Inspection on 11/05/09 for Selena House Nursing & Residential Home

The manager, Mrs Cain has worked hard to improve services to residents since she has been in post. Residents receive detailed pre admission assessments, so that they can be assured that the home can meet their needs. Staff were observed to be particularly sensitive when looking after people who had additional mental health care needs. Mrs Cain has put systems in place to ensure that staff are trained in their roles and know what is expected of them. All residents and their relatives spoken with expressed their appreciation of the care provided. One person reported, "the manager is really good", another relative reported that, "the staff are very kind and helpful" and a resident said "I am very happy here".

What has improved since the last inspection?

At the last inspection, eight requirements and seventeen recommendations had been identified, these have been met. the most significant improvement being the redecoration and new furnishings in the home.

What the care home could do better:

The service user guide requires more detail to give best quality information to prospective residents. the care plans need to be further developed so they are are more person centred and the end of life planning could be enhanced. registered nurse training records need up dating to demonstrate continuing best nursing practice. load handling risk assessments and plans need more detail and the home would benefit from a person having a higher level of competence in this area.

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Key inspection report Care homes for older people Name: Address: Selena House Nursing & Residential Home 192 Oxford Road Stratton St Margaret Swindon Wiltshire SN3 4HA 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: Andrew Pollard Date: 1 1 0 5 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 28 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 28 Information about the care home Name of care home: Address: Selena House Nursing & Residential Home 192 Oxford Road Stratton St Margaret Swindon Wiltshire SN3 4HA 01793822982 01793822982 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Yogindrananth Abhee care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: No more than 2 persons in receipt of terminal care at any one time No more than 2 physically disabled persons at any one time No more than 20 service users in receipt of nursing care at any one time. Date of last inspection Brief description of the care home Selena House is registered to provide nursing and care. It accommodates up to 28 people over the age of 65. On the day of the site visit, there were 23 residents in the home. A registered nurse is on duty at all times supported by care assistants. Support services include catering, domestic, laundry and maintenance staff. Fees are currently #359.32 to #630 per week. Accommodation is provided on two floors. Residents? rooms do not have en-suite facilities, but all rooms have wash hand basins. The main sitting room and adjoining dining room are situated on the ground floor of the building Care Homes for Older People Page 4 of 28 0 2 2 Over 65 28 0 0 Brief description of the care home and there is access to a large garden to the rear of the home. Selena House is located in a residential area of Stratton St Margaret, on the outskirts of Swindon. All local amenities are a short drive away. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. As part of the inspection, four internal survey forms were collected, Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the homes file was reviewed and information provided since the previous inspection was considered. An annual quality assurance assessment was collected on the day of inspection. The site visit took place on 11/05/09. The proprietor and manager were present during the inspection. Care Homes for Older People Page 6 of 28 During the site visit, we met with 3 residents, five visitors and observed care. We reviewed care provision and documentation in detail for several residents. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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 28 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 28 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. Prospective clients and their families are given relevant information and terms and conditions in written or verbal form about the home to assist them in deciding if the home is suitable for their purpose. As a result of effective assessment of needs prospective residents can be confident that needs will be met in a manner to suit the individual. Evidence: Selena House has a statement of purpose and a residents guide to inform people of services offered. Visits by prospective residents to the home are encouraged either for the day or perhaps for lunch dependent on their wishes. The residents guide is available in all rooms and in the main office. A copy of the current inspection report is available to the public in the foyer so that people are fully informed of the homes response to the inspection process. The residents guide does include a copy of the homes contract. The contract has been revised, particularly where residents are in Care Homes for Older People Page 10 of 28 Evidence: receipt of nursing care, so that it conforms to regulations. The statement of purpose has been revised in some areas however it continues to need some revision in certain aspects to fully inform people of services provided. We discussed the fact that they should include the categories of people they were able to care for in the home and the admission criteria. Whilst the home is able to admit people for terminal care and information on how the home is able to meet the complex needs of such people should be detailed in the statement of purpose. Selena House does not admit people for intermediate care. The manager Mrs Cain aims to meet with every resident prior to admission and completes pre-admission assessments. A procedure is in place for emergency admissions. Assessments of a persons needs are drawn up promptly after admission and detailed information gathered from significant other persons involved in their care before admission. All of the residents are older people and are of white UK ethnic origin. The AQAA does not indicate any residents with particular needs related to sexuality. Individual assessments ensure that any specific needs i.e. spiritual and cultural are identified and included in the care support plans if need be. Care Homes for Older People Page 11 of 28 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 plans detail residents care needs, are clearly written and give directions to staff. End of life planning and a person centeredness approach needs further development to enhance quality of care for residents. Appropriate personal and nursing care is offered to residents to maintain residents health, well being and dignity and residents are treated with respect and given choice in how needs are met. Proper arrangements are in place for residents to access health care services and for the administration of their medication to maintain or improve their quality of life. Evidence: Residents have assessments of need drawn up, including manual handling, pressure sore risk and dietary needs. Where a care need is identified, care plans are put in place to ensure that they are met. Care plans seen were in general clearly written and detailed and reflected the care that was provided in practice. Care are clear about different residents needs. It is accepted that the intention is to develop care plans with greater emphasis on a more person centred, holistic approach in the coming year. There is an aim to better Care Homes for Older People Page 12 of 28 Evidence: involve family in the care planning and review process, which will support this. It is suggested that each resident has a biography written and a person centred assessment of their wishes, likes and dislikes which will be at the centre of the service offered to provided more focus on the holistic and social model of care. This will supports peoples health and social needs including, psychological, emotional, and cultural needs and can demonstrate that the home puts residents wishes first. There is evidence of this approach being introduced in the care plans reviewed. In support of this the senior staff will need training in the application of person centeredness and the Mental Capacity and the Deprivation of Liberty Acts as a number of residents have advancing levels of dementia. A record of resident wishes in the event of death is made and it is intended to expand this. Formal end of life Care Plans are to be established in the home whereby residents and relatives are encouraged to think ahead about the care they would like to receive if their health deteriorates. Documents relating to advanced directions will require a mental capacity assessment to be carried out which support the direction. The manager is making enquiries about accessing training in this field and the Gold standard training and documentation, which will further enhance end of life care. Regular evaluations of residents care plans were taking place although this seems to be a generalised statement about all care plan elements. The intention is that named nurses will conduct an annual reassessment and care plan rewrite, which could be linked to Social services, review and involve residents, and relatives. The care plan documentation is changing so that individual care plan elements can be written and evaluated monthly on the rear of the document. Where the home cares for very frail people who are not able to look after themselves, there was evidence that the needs of such people were met, with full documentation relating to changes of position, drinks and meals offered. A full range of equipment to prevent pressure damage was provided and correctly used. There was evidence of consultation with relevant health care professionals, including the community matron, GPs, mental health team and district nurse. Where a resident had more complex needs, such as oxygen therapy or an indwelling urinary catheter, the manager had set up systems to ensure that such matters were fully documented. All medicines were safely stored and there was an audit trail of medicines brought into the home, given to residents and disposed of from the home. It was advised that as surplus medication is taken out of use it is documented in the disposal book at that time not later. Some people were prescribed medications on an as required basis. Care Homes for Older People Page 13 of 28 Evidence: Where this is the case the GP should provide clear directions to staff on what the indicators are for these drugs to be given and the maximum dose to be given in 24 hours. Where a resident is prescribed a variable does of a drug, the number given was not consistently documented and this must take place. Staff showed a positive attitude to their roles and responsibilities ensuring they provide quality of care to the residents. Residents were appropriately dressed and in their own clothes and well groomed. Staff were observed to ensure that residents rights to privacy were upheld. Residents and relatives spoken with supported this view. There was a warm cheerful atmosphere in the home. The staff, resident interactions were respectful and caring. Where a resident showed distress, staff quickly observed this and the person supported. Care Homes for Older People Page 14 of 28 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. There is provision of meaningful recreation for residents to enhance individuals quality of life. Residents are supported in exercising choice in their daily lives and social activities. Mealtimes offer choice of food that residents enjoy and they are supported to eat their food if need be. Evidence: The home has employed an activities coordinator five days per week, she provides individual or small group activities, which were suited to the peoples needs. A weekly programme of activities is on display. The coordinator maintains records of activities, which have been provided. These show a range of different approaches, to meet the different needs of residents in the home. From time to time entertainers visit the home. In the past trips were arranged but at present the dependency levels of the residents are such that it is not viable. As well as the activities coordinator, staff regarded meeting residents social care needs as part of their role. Most residents spent most of their time in the sitting room and it was observed that there was always a number of staff present in the room as well as the activities coordinator. Care Homes for Older People Page 15 of 28 Evidence: The manager regards maintaining contacts with peoples families a key area of care provision. The visitors book showed that a range of people visited the home and several different visitors were seen and spoken to throughout the inspection. Relatives with said they were kept up to date with issues relating to their relative. A suggestion was made that the resident and relative forum be combined, as there may be a limited number of residents who can fully participate. The manager is going to ask the activity organiser to chair most of these meetings. Staff work hard to support residents in exercising choice. Resident can choose bed and rising times and are free to have meals in their rooms if they wish. Choice of meals and drinks are offered. All residents were left with access to drinks. Residents and relative considered the quality of the food to be good. Currently there are no residents with specific cultural or religious needs other than those of a Christian background. At present services previously run by the local churches including hymn singing and Holy Communion are not taking place, the manager is to enquire with local clergy if this facility could be reinstated or some pastoral visits take place. Care Homes for Older People Page 16 of 28 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. There are policies in place to protect residents, investigate complaints or manage allegations of abuse. Arrangements are in place for staff training in these matters so residents can feel safe and have their concerns dealt with. Evidence: The home has a complaints procedure, which is available in the Service users guide and on display. The manager was aware of her responsibilities under the complaints procedure. All of the people who responded reported that they knew how to make a complaint. We have received no complaints since the last inspection. The home has a policy and procedure on the protection of vulnerable adults, this complies with national guidelines. However, the Local Authority No Secrets document was not available and the manager is to acquire a copy. Records showed that about half of the staff have been trained in the adult protection in the last twelve months, training for the remainder is being booked. No safeguarding adults referrals have needed to be made. Care Homes for Older People Page 17 of 28 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. Residents benefit from a safe and well maintained clean environment with good furnishing and decor, their needs are met by having bedrooms and communal rooms and facilities, which are suitable for their purpose. Evidence: The home employs a maintenance man. He reviews all areas of the home each day, changing light bulbs, and other such small matters and performs gardening, painting and decorating as needed within his available hours. He was observed carrying out his duties during the inspection. The home has one large sitting room, with an adjacent dining room. There is a large garden to the rear of the building. Most of the rooms are single, with a few double rooms. All double rooms are provided with screening. There is an assisted bathroom on each floor. All residents in their own rooms had been left with access to the call bell system. Much of the home has been redecorated and attention paid to floor coverings. Chairs in the communal areas have been replaced. Bathrooms and toilets were clean and adequately equipped, some new commodes have been provided in rooms. A range of equipment is provided for people with complex needs including variable height beds some of which are fully profiling. Hoists are provided to aid manual handling with a range of slings. Equipment to prevent pressure damage is provided, Care Homes for Older People Page 18 of 28 Evidence: including air mattresses and air cushions. All areas had single use methods of hand washing and drying to prevent risk of cross infection. All areas inspected were clean and free of dust and debris, including under easy chair cushions bar one. The home has two sluice rooms, one of which has a washer disinfector for bedpans and urinals. All laundry is performed in house laundry is separated at source, staff using colour coded bins to reduce the amount of handling by staff and thereby reduce risks of cross infection. Care Homes for Older People Page 19 of 28 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. Recruitment procedures and evidencing Criminal Records Bureau disclosures are in place to make ensure suitable staff are recruited to care for residents. There are sufficient numbers of staff to meet residents needs. Progress is being made training care staff but Registered Nurse training needs more fully need to be addressed for the benefit of residents. Evidence: The home employs registered nurses, care assistant and ancillary staff. Nursing and care staff are on duty throughout the 24-hour period. In the morning 5 care staff and 1 Registered Nurse are on duty and the activities coordinator. In the afternoons there are 3 or 4 care staff and 1 nurse on duty. At night there is 2 carers and 1 RN, all are waking. The manager has a number of supernumerary hours in the afternoons, Monday to Friday. The manager reported in the annual quality assessment that agency staff were not used. Staff turnover has been low. The home does have the benefit of a small staff bank. Staff will cover for each other in the event of annual leave or sickness. The manager considers all staff to be committed to their roles and aware of residents individual needs and that morale is high. There are sufficient staff employed to provide catering, cleaning and laundry duties. Care Homes for Older People Page 20 of 28 Evidence: Mrs Cain is keen to develop her staff, she ensures that all new staff undertake an induction programme. The programme conforms to current guidelines. Where staff are employed whose first language is not English, she enrols them in an appropriate course at the local college. Following this they commence National Vocational Qualifications, Currently five staff have level 2 and four others on programmes. All care staff have individual training records. These show the range of training opportunities offered. We discussed the need to maintain a record of Registered Nurse clinical learning and updating as a way to ensure their continued fitness. The manager intends to do this as part of the supervision process. Only one member of staff has been recruited since the last inspection whos records were in order. At the last inspection it was written that files relating to newly employed staff were reviewed. These showed that all staff provide an employment history and complete a health status questionnaire. All staff have police checks and have two references taken up. Staff are supervised after they have completed their induction and any issues followed up at that time. We met with one newer member of staff who reported that they had found their induction helpful. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is making progress in consulting with and getting the views of residents about the quality of care provided in the home so that they have their say in how the home is run.Staff supervision is taking place and appraisal is planned, which should lead to improvements in residents quality of life and development of staff skills in care. The health and safety of those who live and work in the home is essentially managed and promoted well. Evidence: The manager, Mrs Cain is an experienced registered nurse who has completed a level 4 managers award qualification. Mrs Cain has worked hard to continue to improve all aspects of her role. An annual quality assurance assessment was completed and submitted to us prior to the inspection and a copy taken on the site visit. In this document the quality of care provided was reviewed. Mrs Cain has set up auditing systems, including audits of accidents, wound care and medicines management. Mrs Cain also organises residents Care Homes for Older People Page 22 of 28 Evidence: and staff meetings, to receive feedback. She reports that she tries to work closely with family members, to receive their comments on the service. It was observed throughout the inspection that visitors appeared to be happy to bring up issues with staff. Staff meetings and resident meetings take place on a regular basis. It was suggested that in future relatives be invited to residents meetings. The home carries out surveys of residents views, it was suggested that in future these could be themed rather than general. There was a high degree of satisfaction expressed by all of the residents and relatives spoken with. Based on the comments received from in house surveys and visitors comment and through observation it is evident that residents feel the home is run in their best interests and it is felt that their needs are being met. The home has health and safety policies. Staff have carried out residents risk assessments and made appropriate provision to protect residents from injury. Padded bed rails are used to reduce the risk of falls where there is an assessed need and consent in place. There are radiator covers in areas of identified risk. Accident records are fully completed and the manager makes an analysis of them on a regular basis. A number of load handling risk assessments gave no detailed directions about what staff were actually expected to do. It was suggested that a member of staff undertake specialised training in load handling so that they can then oversee all risk assessments and ensure they are correctly written and reviewed. There is a formal fire risk assessment and fire plan. The fire logbook was up to date and in order. Drills, checks and maintenance have taken place. Fire safety training for staff is given on induction and then at annual Intervals. It is recommended that all night staff undertake fire safety training three monthly and day staff six monthly. There was a system for monitoring the risk of Legionella disease. A record of hot water outlet temperatures is maintained. The gas appliances have been serviced and a safety certificate was available. The electrical installation safety certificate inspection was up to date. The lifts had been serviced and there were load test certificates for the hoists. The EHO inspected the home in March and gave the home a three star rating. The home looks after some money on behalf of residents. A review of records showed that the amounts of money tallied, there was an audit trail of money handed in, signed for, taken out. It was discussed with the provider and manager that a full invoicing system to charge for additional items such as hairdressing or chiropody, with individual accounts, to reduce the amounts of money held in the home and improve financial security is worth considering. Care Homes for Older People Page 23 of 28 Evidence: A system for staff supervision by cascade is in place. Records are kept and include training needs for care staff. Mrs Cain also regularly supervises staff by working alongside them and encouraging her senior staff to do so as well, to ensure that all staff provide the care that the residents need. Mrs Cain has ensured that staff have been trained in areas relating to health and safety, including manual handling and fire safety. Care Homes for Older People Page 24 of 28 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 1 5(1)(d) The service users? guide 31/05/2008 must include a copy of the summary of the most recent inspection report. The service users? 30/06/2008 contract/terms and conditions must be revised so that it conforms to current regulations. Where a resident is prescribed a medication on an as required basis, a care plan should be drawn up to direct staff on the reasons for when such drugs are to be administered. All bedrooms and rooms which relate to nursing and care must be provided with single use methods of hand washing and drying. 31/05/2008 2 2 5A 3 9 13(2) 4 26 13(3) 30/06/2008 5 26 13(3) All equipment, furniture and 31/07/2008 items used in nursing care must have intact surfaces, to enable them to be wiped down. 31/05/2008 6 35 17(2)S4(9a,b Where the home looks after ) money for residents, there Care Homes for Older People Page 25 of 28 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 must be full individual records of money handed in and paid out on behalf of a resident. All such accounts need to be signed. 7 38 13(4)(a,c) Where safety rails or lap 30/06/2008 belts are used, each resident must have a full risk assessment for their use completed, including protection to safety rails. These assessments must be regularly evaluated. British Standard signage must be provided on the doors of all rooms where oxygen is used. 31/05/2008 8 38 13(4)(a,c) Care Homes for Older People Page 26 of 28 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 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 That the service user guide be updated with the providers qualifications and experience. That more detail be include regarding admission criteria and the nature of needs that can be catered for. That the section relating to consultation with residents be expanded That the person centred approach to care plans is expanded and care plans are individualised in consultation with residents and relatives. That the manager arranges training in the Gold standard approach to end of life planning and introduce the related documentation. That a higher percentage of care staff attain NVQ level 2 awards. That nurse training records are kept up to date to ensure their clinical knowledge supports best practice for the benefit of residents. Consider training a member of staff to a higher level in risk management and load handling to take responsibility for risk assessments in the home. Page 27 of 28 2 7 3 11 4 30 5 38 Care Homes for Older People Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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