Inspection on 11/08/09 for Rosa Freedman Centre

This is the latest available inspection report for this service, carried out on 11th August 2009.

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

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

Other inspections for this house

Rosa Freedman Centre 19/10/06

Rosa Freedman Centre 16/02/06

Rosa Freedman Centre 13/09/05

Rosa Freedman Centre 17/01/05

Rosa Freedman Centre 13/09/04

Similar services:

Spinney (The)

Queen Elizabeth House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

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: Rosa Freedman Centre 17 Claremont Way Cricklewood London NW2 1AJ     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: Duncan Paterson     Date: 1 1 0 8 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 27 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 27 Information about the care home Name of care home: Address: Rosa Freedman Centre 17 Claremont Way Cricklewood London NW2 1AJ 02084580591 02087316174 manager.rosafreedman@freemantletrust.org www.fremantletrust.org The Fremantle Trust care home 18 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Limited to 18 adults of either gender who fall into the category of old age (OP) and who may have dementia (DE(E)). Date of last inspection Brief description of the care home The Rosa Freedman Centre is a care home registered to provide care for 18 older people, some of whom may have been diagnosed with dementia. One of the places is used to provide respite care. The home is part of a complex that includes a day centre and a sheltered housing scheme. Barnet Council used to run the complex and The Freemantle Trust and Catalyst Communities Housing Association have now respectively taken over responsibility for the care and property services in the residential home and day centre. The local authority retains responsibility for the sheltered housing scheme. The care home was purpose built in 1989. There are two nine-place units with identical accommodation on the ground and first floors. Stairs and a passenger lift link the two units. Both units have nine single bedrooms, a kitchen/diner linked to a lounge, a separate lounge, a bathroom, a shower room and four toilets. The general Care Homes for Older People Page 4 of 27 0 0 Over 65 18 18 Brief description of the care home staff facilities are on the first floor and the main kitchen/restaurant serves the home and day centre and is situated on the ground floor. There is a pleasant, accessible garden to the rear of the home. The Rosa Freedman Centre is in a quiet road next to a park. Local shops are nearby as is the Brent Cross shopping centre. There are good transport links. The stated overall aim is to provide a high standard of care and support that is tailored to meet individual needs taking into account each service users right to exercise choice and self-determination in pursing their own lifestyle. Care Homes for Older People Page 5 of 27 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: This inspection took place on 11 August 2009 and was carried out by the lead inspector and a pharmacy inspector. The inspection was unannounced. The inspection involved spending time in the two units of the home talking with residents and staff and inspecting care plans. Senior staff and the manager were also spoken with and a range of the homes records, procedures and certificates were also viewed. The pharmacy inspector inspected the arrangements made for the safe handling of medication. We received nine surveys from residents and four surveys from staff. Two relatives were spoken with on the day of the inspection. The home sent us their Annual Quality assurance Assessment (AQAA) and this was taken into consideration. The manager is new and had just taken up the post in July 2009. She had transferred to this home from one of the other Fremantle Trust care homes in Barnet. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: There were many positive features identified at this inspection. Overall, the standards were good with examples of good practice in each area. The main area needed for improvement is that of medication management. In the main, medication was being properly managed. However, there is a need to review the ordering of medication as we found that one residents medication had run out. Similarly, there is a need for the regular auditing of medication to make sure that safe handling is maintained. We found that a medication error had taken place and care needs to be taken in the future. These matters are serious and a letter has been written to the home requiring details of the actions taken to put these matters right. Other improvements needed include the need to provide additional activities input for residents. Currently, care staff have sole responsibility despite the fact that there is a budget for an activities organiser and that the Fremantle Trust have planned for some Care Homes for Older People Page 7 of 27 time to resource their Barnet care homes with activities staff. Similar Fremantle Trust corporate initiatives should lead to improvements when they are introduced. These are within care planning where a new care planning system is to be introduced and staff training where a new computer package is available. 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 8 of 27 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 9 of 27 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. Detailed and attractive information about the service is available. Assessment information is comprehensive and allows a detailed picture of individual residents and their needs to be drawn up. Evidence: The statement of purpose was reviewed in August 2009 and the service users guide was dated 3 April 2009. Both were on display in the entrance way to the home. Both provide a wealth of detail about the home and the service provided and both are attractively presented with use made of different fonts and photographs. Both provide residents, relatives and others with a good, clear description of the service. Two of the residents spoken with said that they had chosen this home either because it was near to where they used to live or because they liked the small size and atmosphere. There were many positive comments from residents about the service either made to us in person or via surveys returned to us after the inspection. The Care Homes for Older People Page 10 of 27 Evidence: following comments were typical. Staff are wonderful. The carers are very good. I am happy about the care provided. We get everything we need. We were able to talk to some of the residents in detail about the care they received. Although there was much praise for the home and the staff there were some areas identified where improvements were needed. For example, one resident felt that not all staff understood her specific health needs which affected the overall quality of the service. However, another resident said that staff understood her needs very well and that understanding was a source of comfort for her. A relative, although overall happy with the care provided, felt that more progress was needed to obtain equipment for his relative. This had been raised with the manager who was addressing the matter. None of the residents were new to the home. However, a sample of four care plans were inspected to look at the assessment and care planning arrangements. There was evidence that residents needs had been properly assessed before they moved to the home. There are a set of standard forms for each resident which record their needs including details of health needs and their life story. These forms are added to through receipt of local authority assessment information where residents are funded through the local authority. There was evidence that the home has identified and considered residents individual preferences. These were set out on assessments and care plans and staff were able to describe how they assisted residents. For example, one resident is assisted each week to attend church. Another resident was encouraged to attend the day centre and eat meals there. There was great satisfaction expressed from many of the residents about how they were helped by staff. One resident said that being assisted to sit in the garden with her friend meant a great deal to her. The AQAA provided by the home set out the ways in which equality and diversity was being addressed. This included working with individual residents to best consider religious, cultural and ethnic needs as well as assist residents to take a role in the community. There was evidence that residents were being encouraged to use community facilities. Staff took residents out of the home where possible. Care Homes for Older People Page 11 of 27 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. Care planning is overall well organised and the manager is reviewing care plans so that there is consistency and that all objectives and assessments are updated. There are good arrangements for providing residents with privacy and dignity. Medication arrangements are will organised but checks are needed to make sure that residents medication does not run out and is administered accurately. Evidence: Four care plans were inspected to assess the care planning arrangements. Overall, the standard of care planning was good although there was some unevenness where not all risk assessments had been completed or dated. The manager advised that she had been reviewing all care plans since she started work at the home and that process was not complete yet. However, care plans had been reviewed and where this had taken place they were well ordered and clear. In addition to this, the Fremantle Trust organisation plans to introduce new corporate wide care plans. There has been a pilot project to test the new care plans. When introduced, these new care plans should streamline the paperwork involved and make Care Homes for Older People Page 12 of 27 Evidence: care planning easier to manage. The care plans seen, although slightly variable, provided detailed and relevant information about residents needs and how staff should care for them. The care plan objectives were being reviewed monthly and there were a range of risk assessments, including manual handling, skin assessments and nutrition. Details of leisure and interests were also provided. There were also local authority review notes, where applicable. Health care needs were similarly detailed including details of records of consultations with the GP or other health care professionals. The manager also keeps separate records as to when residents sees GPs so that she can use these to monitor progress with staff. There were also records of accidents on individuals files. There was evidence that attention had been given to residents privacy and dignity. Staff were observed to work with residents discreetly and sensitively and residents had been assisted to obtain equipment such as special beds and chairs. Even though one resident said that she had paid for a bed herself. We looked at the safe handling of medication in both units. The medication administration records (MAR) were inspected to see if records for the receipt, administration and disposal of medication were complete. We observed medication being given and looked at storage and a sample of three care plans. We noticed that medication was being given professionally and with gentle encouragement and that the MAR was signed after administration. The MAR were well completed with receipts entered and balances of medicines carried forward from one cycle to the next. There were overall no omissions in the records. We counted many of the packs of medicines which were not in the monitored dosage system and with the exception of one all could be reconciled with signatures for administration. There was good practice of keeping medication profiles and protocols for how to give as required medicines. Further work could be done on keeping the former up to date and recording accurately the variable dose if required. For example, one or two. This also enables the prescriber to review the medication appropriately. We noticed that a medicine was out of stock for one resident. Not enough time had been allowed to reorder it to maintain a continuous supply. We also noticed that staff did not know the drug name and brand name of a drug and had given the medicine twice for five doses. Care Homes for Older People Page 13 of 27 Evidence: Storage was good and secure in the home. The homes medication policy was missing from its folder in both units. The new manager was in the process of updating care plans including risk assessments for self-medication. We were able to track dosage changes of medication to the records of doctors visits in the care plans. We noticed that some residents were able to visit the doctors surgery for medication reviews and for others the GP visited the home. Two residents required injections and the district nurse visited to give these. Both had care plans detailing the reasons for the injections and how to manage the medical conditions. Overall, therefore, we were satisfied that residents were receiving their medication as prescribed and that their health needs were met. It was disappointing therefore to note a repeat incident where there was no supply of medication over a weekend for one resident and that five doses were doubled in error. We have written to the Fremantle Trust warning them that this is a failure to meet The Care Homes Regulations 2001 and requiring them to produce an improvement plan as to how they are to address this matter. Care Homes for Older People Page 14 of 27 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. Staff currently do well to provide residents with activities and day-to-day support. This can be improved through the provision of support to staff through an activities organiser or equivalent. Food provision is well organised and the planned nutrition audit can lead to greater awareness of residents preferences and overall quality of provision. Evidence: Since the last key inspection of 11 September 2007 the staffing levels have been increased and this has had a beneficial knock on effect for activity provision. However, there is still no activities organiser in post which means that currently the primary role for providing activities lies with care staff. The Fremantle Trust plans to provide a team of activities staff who will regularly attend each of their care homes providing activities input. Until that time the manager advised, there is a budget for an activities person at the home although there is currently no one in post. It is recommended that interim arrangements are made to provide activities organiser input to the home so that staff can be supported in their work. Care Homes for Older People Page 15 of 27 Evidence: The manager advised that she had introduced the following since she started work at the home. There is a staff duty system where staff are assigned time during their shift to provide activities. A room has also been set aside for one-to-one activity provision. A member of staff spoken with referred to the new duty system and said that it was helpful and that staff knew what they were doing each day. There were activities in progress during the inspection. Residents were playing a board game, or spending time relaxing in the garden, having visitors or attending the day centre. We were told that there had been trips out of the home as well as a BBQ planned and that staff regularly took residents out of the home. Residents expressed satisfaction with life at the home and the way staff helped them. The serving of lunch was observed in both units. There is a main kitchen which provides food for the day centre as well as the care home. Meals are brought up to the units in heated trolleys from which staff serve residents. The meal was served calmly and carefully with staff helping a small number of residents to eat in a sensitive manner. The majority of residents ate their lunch at the set tables. There was a pleasant, warm , friendly atmosphere with residents appearing to enjoy the meal. Staff were knowledgeable about any special diets and the specific needs and wishes of each resident. The Frematle Trust are to carry out a nutrition audit in each of their care homes this autumn. Residents are to be asked for feedback as part of this process. This will assist with building knowledge about residents wishes. There had been some adverse comments about the food provided at this home earlier this year. The audit should allow the manager to be informed as to any issues and therefore make plans to address them. No adverse comments were received during the inspection. The kitchen was visited during the inspection. The catering staff prepare breakfast and lunch and support the preparation for supper. The care staff will also assist in the preparation of supper in the units and will wash up dishes after meals. The kitchen had been inspected by Barnet Councils Environmental Health service in 2008 and awarded five stars, which is the highest score available. The kitchen staff felt that arrangements for them were overall good but possible improvements included the redecoration of the kitchen and provision of air conditioning. Redecoration can be considered during the overall decorative improvements works which are currently ongoing at the home. Care Homes for Older People Page 16 of 27 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. The complaint and safeguarding arrangements are suitable with staff at the home able to respond appropriately to complaints and to incidents or allegations of abuse. Evidence: The record of complaints for the past year was viewed. These are contained in a file entitled, Fremantle Feedback, which contains details of all complaints as well as complimentary letters and cards. There was evidence that the complaints received had been properly investigated and responded to. One had lead to a local authority safeguarding meeting which allowed greater depth in the complaint investigation. Information as to how to make a complaint about the service is on display in the home as well as contained within the statement of purpose and service users guide. The safeguarding arrangements include a policy and procedure as well as training for staff. The staff spoken with demonstrated an understanding of safeguarding matters and what to do should there be an incident or allegation of abuse. There is literature in the home about the new Deprivation of Liberty safeguards as well as training opportunities for staff. Care Homes for Older People Page 17 of 27 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. Good physical standards are provided. The home is clean, attractive and welcoming with each resident provided with a bedroom of a good size. The home is well equipped for people with disabilities with a passenger lift as well as equipment to assist mobility. Evidence: A pleasant, welcoming environment is provided. The care home shares the building with a day centre which means that there is some additional space for residents and opportunities to attend the day centre. There are two units (one on each floor) both with dining, kitchen and living space as well as an additional lounge. There are assisted bathrooms and a passenger lift connecting the two floors of the home. There are also mobile hoists available. Each bedroom is single and of a large size. A number of bedrooms were visited in order to talk with residents. The bedrooms seen had been personalised for each resident and some having brought in their own furniture and possessions. There is a pleasant garden to the rear of the home which provides a variety of sitting space for residents including some shady areas. We noticed that work was being carried out to decorate and improve the home. New furniture was provided in one lounge, for example. Not all parts of the home had been upgraded. The manager advised that there was programme of redecoration but that Care Homes for Older People Page 18 of 27 Evidence: the work was not yet complete. The laundry was visited. There are two washing machines and one dryer. The laundry worker said that she worked between 8am and 2pm and that care staff assisted outside those hours. The laundry worker has worked at the home for many years and brings experience and flexibility to the role. Care Homes for Older People Page 19 of 27 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. The increased staffing levels have improved the service for residents. Staff now have more time to spend with residents. Recruitment is carried out thoroughly and the introduction of a computer training package to record and analyse staff training details will improve the service and allow the manager to keep up to date with staff training needs. Evidence: The staffing levels have been increased since the last key inspection. There are now two staff on duty in each unit throughout the day. A number of the care staff in the units were interviewed and the overwhelmingly view was that the increase of staff was very beneficial with staff now having more time to spend with residents. In addition to the care staff there is a duty senior officer always on duty throughout the day. This person takes the lead in addressing overall issues at the home as well as monitoring staff and care for residents. The manager is also present as well as administration, catering, cleaning and maintenance staff. A sample of three staff files were inspected to check recruitment. These were the files for newly appointed staff. The files seen showed that staff had been recruited properly. There was evidence that identification had been obtained, that a Criminal Records Bureau check had been obtained and that two references had been received. Care Homes for Older People Page 20 of 27 Evidence: The manager said that she had been auditing staff records to determine whether the required visa checks (if required) had been obtained. This work is ongoing as it is not yet complete. The staff training records were inspected. These are detailed and include records of each training course provided as well as a list of all staff who had attended the training. In addition, there are records of each staff member and an individual profile for each staff member. These records are well organised and will be even better when the new Fremantle Trust computer training records are introduced. The manager said that the computer package is available but that the data needs to be transferred. Once this has been completed a tool will be available to the manager where staff training profiles can be more quickly found and used. The AQAA returned to us reported that 10 of the 15 care staff have completed at least level 2 NVQ qualifications. Care Homes for Older People Page 21 of 27 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 new manager has had immediate effect with staff and residents saying that there has been an improvement at the home. There are systems in place for quality assurance which help to demonstrate that residents views and opinions are taken into consideration. There are also effective systems in place to ensure that a safe, well maintained environment is provided. Evidence: The manager is newly in post although she comes form another of the Fremantle Trusts care homes in Barnet where she had been the manager for a number of years. She brings considerable management expertise and experience to this post and has made an immediate impact. A number of the staff and residents reported that the new manager was very supportive, resident orientated and had made improvements in the few weeks she had been at the home. Some staff stressed the teamwork that had been stressed and that staff were working well as a team. The new manager will need to apply to us for registration but that should be relatively straightforward as she has been a registered manager for some years now. Care Homes for Older People Page 22 of 27 Evidence: The quality assurance arrangements and systems were discussed with the manager. There are a number of initiatives including the regular inspection visits to the home by senior managers (Regulation 26 visits). Copies of these were seen. Also seen were records of monthly audits completed by the manager which record data about the service provided including complaints, accidents and residents. The report of an annual quality audit was also seen. This was a recent report dated 6 July 2009. This report provided evidence that surveys had been carried out with residents and others interested in the home such as GPs. The audit found largely positive findings and noted that there had been excellent feedback from residents. A sample of records was inspected relating to money being looked after for residents. It was difficult to completely follow the arrangements made as the homes administrator had left for the day when these records were examined. However, there was sufficient evidence to show that there were relevant systems in place to track residents money both in and out of the residents account. Residents have their money looked after in a joint residents account unless residents have their own bank accounts. Staff supervision records were inspected. The new manager said that she had only completed one supervision session so far since she had started and planned to do more. The arrangements are that the manager supervises senior staff as well as the heads of support staff such as the chef. Senior staff supervise care staff. A sample of supervision records were inspected. Generally, the frequency of supervision was good with records available for regular sessions. One member of staff said that more frequent supervision would help. The manager will be able to look at staff supervision and retain an overview so that she can tell whether staff are being provided with regular supervision. The health and safety records, fire safety and maintenance records were inspected. These were all available and provided evidence that equipment was being maintained and that the fire system was subject to regular checks and that fire drills were being carried out regularly. This information is held within a number of different files in the office and some was difficult to find. In addition, there was no certificate for the servicing of the lift although there was a log to show that the service had taken place. The manager said that she will bring all this information together for ease of reference. Care Homes for Older People Page 23 of 27 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 24 of 27 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 The home must review its ordering procedures so that continuous supplies of medicines are kept for all residents. This is so that they can be given as prescribed to maintain the health of residents. 04/09/2009 2 9 13 The home must carry out regular audits of medication to ensure safe handling. This will ensure that medicines are correctly transcribed on the MAR, that drug names are clarified if necessary, that medicines are recorded accurately when prescribed as a variable dose and that reasons for not giving can be identified. 04/09/2009 Care Homes for Older People Page 25 of 27 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 9 The medication profiles should be kept up to date so that care staff know which medicines are current and which have been discontinued. Work should continue to provide residents with an activities organiser or equivalent. Transfer staff training records to the new staff training computer package. 2 3 12 30 Care Homes for Older People Page 26 of 27 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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