Inspection on 05/05/10 for Spencer Grove Care Home

This is the latest available inspection report for this service, carried out on 5th May 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Key inspection report Care homes for older people Name: Address: Spencer Grove Care Home Springwood Gardens Spencer Grove Care Home Belper Derbyshire DE56 1JR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Richards     Date: 0 5 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 47 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 47 Information about the care home Name of care home: Address: Spencer Grove Care Home Springwood Gardens Spencer Grove Care Home Belper Derbyshire DE56 1JR 01773599349 01773599344 spencergrove@milfordcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Milford Care Limited Name of registered manager (if applicable) Donna Annable Type of registration: Number of places registered: care home 57 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 57 The registered person may provide the following categories of service only: Care Home with nursing - code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical Disability - Code PD Date of last inspection Brief description of the care home Spencer Grove provides twenty four hour nursing and personal care and support for up to 57 older people and people with physical disability. The home is located in a residential setting cloes to Belper town centre. It is decorated, furnished and equipped to a high specification. Care Homes for Older People Page 4 of 47 Over 65 57 0 0 57 Brief description of the care home Main facilities are over two floors, with all single room accommodation, each having a large ensuite facility, including a walk in shower. There is a choice of lounge and dining areas to each floor, including quiet space and with access to a well presented safe and accessible roof top garden, with seating. There is a large atrium bringing light to the central ground floor internal court yard area, with bedrooms off. There is a choice of assisted communal bathing and toilet facilities that are suitably located and a range of environmental aids and adaptations to assist those with mobility problems, including a nurse call system throughout, a shaft lift, corridor and hand rails and a variety of hoist equipment. A loop system is also provided to assist those with hearing difficulties. There are central kitchen and laundry facilities, with additional separate facilities to enable people to make drinks and snacks. People are provided with care and support from a team of nursing, care and hotel services staff led by a registered general manager and with an appointed clinical nuse lead. There is also external company management support. Up to date information about fees charged, what they cover and the arrangements for their payment can be obtained directly from the home. Fees are determined in accordance with individuals assessed needs, and may include for those eligible, funding assistance via the local Primary Care Trust for nursing care provision and or local authority funding assistance for accommodation and personal care. Care Homes for Older People Page 5 of 47 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 quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; Care Homes for Older People Page 6 of 47 Surveys returned to us by people using the service and from other people with an interest in the service; Information we have about how the service has managed any complaints; What the service has told us about things that have happened - these are called notifications and are a legal requirement; The previous key inspection and the results of any other visits we have made to the service in the last 12 months; Relevant information from other organisations and what other people have told us about the service. The inspection visit of 5 and 10 May included assessing compliance with previous requirements made and the meeting of key national minimum standards. Since our last key inspection and over the last 12 months we have sent out surveys to people on two occasions, following our random inspection of September 2009 there and again more recently. We received returns from some of the people living in the home and their relatives or representatives, some staff working in the home and outside visiting health and social care professionals. There were 38 people accommodated in the home at our inspection, including 15 people receiving nursing care. People who live in the home, visitors and staff were spoken with during the visit. We were assisted by the registered manager and care and development manager for the company. (Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff). Case tracking was used during our visit where we looked more closely at the quality of care and services received by people 6 living in the home. We did this by speaking to them and/or their relatives, observation, reading their care records, and talking to staff. All of the above was done with consideration to the diversity needs of people accommodated at the home. Care Homes for Older People Page 7 of 47 What the care home does well: What has improved since the last inspection? What they could do better: Ensure that suitably qualified, competent and experienced persons are working at the care home and in such numbers as necessary. With consideration given to increasing Care Homes for Older People Page 8 of 47 the supernumary hours provision for the the clinical nurse lead. Thereby better enabling him to perform his role in ensuring effective and consistent clinical support, monitoring and supervision of staff and to ensure nurse capacity for the conducting of pre admission nursing assessments. Implement and sustain formal staff supervision systems. Including for nurses employed at the home. To promote consistent and effective staff practise and to ensure people receive care and support from staff that is appropriately supervised, including for the provision of nursing to service users. Ensure that records to be kept in the home for each service user for their individual needs assessment, care plans and medicines administration are maintained, kept up to date and accurate in accordance with recognised practise concerned with records and record keepng. So as to ensure that peoples health and welfare is best promoted and protected and for the efficient running of the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 47 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 47 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive most of the information they need to assist them in choosing a home and their needs are usually met. Although failure to ensure sustained improvement in maintaining accurate needs assessment information for people may place them at unnecessary risk. Evidence: In their AQAA return, the home told us that they provide people with the information they need to help them in choosing the home and that their needs are suitably assessed before they move there. They told us they had received mostly positive feedback from people about their experiences of choosing the home, as gathered from their most recent annual satisfaction survey. We saw the collated results from this at our inspection visit. Discussions that we held with people during our visit also provided positive feedback from their experiences of choosing the home. Care Homes for Older People Page 11 of 47 Evidence: Examples of these, inlcude, After visiting the home, I was impressed with the overall set up. Impressive reception by the manager. It seemed to fit all needs and was clean and fresh. Pleasant staff. In our survey returns people told us that they were provided with a written contract for the care and services they receive and also sufficient information to assist them in choosing the home. In the AQAA the home also told us they have improved their approach to individual needs assessment, to ensure they can meet the nursing needs of potential service users. They also said that over the coming months, they aim to develop key information for people about their rights, including the arrangements for their individual care reviews. We saw from looking at the homes statement of purpose and service guide, that some information is provided there about the latter. Although not in respect of multidisciplinary arrangements for nursing care reviews. One person that we spoke with, who was receiving nursing care at the home said, that whilst they had agreed to take part in reviews, they did not know the actual arrangements for these. Since our last key inspection, the local primary care trust continuing care team have raised concerns about the service, including their arrangements for carrying out preadmission nursing assessments of people to be admitted to the home. Two survey returns that we received recently from visiting health care professionals to the home, told us they felt that the services assessment arrangements only sometimes ensure that accurate information is gathered and the right service is planned for people. At our inspection visit, the clinical nurse lead told us that when possible, he undertakes pre admission assessments for potential nursing admissions to the home. However, he advised that capacity for this is constrained by nurse availability within the home and that the registered manager, who is not a registered nurse, visits the person either in their own home or in hospital and undertakes an information gathering exercise. This includes obtaning, where available, any key assessment information from relevant outside health and social care professionals. The clinical nurse lead told us that this information is then usually discussed with nursing staff, before a decision to offer a place to any service user is made. We looked at the job description for the clinical nurse lead which details their Care Homes for Older People Page 12 of 47 Evidence: responsibility to carry out pre admission assessment for complex nursing enquiries. This also cites, prepare and take part in all nursing assessments/reviews. The homes statement of purpose refers to needs assessments being undertaken by the home manager or other senior staff of the home, but does not refer to the role of the registered nurse in assessing people for nursing care. We looked at the recorded needs assessment information for six people. Three receiving personal care only and three receiving nursing care and where possible spoke with those people about these and their representatives. For those in receipt of personal care only, we found that their overall needs assessment records relating to their physical care were comprehensive and gave a detailed picture as to where the person required assistance. However, for psychological, spiritual and social care needs, content was brief and contained little in the way of person centred information and background history. With the exception for one, where there was good social history and care planning information determined in consultation with their relative. We found the standard of recording for the needs assessments of those people receiving nursing care to be variable. We have have referred to record keeping under the Management section of this report and made a requirement there. For one person very recently admitted to the home. Their needs were mostly accounted for by way of a standardised recording format. With evidence of referral to outside healthcare professionals in accordance with their assessed needs. However, needs and risk assessment information for that person was not always fullly completed. Examples include for their medicines, nutritional and emotional needs and for the use of bedrails. We found that there were written entries in their daily evaluation record referring to some of those areas of need, although this information was not transferred as necessary into their needs assessment and care planning records. Discussions with that person and with staff indicated that for the most part staff were conversant with her actual needs, although told us about three areas where they felt staff were not. Risk assessments for another service user case tracked did not always have recorded reviews at monthly intervals, despite instructions for this to be so. Care Homes for Older People Page 13 of 47 Evidence: The manager told us that they were in the process of conducting an audit of all peoples nursing records. We saw a written plan for this to be completed by 14 May 2010. Nursing staff confirmed this was in process and we saw some evidence of this auditing work in progress for the second nursing resident that we case tracked. The third persons nursing needs assessment records were comprehensive and reasonably well recorded. The nearest relative acting on behalf of that person told us, that following their complaint earlier in the year relating to alleged omissions in care, as investigated via local authority safeguarding procedures. That they were now satisfied that their needs are being fully accounted for and met in consultation with them. Although said that this took quite some time to achieve. None of the personal care records held assessment documents that related to peoples ability to make decisions for themselves under the Mental Capacity Act. Although, the nursing care records that we looked at referred to this within peoples pre admission assessments. Relevant documentation was also in place in one of those, regarding advanced decisions made about care and treatment and treatment for one person. Service users or their representatives had signed their recorded needs assessment information, including indicating their willingmess to take part in the care plan review process. Although one nursing resident said they did not know the actual arrangements for their nursing care reviews. All but one of the care records we examined contained key contact details for relevant family and friends and health and social care professionals involved in their care, along with a recent photograph and physical description for each person. NMS 6 does not apply here as the home do not provide for intermediate care. Care Homes for Older People Page 14 of 47 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. There are undoubtedly many examples of people receiving the care they expect, that is delivered in the way they prefer, by staff that treat them with dignity and respect. However, ongoing failure to underpin and promote consistent and evidence based care delivery and practise, by process of effective record keeping, may result in omissions of care, thereby placing people at unnecessary risk. Evidence: At our random inspection conducted in September 2009. We found that an action plan was developed between the home, the local primary care trust and local authority arising from concerns those authorities had raised about the service. Included matters relating to clinical leadership and care delivery. At that visit we found that the home was working towards meeting this, including for the review and updating of peoples needs assessment and care planning records. In our AQAA, the home told us their service does well in promoting peoples rights to Care Homes for Older People Page 15 of 47 Evidence: inclusion, dignity, decision making and in involving peoples families and advocates in their care. They told us they could do better by ensuring improvements with their record keeping in respect of peoples care records. They also told us that they have made improvements to develop clinical practise in the home, including for diabetes care, catheter care and wound management. They also referred to the local primary care trusts clinical auditing of their service during 2009, in which they said they scored well in all areas, other than for dementia care. Although did not tell us the date of this audit. Some of their service improvements aimed for, as identified in the AQAA, include developing their communication and consultation arrangements with their visiting GP practise, implementing the national dementia strategy, Living Well along with recognised End of Life strategies and associated care documentation. Most people who completed our questionnaire surveys about the service, told us that they always received the care and support they need, including medical support. Although two said they sometimes do. One person told us that the standard of nursing care varies, which they felt to be a concern. Peoples relatives told us that they always or usually find that the service gives the care and support to their relative that is expected or agreed. Comments that we received, include Mother is well supported and happy. The general care is very good. The home is well organised and staff treat us with dignity and good humour. Service users and relatives that we spoke with during our visit also gave positive feedback about their care and support. Relatives of two service users with dementia told us, Health and medical needs are met with good communication and consultation with the family. They always put mothers interests first and we can see her care plan and are always kept informed. Staff are very caring and know mums preferences and likes and dislikes. She receives the care we expect. Care Homes for Older People Page 16 of 47 Evidence: Survey returns from and discussions with visiting health professionals were variable in the feedback they gave. Four said that peoples health care needs are not always, but usually properly monitored, reviewed and met by the service and that the service usually seeks advice and acts on it to meet those needs. Two said they sometimes are with one person telling us that efficacy was dependant on which staff are on duty. Two said that peoples medicines and potential health risks were not always effectively managed, giving examples of this. One other referred to ongoing problems with record keeping, care planning, risk assessments and incident reporting. Two staff survey returns told us that they are not always kept up to date with new ways of working relating to healthcare and medicines. We have referred to the arrangements for staff support and training under the Staffing section of this report. We looked at the written care plans for the 6 people that we case tracked. For those receiving personal care, we found that overall these were recorded to a consistent standard. Proportionate to the level of problems identified and in accordance with each persons risk assessed needs. They had recorded monthly reviews and daily records evaluating peoples care as linked to their written care plans. Although social care plans were not well recorded, informative or person centred. For the 3 people receiving nursing care, we found the standard of recording to be variable, with areas of omission evident. We also saw areas of duplication where there were two or more care plans in a persons file for the same need, but with overlapping and variable care interventions specified on each. For example, one for nutrition and one for eating and drinking, which may be potentially confusing for staff. One of those people told us, that whilst staff provided them with good overall care and support that they were frustrated as staff kept offering them food which they were unable to tolerate due to their medical condition. For two of the people case tracked we saw previous written entries made in their individual daily care evaluation records, indicating either changes in that persons condition and, or, with added care instructions for staff to follow relating to these. However, those changes and care instructions were not translated into a written care plan for staff to follow. Failure to ensure clear and up to date care plans in this respect could potentially result in people not consistently receiving their required care. Care Homes for Older People Page 17 of 47 Evidence: An example found in the daily record for one of those, related to the adminstration instructions recorded by the nurse there, in respect of their prescribed pain relief medication. This entry was made some days previously and could only be seen by looking back in those records. The instructions were not translated into a care plan. There being no care plan in respect of their medicines. This is particularly important where a person is prescribed medicines to be given as required and with variable dose instructions, which we could see from looking at their medicines administration record chart, applied to this person. The resident also told us that they were recently offered an incorrect dose, which resulted in the service user having to instruct the staff member administering this medicine. Two people had written care plans specifically relating to their medical health conditions. However, these were merely a statement of their actual named conditions, gaving a brief medical definition for each condition. There was no written detail for any action or care interventions for staff to follow in relation to them and they did not constitute a working care plan in accordance with recognised practise, such as the nursing process. We have referred to record keeping under the Management section of this report and have also made a requirement there about this. Our pharmacist inspector spent over 6 hours looking at the arrangements for the ordering, receipt, storage, administration and disposal of people medicines. This included looking at records, observing and speaking with staff. Findings were as follows, Although most medication management processes in the home now follow best practise, we found that staff did not always follow current medication procedures correctly. The medication requirement that we made at our previous inspection is met, although further improvements in medication record keepng are needed to ensure a full record is maintained of all medicines received and used in the home. As indicated above we have referred to record keeping practises in the home, including for peoples medicines, under the Management section of this report and made a requirement there about these. Recommendations that we made previously, some 12 months ago, about hand written instructions on the medicines administration record sheets or MAR and for the monitoring of medicines storage temperatures had not been fully implemented. Care Homes for Older People Page 18 of 47 Evidence: We looked at 31 MAR sheets for accuracy and completeness and found no significant gaps in the recording of the administration of medicines to people, that are taken by mouth. This tells us that people living in the home can expect to receive these correctly. However, we found on two MARs that staff had misinterpreted the printed safety instructions for a particular medicine and had not checked their assumptions with the prescriber. Changes in the use or directions for prescribed medicines should only be made after full consultation with the prescriber and the reasons for any changes clearly recorded. Records for the use and administration of prescribed skin care products on eight MARs were inadequate. The records did not consistently show that these were being administered to the person they were prescribed for. Or if omitted, the reason for this. Although staff told us that they administer them to people in their own rooms, this means that records do not provide evidence of correct use so that the benefits of all prescribed treatment can be accurately assessed. Hand written entries made by staff on 3 MARs had not been checked by a witnessing staff member and lacked essential details, such as the quantity of medicines received. The quantity of medicines retained at the end of the monthly cycle was also often not recorded in the carried forward section of the new MAR. Thereby providing no audit trail to check whether these medicines have been used correctly, or whether sufficient medicines will be available for the whole of the next month. We found that two people were responsible for taking some of their own medicines on a regular basis, but that no agreements that this would happen, or details as to how these arrangements would be checked could be found. As detailed above we have referred to record keeping under the management section of this report, including for medicines and made a requirement there about this. However, we also saw examples in the form of medicines care planning records for some people which showed where staff work closely with local healthcare professionals to improve peoples health and wellbeing of people. A visiting community nurse told us that that referrals to her from staff seeking health care advice on behalf of some people in receipt of personal care only in the home were relevant and appropriate. The arrangements for medication ordering, receipt and disposal were overall satisfactory. Including good practise for the checking of repeat GP prescriptions for accuracy before the medicines are delivered. Although we found excess supplies of a Care Homes for Older People Page 19 of 47 Evidence: controlled medicine, where these were not disposed of as necessary. We also found that staff omitted to record the opening dates on containers of oral liquid medicines and skin care products. This means it is possible for some of these products to be used beyond the recommended in use period from opening. The nurse administering these said she was not aware of the need to do this. Evidence of that persons training and medication competency assessment was seen with areas of acceptable competency and development clearly identified. We saw that the nurse gave out the morning and lunch time medicines alone. She confirmed she had commenced the morning round at around 8 am and continued to do this until well past 11 am. We have referred to Staffing skill mix under the Staffing section of our report. Care Homes for Older People Page 20 of 47 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home enjoy lifestyles and routines that suit them and are mostly provided with meals they enjoy and that suit them. Although at the present time, opportunities to take part in organised leisure and social activities are limited by levels of staff support. Evidence: In our AQAA the home told us that they regularly consult with people about the arrangements for activities and meals provision. Improvements they told us they have made as a result of this, have included more recent successful recruitment to the activities co ordinator role. Resulting in improvements underway to re establish the organisation of activities and entertainments, promoting inclusion for those with sensory impairments and re establishing a monthly church service for people. Information provided in the AQAA also told us that more recent consultation with people has informed the home about areas that they could further improve. With improvements planned to include developing better access for people to the local community, increasing the variety and frequency of activities, developing them to suit those people with dementia care needs and providing more information for people Care Homes for Older People Page 21 of 47 Evidence: about local and national support and advocacy groups. At this inspection feedback from people surveyed told us that since the recruitment of the new activities co ordinator, arrangements for these were starting to improve again. Although people said that further improvements could be made. Most people that we surveyed told us that they usually enjoy the meals provided. Some people commented that teas are very good, but felt improvements could be made regarding the quality of meat served at lunch time, which they said is often difficult to chew. We discussed this with the manager at our visit, who agreed to look into this. Also for the provision of late suppers for people who wish to go to bed later. Peoples relatives surveyed told us that they felt people are usually supported to live the life they choose and that their diverse needs are met. At our inspection we saw results collated by the home from a recent satisfaction survey undertaken with people in respect of meals and mealtimes and being treated as an individual. For meals, comments ranged from, Excellent good. Good choice and variety, to Generally good, although not all residents are offered a choice of different foods that are available, with some staff making more effort than others. In their survey overall results indicated 30 percent of people rated meals as excellent, 63 percent good and 7 percent fair. Some people had asked for more fresh fruit. We saw this to be provided at our visit and that food choices were listed on the menu board displayed. For individual treatment, comments ranged from, A good attempt is made to cater for individual preferences, to relatively long periods left alone in room. Overall ratings here resulted in 27 percent excellent, 70 percent good and 3 percent fair. We spoke to the care staff member who has been allocated two days per week as the homes activities coordinator since January. A list of events for the month of April was on display, which anyone could take part in, although there was no evidence of anything planned on the day of the inspection. The staff member referred to told us that things were in their early stages of re organisation and that further equipment and materials were needed. We found that a collage making activity had taken place with a small group of people a few days earlier. One person that we spoke with told us he had joined in with this and found it a bit of fun. Care Homes for Older People Page 22 of 47 Evidence: We found that a number of sponsored events had taken place, including for staff and family members to join in with, to raise funds for the residents amenities fund. Other organised events that have taken place include baking sessions, outside entertainers and a slide show. The care staff member told us that in the short time she had been involved as activities organiser, that the numbers of people interested in joining in had risen to a regular group of eight people, but found that generally people were difficult to motivate. She told us she has secured contact with colleagues from an outside local statutory care team, who have a role to reach out people living in care homes in order to improve the quality of their lives. During our visit we saw that a number of people were reading newspapers and listening to music and with many receiving visitors from friends and family throughout the day. People told us that they were very happy with their lives at the home and many said they were not overly concerned about always joining in with organised activities. Although the hairdresser visiting each week to attend to peoples hair is very popular. We have also made comment under the Choice of Home section of this report about how peoples spiritual and social care needs are assessed and determined, which should assist in ensuring more person centred social care planning. We spoke to some relatives and friends during our visit who said they were always made welcome and offered a drink. They also told us that the home communicates well with them. We observed lunch served where a choice of meals was offered to people. Where they needed help, staff were seen to individually sit with them to offer the assistance they needed. A brief visit was made to the kitchen and the cook described current arrangements, working to a four week menu. We noted from a sample of these that there was a variety of traditional style meals on offer and that choice for the main meals of the day is available, including hot and cold options at breakfast and teatime. People were positive at our visit in their feedback about the standard of food at the home, with several mentioning good quality and quantity. We were told that the food is much to my taste and I have been putting on weight. That the food is excellent and plentiful; weve brought him in some trout, which the cook deals with for him, no problem, and that the meals she gets are particularly important to my mother. One Care Homes for Older People Page 23 of 47 Evidence: person was less favourable about the food and commenting they found it to be inadequate and telling us food is not much to my choice. Arrangements for storage and stock control of food supplies were satisfactory, and we saw evidence that food safety is well managed. The cook deals with people who have special dietary needs, these have included diabetic and softened diets. Her arrangements for these indicated, knowledge of those needs. Care Homes for Older People Page 24 of 47 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. Consistent findings from joint agency safeguarding and complaints investigations and indicating recurrent themes arising, that may pose unnecessary risks to peoples health and welfare. However, the full and ongoing implementation of the homes nursing and management action plans, should reduce those risks in service users better interests. Evidence: In our AQAA the home told us they promote peoples rights to raise concerns, access their complaints procedure where necessary and that they encourage suggestions and feedback from people to inform service improvement. They also say that they reflect on and identify learning outcomes from complaints received. They said they could improve by raising peoples awareness about how to complain and in ensuring more systematic logging of complaints raised by people. Improvements they told us they have made over the last 12 months, include provision of training for most staff in dealing with aggression and challenging behaviour, revision of staff whistleblowing procedures and for the responsive recording of complaints regarding the laundry. They also gave us some statistical information that we asked for about complaints they have received about their service. Care Homes for Older People Page 25 of 47 Evidence: Since our last key inspection there have been 17 complaints investigated by local authority joint agency safeguarding adults procedures. Fifteen alleged neglect of individual service users and 2 their alleged physical abuse. The latter two were reported directly by the home in accordance with recognised procedures and suitable action taken in respect of the agreed investigation of these. Of the 15 reported allegations of neglect and from joint agency investigation of these. 1 was substantiated, 1 partly substantiated, 12 not substantiated and 1 is currently in process. Recorded outcomes consistently arising from joint agency investigations of these indicate clinical governance and record keeping failures for the assessment, planning, review and evalation of peoples care. Mostly concerning the nursing unit of the home. Due to concerns previously raised with us by the local primary care trust concerning in management, nurse leadership, clinical decision making and notifications to outside agencies. We undertook an unnannounced random inspection of the home in September 2009. We found at that visit, that action plans agreed with the local primary care trust were being implemented, including for the review and update of peoples written care plans. Survey returns that we received from people who use the service and their relatives all said they always or usually know who to speak with if unhappy and how to complain. One person commented that the home had recently responded well to issues they had raised and taken appropriate action where needed. At our visit people said they would speak to staff if they had any concerns or problems and said they had no reason to make formal complaints. We saw the complaints procedure displayed around the home, which is available in large print and other alternative formats. This procedure corectly provides people with our contact details, it incorrectly places us at the end stage of their complaints procedure advising them they may contact us if they are not happy with the outcome of their investigation. We discussed this with the manager, who agreed to ensure that this is amended to correctly inform people that we are not part of the homes complaints procedure stages, by stating there that people have the right to contact us at any time they choose. Staff said that they receive training and regular updates in recognising abuse and reporting procedures for this and that they were able to access the homes procedures Care Homes for Older People Page 26 of 47 Evidence: for these. Care Homes for Older People Page 27 of 47 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is purpose built, with established standards of maintenance, decoration, physical comfort and overall cleanliness. Evidence: In our AQAA the home gave us a lot of information telling us that the home is well maintained, clean, safe and decorated, furnished and equipped to a high standard. Declaring robust infection control procedures. They told us about improvements they have made, areas where they could do better and their aims for these over the coming months. These include ensuring improvements in their laundry service, undertaking 3 monthly infection control audits and reviewing their internal infection control standards to ensure they meet with current Codes of Practise. Also to ensure that cleaning hours for the home are increased in accordance with resident numbers. They also told us that some en suite showers were not suitable for use, but that these were under review with their building contractors in accordance with their building warranty. People that we surveyed said that the home is always kept fresh and clean. Although we received a significant number of comments telling us that the laundry service Care Homes for Older People Page 28 of 47 Evidence: requires improving. These related to the quality of washing and ironing, missing items and people finding others clothes in their wardrobes. At our visit, areas of the home that we saw were found to be clean, safe, well maintained, furnished and equipped and odour free. However, we found two care staff on duty on the first floor unit of the home were providing personal care to people but not wearing uniform protective clothing. We brought this to the attention of the manager. We also found from discussions with people that there had been a recent outbreak of infection in the home, which the home had not notified us about. We have referred to this under the management section of this report and made a requirement there. People said they were particulary pleased with the environment, which they felt to be impressive and to a high standard. Many said they enjoyed the choice of daily living space, including the courtyard and garden areas. Kitchen staff talked to us about the Environmental Health Officers report and showed how the two recommendations that had been made therein. had been actioned. We saw records of action plans resulting from the homes recent satisfaction survey with people in respect of their rating of the environment and facilities. These included recent improvements to the standard of laundry in response to the signficant number of comments made by people expressing disatisfaction with this service. We saw the laundry to be well equipped with a good range of functioning washers and dryers and we were told by the manager that all of the laundry was completed each day by specific laundry staff. We were also told that systems within the lauindry had recently been overhauled due to problems arising with the quality of laundering and ironing and personal missing items. That new systems were in place to track soiled items from bedrooms to washing machine and back out again. Problems and issues were noted to be substantially improved. All residents observed in the home were seen wearing clean and well presented clothing. Two people commented in their survey returns that their en suite shower had not worked since September 2009 and three people made comments about problems with entry to the building still being an issue. The manager confirmed at our visit that matters relating to those showers was still not resolved, but that regular visitors to the home are being provided with pass key fobs to enable ease of access to the Care Homes for Older People Page 29 of 47 Evidence: building. We saw some of these to be in use and one person told us they were pleased with their provision. Care Homes for Older People Page 30 of 47 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. Peoples needs are met from staff that is suitably recruited and inducted and for the most part, trained. Although a more measured approach to the ongoing monitoring and review of staff skill mix and deployment arrangements, may ensure peoples assessed and recorded needs are more consistently and effectively accounted for. Evidence: In our AQAA the home told us they involve residents in staff recruitment, ensure suitable induction of new staff, provide the right staff skill mix and ongoing rolling training plan for staff. Information provided there tells us about some recent improvements they have made. Examples include, additional staff recruitment, including to a substantive clinical nurse lead post and dedicated training co ordinator role and establishing ways of broadening access to NVQ training for staff. Information provided at our inspection confirmed that out of a total of 33 care staff, 14 have achieved NVQ level 2 in care with 3 enrolled to do and with 1 staff achieving NVQ 3 with 2 enrolled to do. This means that less that almost 50 percent of care staff have achieved at least NVQ level 2 training status. Improvements identified in the AQAA for the coming months, include further Care Homes for Older People Page 31 of 47 Evidence: development of their staff training programme, introduction of personal development plans for staff and support for staff whose first language is not English. The home also gave us some statistical information that we asked for relating to the staff employed and areas of their training and development. Since our last key inspection we have also undertaken a random inspection of the service in September 2009. The was because of concerns and information that we received from the local Primary Care Trust as referred to under the Healthcare and Complaints section of this report. At our random inspection we found there had been a high staff turnover, with significant use of agency staff. There had been 3 acting clinical nurse leads in post between January and to August 2009. There was no identified clinicial nurse lead for the service at our visit and for at least one month previous. This meant there was no clinical nurse leadership and overview for clinical decision making concerned with peoples care. We made a requirement from that inspection, that the provider ensure a clinical nurse lead be identified immediately for the home, and we wrote separately asking for written confirmation of revised staffing arrangements. The provider wrote to us on 24 September 2009 confirming details of the appointment of a clinical nurse lead to acting capacity and for their staffing arrangements. At this inspection people surveyed said that staff is usually available when they need them. That they usually listen and act on what they say and treat them with dignity and respect. Comments received from people, included, Most staff are very good. Staff are attentive. Staff are friendly and treat people with respect. Some staff are better than others. A significant number of survey returns, said that more staff were needed at times and some people said they felt more dementia care training was needed. We have referred to some improvements planned by the home relating to dementia care strategy under the Healthcare section of this report. Training statistics provided at this inspection and discussions with staff told us that a signficant proportion of staff have undertaken this training, although not all. Care Homes for Older People Page 32 of 47 Evidence: Two staff survey returns told us that they are not always kept up to date with new ways of working relating to healthcare and medicines. Staff that we spoke with at our visit expressed enthusiasm and commitment to their work and they described overall satisfactory arrangements for their recruitment, induction and training. Although we found staff supervision and support systems were not fully opertional. We have referred to this under the Management section of this report and made a requirement there. All those spoken with confirmed their access to training and updates for core health and safety areas during the last 12 months and gave examples of many other areas concerned with peoples health care needs, such as nutrition, tissue viability, medicines, End of Life care and challenging behaviour and aggression. The clinical lead also told us about extended role training he had undertaken, including for cannulation and catherisation. Although, extended role training is not included in the homes training matrix record. We also saw significant gaps in training recorded on the training matrix providied, particularly for many aspects of health care, including medicines. However, discussions with staff told us that this record may not be up to date. We have referred to record keeping under the Management section of this report and made a requirement there about this. We saw that a training plan was recently determined, to be rolled out to staff, role dependant. To provide training to be held between May and October for record keeping, accountability and delegation skills, confidentiality, leadership, team building and dignity and with further medicines training for key staff. Staff felt that access to training is developing well, together with the staff team. Staff on the nursing unit told us that the staff team is more stable than previously and with improved team working and leadership. Although, some comments were made that this depended at times as to, who was on duty and also the skill mix provision. It was the opinion of those staff this could be improved by the clinical lead having more supernumerary time with a second nurse allocated to cover the shift, thereby enabling increased clinical support, monitoring and supervision of staff. Current duty rotas that we saw, showed 1 registered nurse, 1 senior care and three care staff provided throughout the day and with separate staff at night. Of the nurses, 1 is the clinical lead, 2 are more recently employed experienced nurses, 1 newly qualified, 1 recently transferred from another home in the group and 2 part time. We also observed during our visit, and as referred to under the Healthcare section of Care Homes for Older People Page 33 of 47 Evidence: this report, that the medicines round conducted by the one nurse on shift during the morning took an excessive time period to complete, with a relatively short time period before the lunch time medicines round was conducted by the same nurse. We saw from information provided on the AQAA that 15 staff have left employment at the home over the last 12 months, although the use of agency staff has reduced, with use of agency nurses now mainly at night. However, use of the same agency staff was established to assist in promoting continuity for people receiving care. The clinical lead confirmed his recent appointment to a substantive post and advised that he now works one or two shifts per week on a supernumerary basis. Results of the homes recent satisfaction survey were seen. These included a range of comments from people about staffing arrangements and approaches to care. Although there was no overall measured rating for these. Comments included, Staff always listen and are friendly and caring. Almost all the staff are excellent. Staffing levels could be improved and more experienced staff are needed. The action plan implemented as a result of this tells us that staffing levels have been increased recently as indicated in our findings below. We looked at the duty rosters for care staff in the personal care unit and found that stability had also been regained with minimal use of agency staff and sufficient numbers deployed. There was a senior carer and two other staff on the day shifts and a separate group of staff covering the night shifts. Staff told us that this had been a big improvement from the previous allocation of two on the day shifts, with regular short term sickness and absenteeism now almost eradicated. They also told us that the way they are deployed to work the whole shift on one floor is resulting in better continuity and a more satisfactory way of working. Although duty rotas provided for the home, did not specify the deployed location for care staff in the home. Staff on the personal care unit demonstrated a good knowledge of people in the home and their needs. One relative told us they felt there was now usually enough staff on duty and two people living at the home said that in the recent past they had sometimes had to wait up to twenty minutes for attention needed. Care Homes for Older People Page 34 of 47 Evidence: Care Homes for Older People Page 35 of 47 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. Action being taken and also proposed by the home, with a commitment to achieving requirements made in this report, should assist in the redress of matters arising from the leadership and staffing difficulties of the last 12 months. Thereby ensuring that service users best interests are more consistently and effectively promoted. Evidence: In our AQAA the home told us that they have forward thinking and visionary management and run their service in peoples best interests and by way of effective quality assurance and monitoring systems. The AQAA gave us with examples of many positive quotes received by the service from their recent satisfaction survey returns conducted with people who use the service or who have an interest there. We have referred to examples of these under the relevant outcome sections of this report. They told us about what they could do better. This includes developing a more Care Homes for Older People Page 36 of 47 Evidence: systemmatic approach to providing guidance, support and advice for nurses employed at the home. Telling us that they aim to develop this and to improve approaches to clinical governance. They did not tell us how they intend to achieve this, although referred to the recent development of a range of checklists for auditing purposes in this area. Forthcoming development aims for the service also referred to embedding the principles of the Mental Capacity ACt 2005 and Deprivation of Liberty Safeguards 2009 into their care planning practises. At this inspection we saw that policy and procedural guidance is introduced for staff to asist them in applying these principles into practise and staff told us they have been asked to read these and complete a questionnaire to assist the manager in establishing targeted training for this for all staff staff groups. In the AQAA return, they did not give us dates requested for the last review of their operational policies and procedures. Although at our visit we were advised that these were under company review. At our visit we spoke with the manager about the arrangements for her training and development and found that she has achieved further recognised training in relation to care, core health and safety and management. As referred to under the Complaints and Staffing sections of this report. During the period from January to August 2009, staff turnover included four separate nurse clinical lead appointments. The provider did not formally notify us of these changes in writing and at our random inspection referred to above, we found there was no clinical lead appointed to ensure the overseeing of the delivery of nursing care in the home. Following that inspection, we raised our concerns about this in writing with the provider who subsequently notified us of the appointment of an acting clinical nurse lead on 17 September 2009. This had recently been made substantive. Staff in the nursing unit told us, that overall they felt management and staffing arrangements to be more settled and with good working relationships. All staff were positive about the current operation of the home and reported good morale amongst the staff group. That senior staff are very approachable and that management listens to the seniors now and we can better influence the way the home is run. However, many said they do not receive regular formal supervision and discussions Care Homes for Older People Page 37 of 47 Evidence: with nurses told us there is no formal system for clinical supervision. Although discussions with the senior carers indicated that that the redevelopment of formal systems for staff supervision and appraisal were being reestablished. A nurse recently employed told us as a formal trainer in clinical superivision, that she had raised this as an area for development. Establishment of these systems should better ensure that staff are properly supported and their work is being positively and continuously monitored. Some staff felt that further improvements could be made in terms of staff skill mix, which we have referred to under the Staffing section of this report and made a requirement and recommendation there about this. We spoke with the manager, clinical lead and nurses on duty about the action they are taking to address matters arising from complaints investigations concerning identified record keeping failures and as referred to under the Complaints and Healthcare sections of this report. We were advised that an action plan is in place with weekly management and nurse review meetings and we saw minutes and records of these. We also saw records of revised approaches to quality monitoring arising from these and relating to care systems and record keeping. A monthly audit format, recently completed by senior management in the absence of the clinical nurse lead at that time, identified some omissions in record keeping, mainly in relating to medicines adminstration records. The recorded audit area relating to medicines, was not fully completed by the person undertaking this in accordance with the format provided. Including as to specifying action discussed and with whom, and who is to be responsible for ensuring this is achieved. We discussed this with the clinical nurse lead who had recently returned from a period of leave. He advised us that he would take action to ensure this was properly followed through. We looked at the minutes and action plans from the weekly nurses meetings referred to above. These identified omissions continue to be indentified in clinical care record keeping, including for medicines. Although we saw work in progress to ensure all peoples needs assessment and care planning records be fully revised and updated by 14 May 2010. As referred to under the Healthcare section of this report. Staff described suitable arrangements for ensuring safe working practises, including provision of equipment and training records supported this. Care Homes for Older People Page 38 of 47 Evidence: Standards of health and safety activity and regular servicing of equipment had been maintained, and a full audit of health and safety matters was also carried out. Observations made around the building and a sample of fire safety activity and equipment records supported that the home was hazard free at the time of the inspection. Although two care staff working and providing personal care to people were not wearing protective uniform clothing We have referred to this under the Environment section of this report and made a requirement there about this. We also found from speaking with people, that there had been a recent outbreak of infection in the home before our inspection visit. Management had not formally notified us of this in writing as is required. Although information provided by the manager at our visit told us that they had notified other agencies required and instigated correct procedures. There have been two previous failures during the last 12 months in the provision of required written notifications the Commission. Care Homes for Older People Page 39 of 47 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 40 of 47 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The rationale for 30/06/2010 determining the conduct of pre admission nursing assessments by the home in respect of any service user, must be clearly defined and account for best practise. So as to ensure that the needs of the service user have been assessed by the person most suitably qualified or trained to do so and, To assist nurses employed at the home in maintaining and developing their professional skills. 2 7 15 Service users written care 30/06/2010 plans must always set out in detail, the action which needs to be taken by care staff in accordance with their risk assessed needs. And be kept under review and revised in accordance with Page 41 of 47 Care Homes for Older People 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 any necessary changes to a persons care and treatment. This includes in respect of peoples medicines. To ensure that service users needs in respect of their health and welfare are suitably accounted for and met. 3 9 13 People must receive their medicines as prescribed, including in respect of creams and lotions. With a record of the date on which they were administered to any service user. Changes in the use or directions for prescribed medicines must not be made without full consultation with the prescriber and the reasons for any changes clearly recorded. 30/06/2010 To ensure that people receive their medicines as prescribed. To provide evidence of their correct use and application and to enable the benefits of prescribed treatment to be accurately assessed. Care Homes for Older People Page 42 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 26 13 Staff must always wear uniform protective clothing as are appropriate to the course of their duties and in accordance with recognised policies and procedures for the control of infection. So as to ensure suitable arrangements to prevent infection, toxic conditions and the sperad of infection at the care home. 30/06/2010 5 27 18 It must be ensured that at all times suitably qualified, competent and experienced persons are working at the care home and in such numbers as necessary. So as to ensure that, Peoples health and welfare is consistently promoted and protected. To enable the necessary support and supervision of staff appropriate to the work they are to perform. To enable the clinical nurse lead to effectively deliver the responsibilities of his role in accordance with his job description and level of accountability. 30/06/2010 Care Homes for Older People Page 43 of 47 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 6 36 18 Formal staff supervision systems must fully implemented and sustained. Including for nurses employed at the home. To ensure that all persons working at the home are appropriately supervised, including for the provision of nursing to service users. To promote the delivery of consistent and effective practise in accordance with peoples assessed needs. 31/07/2010 7 37 17 Records to be kept in the home for each service user in respect of their needs assessment, care plans and medicines administration. Must be maintained, up to date and accurate, in accordance with recognised practise concerned with records and record keeping. To ensure that peoples health and welfare is promoted and protected. To ensure the effective and efficient running of the service. 30/06/2010 8 38 37 Written notification must be given to the Commission 30/06/2010 Care Homes for Older People Page 44 of 47 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 without delay of the occurence of any incident in the home as specified under Regulation 37 of the Care Homes Regulations. This inlcudes for outbreaks of infectious disease. So as to ensure peoples health and welfare is promoted and protected. 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 Key service information provided for people should include the arrangements for multi disciplinary care plan reviews for those people placed in the home for the purposes of nursing care. Assessment information in respect of peoples spiritual and social needs should be developed in consultation with them to determine their lifestyle preferences and to assist in promoting these. Needs assessment information relating to individuals capacity to consent to their care and treatment should be clearly recorded within their current needs assessment records. Clinical risk assessments should be reviewed at least at monthly intervals. Written care plans should be consistently formulated in accordance with a recognised model such as The Nursing Process. Arrangements for the disposal of controlled drugs should ensure that this is undertaken in a timely and prompt manner. So as to prevent excessive amounts of these remaining in the home for any unnecessary time period. Page 45 of 47 2 3 3 3 4 5 3 7 6 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 8 9 9 9 9 The temperatures of all medication storage areas, including the refrigerator should be checked regularly and recorded. Opening dates should be recorded on all oral liquids and skin care product containers. Carried forward quantities should be recorded on the new MARs each month to allow for checks of medicines available to be made. All hand written entries made on medicines administration record charts (MARs) and changes should be checked for accuracy and completeness at the time they are made by a second witnessing staff member. People living at the home should be further supported to enjoy a range of social and leisure activities that are based on a clear assessment of their needs and interests. So as to promote a person centred approach to social care and activities. The home should ensure that the necessary repair work is undertaken to those showers which are not functioning as soon as possible. The recorded staff rota should indicate the unit location that staff on duty are deployed to. Consideration should be given to increasing the supernumary hours provision for the the clinical nurse lead. Thereby better enabling him perform his role in ensuring the effective and consistent clinical support, monitoring and supervision of staff and to ensure capacity for the conducting of pre admission nursing assessments. Extended role training completed by nursing staff should also be included on the homes training matrix record. 10 9 11 12 12 19 13 14 27 27 15 30 Care Homes for Older People Page 46 of 47 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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