Inspection on 03/06/09 for Red Gables

This is the latest available inspection report for this service, carried out on 3rd June 2009.

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

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

Other inspections for this house

Red Gables 21/06/07

Red Gables 04/07/06

Similar services:

Snydale Care Home

Staveley Birk Leas Nursing Home

Fairmount Nursing Home

Currergate Nursing Home

Brookfield

Castlethorpe Care Home

Elmleigh Convent

Woodlands Respite Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Red Gables Parish Ghyll Drive Ilkley West Yorkshire LS29 9PR     The quality rating for this care home is:   one star adequate 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: Mary Bentley     Date: 0 4 0 6 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 30 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 30 Information about the care home Name of care home: Address: Red Gables Parish Ghyll Drive Ilkley West Yorkshire LS29 9PR 01943601113 01943602425 heather.furness@queenslandcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Queensland Care Limited care home 32 Number of places (if applicable): Under 65 Over 65 32 32 dementia physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 Red Gables provides nursing and personal care for up to 32 older people. It is situated in a quiet residential area close to Ilkley town centre. It is situated on a hill which means that people are likely to need transport if they want to have access to the facilites in the town centre. The large detached Victorian style property has been extended to provide a variety of communal areas and additional purpose built bedrooms with en-suite facilities. There are steep steps to the front door but there is also a ramp for people with limited mobility. There is level access to a patio at the back of the home where people can sit outside, weather permitting. However, the home does not have an enclosed garden and this means that some people are not able to be outside unless they are accompanied by staff. Car parking is available in the grounds. Care Homes for Older People Page 4 of 30 Brief description of the care home In June 2009 the weekly fees ranged from 460.00 to 700.00 pounds. Other services such as private chiropody and hairdressing are provided at an additional cost. More detailed information about the fees is available from the home. 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: The last inspection of this service was carried out on 17 June 2008. Since then we have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely enforcement action will be taken. This is what we used to write this report: 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 gave us some numerical information about the service. Care Homes for Older People Page 6 of 30 The results of any visits that we have made to the service in the last 12 months. We have not made any additional visits since the last key inspection. Surveys returned to us by people using the service and from other people with an interest in the service such as visiting health care professionals and staff. In total twelve people completed surveys for us. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Relevant information from other organisations. A site visit carried out over 2 days. The first day of the visit (3/06/09) was unannounced and one inspector visited the home between the hours of 4:00 pm and 8:30 pm. On the second day two inspectors visited the home between the hours of 09:30 am and 5:45 pm. During that time we spoke to people living in the home,staff and management. We looked at various records including care records,looked at some parts of the home and observed staff as they carried out their duties. What the care home does well: What has improved since the last inspection? The home has been through a unsettled time since the last key inspection. The registered manager left shortly after that inspection and another manager was appointed later in 2008. That manager left earlier this year and the current acting manager has been in post since March 2009. It is hoped that the appointment of this manager will give the home some stability and allow them to move forward with making improvements to the service. There were five requirements following the last inspection. Since coming into post the acting manager has been working to address these requirements and therefore none have been carried forward as requirements. Some have been included in this report as recommendations. Improvements have been made to the care records but there is still more work to do to make sure peoples personal and health care needs are met. Improvements have been made to the way peoples medicines are managed. People are receiving their medicines and medicines are only given to the person they are prescribed for. The way food and fluid charts are completed for people who are nutritionally at risk has improved. This means there is now a more accurate record of what people are eating and drinking. The charts showed that more attention is needed to making sure people are offered nutritious snacks outside of set meal times and this was discussed during the visit. Care Homes for Older People Page 8 of 30 There is an ongoing programme of refurbishment and the home has continued to provide a clean and comfortable place for people to live. The acting manager has started a programme of staff training to make sure staff have the skills and knowledge they need to care for people properly. 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 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move in and they are encouraged to visit the home before making a decision about moving in. This helps people to decide if the home is the right one for them. Evidence: Six people who use the service completed surveys for us. They all said they had been given enough information about the home before moving in and all said they have received contracts. We saw completed pre-admission assessments in some but not all of the care records we looked at. The acting manager told us that since she has been in post she makes sure that peoples needs are always assessed before they move in. One person told us they had come to the home for a trial stay before deciding to move Care Homes for Older People Page 11 of 30 Evidence: in permanently. They said they are pleased with the care and facilities and would recommend the home to other people. Another person said they felt the staff at Red Gables had the skills and experience to care for them appropriately, they said they had been well supported through the admission process and settling in period. The information in the brochure which tells people about the communal areas available for people to use is not very clear. This was discussed during the visit and the area manager said she is aware it needs to be changed. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall peoples needs are met. However, this is not always reflected in the care records and therefore there is a risk that needs could be overlooked. People, or those close to them, are not always involved in drawing up and reviewing their plans of care and this means that care may not be delivered in a way that takes account of peoples abilities and preferences. Evidence: Most people told us they are happy with the care and support they receive. We also received positive comments from peoples relatives. One said their relative is genuinely cared for and treated with respect and affection and another said their relative has been at the home for over a year and they feel that all her needs are met. One person said they thought staff should be more careful when helping people with arthritis to move as it can be painful. We looked at three peoples care plans. Since coming into post in March 2009 the acting manager has been working on improving the way peoples care needs are Care Homes for Older People Page 13 of 30 Evidence: recorded. The care records have an assessment of peoples needs and this is used to draw up the care plans. In most cases the care plans have information about peoples health, personal and social care needs. However, more needs to be done to make sure the care plans are accurate, up to date and provide clear instructions for staff. There was very little evidence to show that people or those close to them are involved in drawing up and reviewing their care plans. The homes own survey carried out earlier this year has identified this as an area that needs to be improved. In one persons records the daily notes stated that he was not eating very well over the past few days. There was no care plan in place to tell staff how to deal with this. In the same persons records we saw that there was detailed information about the treatment of a wound and staff told us that a pressure relief mattress had been provided. However, there was no information in the care plan to show how staff should help this person to reduce the risk of pressure damage. In another persons records we saw that they had a care plan setting out how staff should respond when they became anxious. However, during the evening we saw that this person was upset and anxious and staff did not provide support in the way the care plan said they should. In another persons records we saw that not being able to go outside unless they are accompanied by staff is creating difficulties for them. The daily notes also showed that some staff are having difficulty dealing with this. During the evening we saw that one member of staff spent a considerable amount of time with this person and went outside with them on a number of occasions. However, this meant that this member of staff was not available to provide care to other people. This was discussed during the visit. There are risk assessments in place relating to falls, nutrition and pressure sores. However, when people are identified as being at risk there are not always plans in place to show how these risks will be managed. For example, one persons records showed that they have a high risk of developing pressure sores but there was no plan to say how this risk should be reduced. During the evening we saw that some people who had been identified as being at risk of developing pressure sores were not helped or encouraged to move or change their position for long periods of time. This can increase the risk of developing pressure damage. Care Homes for Older People Page 14 of 30 Evidence: In another persons records we saw that the falls risk assessment had not been reviewed following recent falls. The home keeps a record of when people have fallen but it was not clear how this information is used to help reduce the risk of similar incidents happening again. This was discussed during the visit. The home told us they have difficulty getting access to the NHS falls prevention team and they are following this up with the Community Matron who visits. We looked at some of the food/fluid charts which are used to keep a record of what people are eating and drinking when there are concerns about their nutrition. The recording of peoples dietary intake has improved since our last visit. However, the charts showed that while people are having drinks some are not having anything to eat between the evening meal and breakfast the next day. This means that for some people there can be a gap of 15 or 16 hours between meals. This was discussed during the visit. The home told us that food is available, however it is clear that staff need to be more pro-active about offering people food outside of set meal times. Overall the systems for ordering, storing and administering medicines are satisfactory. However, there were two tablets in the bottom of the medicine trolley that had not been prescribed for anyone living in the home and the acting manager was unable to offer any explanation. The temperature in the medicine storage room was 27 degrees C when we visited. The recommended maximum temperature for medicine store rooms is 25 degrees C. The area manager said she would arrange for air conditioning to be installed. There was only one person in the home managing their own medicines. The acting manager said that people are supported to manage their own medicines if it is safe for them to do so. The care plans we looked at did not have any information about how people wanted to be cared for at the end of their lives. This was discussed during the visit. The home told us that they have arranged training on palliative care. They are also planning to introduce the Liverpool Care Pathway which is a model of good practice for end of life care. 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. The home offers people the opportunity to take part in a range of activities. However, because the home provides care for people with dementia a more person centred approach should be developed to make sure that everyone gets the support they need to make the most of their abilities and follow their personal interests. Evidence: Four of the six people who completed surveys for us said there are always activities for them to take part in if they want to. One person said the activities organiser does a first rate job. The company employs an activities organiser who divides her time between Red Gables and two other homes, one in Ilkley and one in Harrogate. She has no set times for being at Red Gables but plans events well in advance and is always around to celebrate special occasions. On the day we visited the activities organiser baked scones with some people in the morning and in the afternoon there was a visiting entertainer. People seemed to enjoy these activities. The activities organiser told us she tries to see people as soon as possible after they Care Homes for Older People Page 16 of 30 Evidence: move in to find out about their interests. She keeps records of what people have done and whether or not they enjoyed the activity. The care records also have some information about peoples social care needs. However, the social care plans we looked at did not have a lot of information about peoples individual interests. One person raised some concerns about the canal trip which used to take place every year and was cancelled this year. The home told us this was not because of funding but was due to lack of interest. They said canal trips could be organised for individuals if they wanted to go. Trips to tropical world in Leeds, Langroyd Hall and a nature reserve have already taken place and a trip to Blackpool is planned in July. Some events are organised with the companys other home in Ilkley, for example a BBQ is planned for later in June. The home provides transport to encourage people to attend these events. When we spent the evening in the lounge we saw that there was not much to engage peoples interest and staff did not have much time to spend with people. We saw that some of the people in the lounge would have benefited from staff having time to spend with them. One person said he would like to listen to the evening news but could not hear the TV, he said he didnt know why the television was on when the volume was so low that people could not hear it. Visitors told us they are made welcome and one person said as a regular visitor I am made to feel part of the residential family. There is a computer which people living in the home can use and one person has their own site on Facebook. The manager is hoping that more people will be interested in using the computer. People are supported in attending their own places of worship if they choose to and members of the Methodist Church visit the home regularly. We had lunch in the home; the meal was good and well presented. People told us that the food is always good and said they are offered an alternative if the dont like what is on the menu. Comments included I have never had a bad meal since coming to live at the home and I have no complaints at all about the quality of the meals provided. There were only seven people in the dining room at lunchtime. The manager said this is because people can choose where to have their meals but said staff do encourage Care Homes for Older People Page 17 of 30 Evidence: people to use the dining room. During the previous evening we saw that the people in the lounge stayed there for their evening meal with tables in front of their armchairs. We did not hear anyone being asked in they wanted to go to the dining room. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information about the complaints procedure and complaints are taken seriously and acted on. To make sure that people are protected and their rights are upheld the planned training on safeguarding and related subjects should take place as soon as possible. Evidence: People told us they know who to speak to if they are unhappy and know how to make a formal complaint if they need to. We have received seven complaints about the home since the last inspection, most of them between January and May this year. Five of these included concerns about safeguarding (protection of vulnerable adults) and were referred to the Local Authority safeguarding unit. The home has co-operated fully with investigating these complaints and where necessary has taken appropriate action to make improvements to the service. The home has policies and procedures to make sure people are protected. Some staff have recently attended training on safeguarding and more training is planned. Bradford Social Services run a two day training course on safeguarding for managers of care services and we recommend that the acting manager attend this training. Care Homes for Older People Page 19 of 30 Evidence: Some training has taken place on the Mental Capacity Act and the Deprivation of Liberty legislation and further training is planned. There is some information about peoples capacity in the care records however more work is needed to clarify the extent and limitations of peoples capacity. During the visit we identified some concerns about the suitability of the environment to meet the needs of one particular person. We suggested that the home arrange for an advocate to support this person. Care Homes for Older People Page 20 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 home provides a clean and comfortable place for people to live. Improvements are needed to make sure it is suitably equipped to meet the needs of the people who live there. Evidence: When we visited the home was clean, tidy and free of unpleasant odours. The general standard of decor and furnishings is good and there is an ongoing programme of refurbishment. The home told us they have submitted a planning application to put an extension at the back of the existing building. On the ground floor there is a bedroom off the main lounge. The ramp into this room is very steep and the maintenance man confirmed that it does not comply with the legal requirements. There is no lock on this room which means that the person who occupies the room and other people could be at risk of falling on the ramp. This was discussed with the area manager during the visit. She agreed to get expert advice on how to address this. Should the planning application be approved this room will be demolished to make way for the extension, however in the short term measures must be taken to reduce the risk. The home does not have an enclosed garden. This means that people who may be at Care Homes for Older People Page 21 of 30 Evidence: risk of wandering cannot go outside unless they are accompanied by staff because the home is close to a busy road. Some bedrooms and the toilet adjacent to the lounge on the ground floor do not have locks on the doors. This compromises peoples privacy. This was discussed during the visit. We saw that people have some of their personal belongings in their rooms and the majority of rooms are bright and airy. People told us they are happy with the standard of the accommodation. Comments included, my room is large enough for me to have my personal belongings on display and is kept spotlessly clean and in my opinion the accommodation is first class and the staff try hard to create a homely atmosphere. The laundry is suitably equipped but the laundry room is in need of some refurbishment. One person said there are sometimes problems with the way personal laundry is managed; they said the wrong clothes are sometimes put in their relatives room. When we looked around we checked some peoples personal clothing and did not find any problems. The home told us they are looking at ways to improve how they manage peoples personal clothing. Generally the systems for reducing the risk of cross infection are satisfactory. However, we saw some staff going into the kitchen without putting on protective clothing. This is not good practice as it increases the risk of cross infection. The home has been given a 4 star (the maximum is 5) rating by the Environmental Health Department for its standards of food hygiene and safety. Care Homes for Older People Page 22 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 are not always enough staff to make sure that peoples needs are met in a timely way. People are protected because all the required checks are completed before new staff start work. Evidence: People told us that staff are usually available when they need them and said staff usually listen to them and take notice of what they say. People said the staff are friendly and caring, one person said they greet you with a smile and ask how you are. There are usually 5 staff on duty in the morning, until 2:00 pm, a nurse and 4 care assistants. In the afternoon and evening there are usually 4 staff, a nurse and 3 care assistants. Overnight there are 3 staff, 1 of whom is a nurse. During the week, (Monday to Saturday) there are housekeeping staff on duty and from Monday to Friday there is a laundry assistant. When these staff are not on duty care staff are responsible for housekeeping and laundry. There is a cook on duty everyday until mid afternoon, usually 3:30 pm during the week and 2:00 pm at weekends. Outside of these times care staff are responsible for organising meals. This reduces the amount of time care staff have to spend with people either giving Care Homes for Older People Page 23 of 30 Evidence: care or just sitting and chatting. A number of people in the home have dementia which means they may not always be able to articulate their needs clearly. Staff need to be available to make sure this group of people get the support they need to meet their needs and occupy their time meaningfully. On the first day of this inspection we arrived at the home at approximately 4:00 pm and spent a lot of the evening in the lounge observing what life is like for people living in the home. During that time we saw that staff spent very little time with people in the lounge. When staff did come into the lounge it was nearly always to do a particular task such as collecting cups. They usually had a brief word with one or two people and then left. During this time one person was upset and would have benefited from some support from staff. As the evening went on this person continued to be upset and this in turn upset other people. Some people who were able left the lounge to go to their rooms. Others were unable to leave and by the time the night staff came on duty one person was shouting for staff to take her to her room. We looked at 3 staff files and they showed that all the required checks are done before new staff start work. This includes two written references, PoVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) checks. Staff told us that they were not allowed to start work in the home until their CRB checks had been returned. We saw records of induction training for new staff. Three staff who completed surveys for us said the induction training they received when they started work covered most of what they needed to know to do the job. In their self assessment the home told us that 2 care staff have achieved an NVQ (National Vocational Qualification) in care at Level 2 or above. They plan to provide more NVQ training in the next 12 months. Since coming into post the acting manager has been working to make sure that all staff are up to date with mandatory training such as moving and handling, fire safety and First Aid. Training has also been provided on dementia care and more training is planned on subjects such as palliative care and nutrition. Care Homes for Older People Page 24 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. More needs to be done to make sure that people experience good quality outcomes across all areas of the service and the new management team are clearly committed to achieving this. Evidence: There have been a number of management changes since the last inspection. The new acting manager has been in post since March 2009. She has not yet applied for registration with the Commission. She is a nurse with many years experience caring for older people. She does not have much management experience; however she is being supported by the area manager who visits the home several times a week. Staff said the acting manager is approachable and supportive and said they have seen improvements in the service since she started. The home sent questionnaires to people using the service in March this year. Care Homes for Older People Page 25 of 30 Evidence: Approximately 60 were returned and these showed that people are generally satisfied with the service. For example everyone who replied rated the choice and presentation of food as excellent or good. People also identified areas where they felt improvements could me made, these included, involvement in care planning and the quality of the laundry service. The home told us they have monthly meetings for people using the service. However, the notes of recent meetings were not available, the most recent record available related to a meeting held in September 2008. When we visited last year we were concerned that some of the issues talked about in these meetings were not being passed on to the manager to deal with. The acting manager assured us that she is made aware of what is discussed at these meetings and said she has attended some meetings. However, without records it is difficult for the home to show that they are listening to people and acting on what they say. The home does not get involved in dealing with peoples finances and does not hold any personal money for people. Any additional services that are provided are charged for on the monthly invoices. The self-assessment completed by the home indicated that all the required maintenance and servicing of equipment is up to date. The records we looked at confirmed this. Care Homes for Older People Page 26 of 30 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 27 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 7 15 Everyone living in the home 28/08/2009 must have a care plan which sets out in detail how their personal, health and social care needs are to be met. The plans must be kept up to date to reflect changes in peoples conditions and there must be evidence that people or their representatives are involved in planning and reviewing care. This is to make sure that all peoples assessed needs are met and to make sure that care is delivered in a way that takes account of peoples abilities and preferences. 2 19 13 Appropriate measures must be taken to provide safe access the bedroom off the lounge. To reduce the risk of people being injured. 31/07/2009 Care Homes for Older People Page 28 of 30 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 1 The brochure should be changed to make sure it gives clear and accurate information about the communal areas available for people to use. When people are identified as being nutritionally at risk they should be offered nutritious snacks outside of set meal times. Appropriate arrangements should be made to make sure that the temperature in the medicine store room is maintained below 25 degrees C so that medicines can be stored properly. A more person centred approach to social care should be developed to make sure everyone living in the home gets the support they need to follow their personal interests and make the most of their abilities. Staff should encourage people to go to the dining room for meals. In addition to the social aspect people will benefit from moving around the home and sitting in an upright position to eat can help with food digestion. The acting manager should attend the safeguarding training provided by Bradford Social Services. There should be a safe outdoor area so that people are able to go outside without the need to be accompanied by staff at all time. Records of meetings for people using the service should be kept along with a records of any actions taken in response to suggestions, issues or concerns raised by people in these meetings. So that the home can demonstrate it is listening to people and acting on what they say. 2 8 3 9 4 12 5 15 6 7 18 20 8 33 Care Homes for Older People Page 29 of 30 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. 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