dementia awareness training. All of the staff surveys that were returned told us their induction covered very well everything they needed to know to do the job when they started. They all stated that they were given training relevant to their role, helped them understand and meet the needs of people and kept them up to date with new ways of working. Three of them stated that their training gave them enough knowledge about health care and medication, one that it wasnt applicable to them. They all stated that they felt they always had enough support, experience and knowledge to meet peoples needs. One commented, Orchard Views ensures staff have access to all training that is available. This was reflected when we spoke to staff during the visit. Both of the representatives surveys that were returned stated the care workers usually had the right skills and experience to look after people properly. They commented, the staff are friendly, readily available to answer questions and offer advice (tailored to my relatives needs), but have more staff so response times to the buzzer could be quicker. All the surveys returned by staff told us their employer carried out checks such as a CRB and references before they started work. When we spoke to staff they also said this. The AQAA stated there was a recruitment policy in place and that everyone who had commenced employment in the last twelve months had received satisfactory pre employment checks. This supported what staff had told us in their surveys and when we spoke with them. However, this was not what we found when we looked at three staff files. All files contained an application form, declaration of health and identification. All of the staff had commenced employment on a POVA first check, but there was no written evidence about who had been appointed to supervise the new worker pending receipt of, and satisfying themselves of, the outstanding information in relation to the criminal record certificate. Discussions with staff told us they were supervised whilst their full CRB was returned. In one instance, there was further information recorded on the criminal record certificate, but the service had not conducted a risk assessment to identify any risks that may be raised as a result of this and the reason for the decision to employ the person. In two of the files only one reference had been received. Two of the files identified a full employment history had not been obtained. The service had been told about how a number of these failures did not protect people at the last inspection and a requirement made. They told us in their improvement plan they had met this requirement by September 2009. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home was based on openess and respect, but both the owner and manager need to make sure they fulfil all of their responsibilities in meeting the legislative requirements and National Minimum Standards of a registered care home to ensure the health, safety and welfare of people and staff. Evidence: On the whole, people were pleased with the service they received and spoke highly of the manager and staff. The manager had many years experience within the caring profession and was now registered with the Commission. She has her Registered Managers Award and had a good knowledge of the needs of people. Her direction and leadership promoted a relaxed and friendly atmosphere. However, the provider and manager did not responded in a timely way with their improvement plan after the last inspection, telling us how they will improve their service and meet requirements we made. It took from February 2009 until July 2009 to gain a satisfactory improvement plan, signed by the owner. A warning letter is also Care Homes for Older People Page 24 of 30 Evidence: being sent after this inspection in order to gain compliance with a previous requirement in respect of the satisfactory recruitment of staff. All sections of the AQAA were completed, but the information was insufficient in describing how the service were meeting the outcome areas in the National Minimum Standards. In the AQAA the manager told us regular audits were carried out, but didnt identify what these were. On our visit we saw that the manager had conducted a client satisfaction survey but had not collated the information from them into a plan for improvements for the service, as recommended at the last inspection. Someone was carrying out visits to the service on behalf of the owner, to determine the quality of care provided in their opinion. These were not very detailed and where they had identified action, a timescale for action was not included. People were encouraged to maintain control over their finances unless they did not want to or lacked capacity. We checked the record of financial transactions for two people. For one person the actual monies remaining did not correlate with the balance on the record. The manager was asked to audit all the records to find the discrepancy. She was also advised to check the insurance to make sure it was sufficient to cover all money that was held in the safe, as she didnt know what this was. The AQAA stated maintenance of equipment was in place for portable electrical equipment, hoists, fire detection and alarms, fire fighting equipment, emergency lighting, emergency call equipment, the heating system, premises electrical circuits and gas appliances. It also stated a contract for soiled waste disposal was in place. When we looked round the building fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. A fire risk assessment had been carried out, which meant an assessment of the service had taken place to identify action that needed to take place to safeguard people in the event of a fire. However, it didnt identify how often staff required to attending training or drills to make sure they were competent in the procedures to follow should there be a fire. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 Regulation 19, section (1) 11/01/2010 (b) Staff must not commence employment until two written references have been received and a full employment history has been obtained, including satisfactory written explanations of any gaps in employment. Previous timescale of 10/12/2008 not met. So that people are protected from harm. Care Homes for Older People Page 26 of 30 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 3 14 A comprehensive full needs assessment must take place before people are admitted. This would mean the person will not be placed at risk or not have their wishes adhered to, by the service having insufficient information. 17/01/2010 2 19 23 All parts of the home must be reasonably decorated. So that the environment is of good enough quality for people. 11/06/2010 3 19 23 The refurbishment of bathrooms, showers and toilet areas must continue. So that the environment is of good enough quality for people. 11/06/2010 Care Homes for Older People Page 27 of 30 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 4 19 16 Adequate furniture, bedding, 11/06/2010 curtains, floor coverings and other furnishings must be provided in rooms occupied by people. So that the environment is of good enough quality for people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 When a risk has been identified in a risk assessment, the action taken to reduce the risk should be transferred to the plan of care, so that staff know what they need to do to meet peoples needs in a safe way. Competency assessments should be undertaken on staff who have responsibilities for dealing with medication. This would demonstrate they were competent to undertake those responsibilities. Peoples allergies to medication should be recorded on the actual medication administration record. This would reduce the risk of people being given medication they were allergic to. Staff should be reminded that the reason they make a second signature on records is to verify the information recorded is correct. There should be a record of which member of staff is supervising a new employee when they commence duty on a POVA/ISA first check, pending receipt of the outstanding information in relation to the outstanding information on the CRB. This would demonstrate people are protected by the homes recruitment practices. Where a criminal record certificate contains information about a person, a risk assessment should take place that Page 28 of 30 2 9 3 9 4 9 5 29 6 29 Care Homes for Older People 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 demonstrates the decision to employ them and that they are safe to work with vulnerable people. 7 33 Quality assurance systems should be more robust and end in the formulation of an annual development plan, so that there is continual development in the service to improve outcomes for people. The insurance cover for the amount of money kept in the safe should be checked to make sure peoples money is sufficiently safeguarded. The fire risk assessment should identify how often staff require fire training and attendance at fire drills, so that they are competent of the action they need to take to safeguard people and themselves in the event of a fire. 8 35 9 38 Care Homes for Older People Page 29 of 30 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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