Inspection on 02/09/09 for St Georges Hall & Lodge

This is the latest available inspection report for this service, carried out on 2nd September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Georges Hall & Lodge 16/03/09

St Georges Hall & Lodge 09/03/09

St Georges Hall & Lodge 04/03/08

St Georges Hall & Lodge 11/10/06

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report Care homes for older people Name: Address: St Georges Hall & Lodge Middleton St George Hospital Site Middleton St George Darlington Co. Durham DL2 1TS     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 Lowther     Date: 0 7 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: St Georges Hall & Lodge Middleton St George Hospital Site Middleton St George Darlington Co. Durham DL2 1TS 08456032558 01325335487 stgeorgeshall@try-care.co.uk www.orchardcarehomes.com Orchard Care Homes.Com Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 83 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 83 The registered person may provide the following cateory 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: Dementia Code DE, maxuimum number of places: 62 Old age, not falling within any other category - Code OP, maximum number of places: 21 Date of last inspection Brief description of the care home St Georges Hall and Lodge is a residential care home with nursing, newly built in 2006. The layout of the building is split into three units that run with distinct staff teams but share some facilities such as the kitchen, laundry and garden areas. There Care Homes for Older People Page 4 of 27 Over 65 0 21 62 0 0 9 0 3 2 0 0 9 Brief description of the care home are 83 individual rooms each with en suite bathroom . All rooms are equipped with TV and DVD player. The home also has assisted bathing facilities in communal bathrooms. There are several communal lounges and dining areas. There is a landscaped garden at the rear of the building for people to use and an outside summerhouse for people who smoke to shelter from the elements. The home itself is no smoking. The home is situated near the Durham Tees Valley airport site and is not in easy reach of community facilities such as shops, banks, leisure facilities and pubs. However there is a hotel nearby. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 this service experience adequate quality outcomes. The last key inspection of St Georges Hall and Lodge was carried out in February and March 2009. As a result of that inspection many requirements and recommendations were made and the service was assessed as poor. A random inspection was carried out in April 2009 where we found that some progress had been made, but not sufficient. Enforcement action was therefore commenced and the company were issued with a Statutory Requirement Notice telling them what they must do. A second random inspection was carried out in June 2009 where further progress had been made, however there were issues which had not been addressed within the given timescales. We also found several new serious issues, and a warning letter was issued . This unannounced inspection of this home took place on the 2nd and 7th September Care Homes for Older People Page 6 of 27 2009. This inspection focused on all of the key standards and to check whether the previous requirements had been met. Records were examined and a tour of the building took place. Time was spent talking to staff, the people who live in the home and their relatives. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The fees charged at the time of this inspection were between 398 pounds and 700 pounds per week. This does not include the cost of hairdressing, chiropody, newspapers and toiletries. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Ensure that revisions to care delivery are only made following in depth risk assessment reviews which are fully documented and agreed with management. The prescriber should be asked to provide information when medication has a dose of as directed or when required. This makes sure that the medication is given correctly. Care Homes for Older People Page 8 of 27 The activities programme should be developed to include trips further afield. Menus should be on display to help people remember what is for lunch. The manager should discuss the complaints procedure during meetings so that people are aware of their rights. All staff should receive regular training in safeguarding adults to make sure that people are protected from abuse. Continue to improve environment as planned so that it is suitable for people with dementia. Review domestic hours to make that the home is kept clean and odour free at all times and address the unpleasant odour in some of the toilets. The lounges should be supervised at all times as per homes policy. The names and qualifications of the nurses on duty should be identified on the duty rota. Staff must receive in depth training on the needs of people with dementia. To make sure that they have the knowledge to meet this specialist need. Progress staff training to ensure that all staff are supported and competent when dealing with challenging behaviours. The current training should continue to achieve a minimum ratio of care staff having an NVQ Level 2 in Care as identified in the National Minimum Standards. Continue to progress improvements in the recording of accidents to include evidence of the time last seen when an accident has not been witnessed. Take action and implement systems which provide accurate, up to date and easy access to staff training records. Ensure that the information entered within care records and accident reports corresponds and that any variations are investigated. Provide a first aider in the home at all times to make sure that people receive the appropriate treatment. 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 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Unable to assess at this inspection. Assessed as adequate at the last inspection. Evidence: This standard area could not be assessed at this visit as there have been no admissions since the last inspection. The home has adequate assessment tools in place to assist the assessment process. A new manager has been appointed and was able to demonstrate through discussion that she is aware of the need to fully assess people in consultation with other professionals before they are admitted to the home. This includes people who are readmitted after a stay in hospital. There were appropriate assessments seen in those records reviewed. The home do not admit people for intermediate care, therefore assessment of Standard 6 is not required. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate systems are in place to ensure that health care needs of the people who live in the home are met. Evidence: The last random inspection report contained a requirement that care plans be kept under review and where appropriate after consultation with the service user or a representative, be revised to reflect the service users changing health and welfare needs. It also contained a requirement that the plans must clearly identify how their needs in respect of health and welfare are to be met. The care plans viewed at this visit were found to be comprehensive and in the main contained good information. Examples seen had plans in place for risk of developing pressure sore, which was up to date. For one service user the plan for support with personal hygiene was person centred and made reference to the preferred time of rising, that the person liked tea with no sugar, and that they liked to wear perfume and jewelry. The communication care plan was also good as it highlighted the need for the person to be wearing glasses and a hearing aid and that they could lip read. The Care Homes for Older People Page 12 of 27 Evidence: plan with regard to agitation what the person does when agitated and the actions staff should take to diffuse the situation. There was also a risk assessment in place to identify that she should not have a nurse call bell and the reasons why. We found this plan to be informative, person centred and easy to follow. Relatives spoken with said that when they had been invited to attend a review of their family members care, the staff went through the care plan with them. Two further care plans seen were person centred and informative. There was evidence in both to confirm that people are involved in the care planning process and agreed to the content. However in one set of records seen the care records with regard to how one person was being looked after when sitting in a chair did not correspond with what staff were actually doing. This would mean a member of staff who did not know that person would not know how to look after her properly. Revisions to care delivery should only be made following an depth risk assessment reviews which are fully documented and agreed with management. A pharmacy inspector looked at the medications. There are very few administration gaps on the MAR charts meaning that people living in the home can expect to receive their prescribed medication correctly. The quantities of medicines received into the home and brought foreword each month are now clearly entered on each persons MAR making it easy to check whether sufficient quantities are available. Medication for two people had been out of stock during August but systems have now been implemented to order and receive medicines into the home which are required outside the normal monthly cycle. There is no record of staff authorised to administer medicines. This makes it difficult to identify who was involved in administration if a problem or error was to occur. Good records were now kept of interactions with surgeries and pharmacies. Medicines are stored securely either in locked trolleys or cupboards. The temperature of the medicine storage rooms and fridges are regularly monitored and recorded. The date of opening is added to liquid medication and medication with a limited use once open. There is now a system in place for management to audit medication and action is taken to correct any problems which are found, records of action taken are made. There were seven outstanding requirements, one new requirement and four recommendations with regard to medications in the last random inspection report. The pharmacist inspector considered that all of the requirements had been met. People were in the main seen to be treated with dignity and respect. All of the people spoken with confirmed that the staff are good. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally enjoy a variety of activities, however, this could be developed further to ensure residents have opportunities to lead a fulfilling lifestyle. They are able to maintain family and other contacts to a good degree should they wish. This ensures they do not become socially isolated. People enjoy a varied menu and the mealtime experience is good, which promotes their health and well-being. Evidence: There is an activities co-ordinator who divides his time between the lounges. Activities available to people are displayed in the corridors and include crafts, gentle exercise, bowls, bingo and current affairs. However, the activities programme on display was for week commencing 24 August 2009 and not week commencing 31st August 2009. It was good to note that care staff also engaged residents in activities. There is an activities cupboard in each lounge and before lunch one member of staff involved residents in a painting session. However, the home does not have a mini bus and there are not many trips out. Relatives are able to visit any time they choose to. They said they are sent minutes of the relatives meetings so that they are kept informed of what is happening in the Care Homes for Older People Page 14 of 27 Evidence: home and that staff give us them full report. Residents can choose to spend time alone or in company and get up at what time they like. For example, late morning, well after breakfast had finished, one resident was being supported by a member of staff to have breakfast. Throughout the visit the care staff were respectful and dignified in their approach to residents. For example, quietly whispering in the residents ear, if they needed assistance to use the toilet, getting down to the level of the residents when talking to them and supporting the residents to walk at a pace suitable to them. However, not all of the staff were dignified in their approach and this was discussed with the manager at the end of the inspection for her to address. The inspector saw that staff offered the residents choices throughout the day, for example, what to eat and drink. We sat with residents during lunch. There was a choice of main meal and the tables were nicely presented with clothe, napkins and condiments. However, there were no menus on display to help people remember what there was to eat each day, which is an area for future development. Some residents eat in the lounge, some in the dining room and some in their bedrooms. A protected lunch policy has been introduced. This involves closing the dining room doors once the meal has been served so that residents can enjoy a quiet mealtime experience with no distractions. This was observed to work well in practise and residents appeared to enjoy the quiet mealtime experience. Staff offered support where it was needed, in a sensitive,discreet manner and residents were able to eat their food at a pace that suited them. Throughout the morning staff offered residents a choice of refreshments which were freely available to people in the lounges. The random inspection report from April contained two requirements which were not assessed at the visit in June. The first was about the need to have arrangements in place to ensure that staff support and assist all service users with their food intake, so that they receive a nutritious and where required a fortified diet which is appropriate to their assessed needs. The second was about the need for food records to be kept in sufficient detail to demonstrate whether the diet was satisfactory. Food records were viewed at this inspection. From the evidence available it was considered that these requirements have now been met. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns and complaints are dealt with appropriately. However the lack of training in adult protection for some staff could potentially place people at risk. Evidence: Information about complaints, how and who to make them to, is made available to the people who live in the home and their families through information displayed in the entrance to the home and in the Service Users Guide. Some of the people spoken with new how to make a complaint, whilst others did not. One person who lives in the home said he did not have a copy of the complaints procedure. Relatives said that they would feel able to complain, and had done in the past about missing laundry. There were 14 complaints recorded since the last inspection. Some of these were dealt with internally whilst others had been referred to Darlington Borough Council. Those dealt with internally had been dealt with in the stated timescales. The staff spoken to during the inspection were asked about abuse and what they would do if they saw or heard anything inappropriate. Whilst people said that they would bring it to the attention of the person in charge. However it was identified that some of the qualified nurses have not received training in this area. As they may be the person in charge, the lack of training could mean that allegations are not dealt with appropriately and people may be placed at risk. All staff must receive training in Care Homes for Older People Page 16 of 27 Evidence: protection of vulnerable adults (POVA.) Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and is decorated and furnished to a good standard. However it has not yet been adapted and therefore is not suitable to meet the needs of people with dementia. Evidence: During a tour of the building we saw that many of the rooms are decorated to the persons own taste and there was evidence to confirm that people can take in some personal items when they go to live there. This includes pieces of furniture as well as photographs and ornaments. St Georges provides a service to people with dementia, however, the environment has not been adapted to meet the special needs of this client group. For example: all of the corridors look the same and there is little in the way of signs to help people find their way around. Grab rails are a similar colour to the walls and although there are signs and pictures on toilet and bathroom doors these are quite small and placed high up and may be difficult for some people to see. The names of residents have been placed on bedroom doors but nothing else, for example pictures or items which may be familiar to the individual, as an additional aid to help some people find their way. We spoke to the manager about this issue. They told us that the home is taking part in a piece of research which involves completing a baseline assessment of the number of falls, the extent to which residents are incontinent and those people who wander. Care Homes for Older People Page 18 of 27 Evidence: The environment is then to be adapted and a further assessment completed to establish if the changes have helped people with dementia in terms of reduced number of falls etc. Toilets are not homely. Boxes of gloves, aprons and wipes are stored on display in these areas making them appear institutional. There was also a strong odour in two of these we looked at. There is currently one member of domestic staff allocated to each of the two floors. However, during the morning we looked in a residents bedroom on the first floor which had bits of debris dirt on the carpet and a hoist whose base was heavily soiled with what appeared to be food debris. When we left the home, late afternoon/early evening, we checked this room again and it still had not been cleaned. Bedrooms we looked at on the ground floor were clean and some benefit from french doors which open onto the enclosed well maintained garden. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from well trained staff, however, further training on the needs of people with dementia is needed. Evidence: The manager told us that for the current occupancy staffing levels during the day were 1 qualified nurse and 5 care staff for 20 people on the first floor, 1 qualified nurse and 3 care staff for 14 people in the downstairs nursing unit, and either 2 or 3 care staff for 10 people on the residential unit. At night there is 1 nurse and 3 carer staff upstairs, 1 nurse and 1 care staff on the downstairs nursing unit and 2 care staff on the residential unit. It was difficult to identify from the rota the qualifications of staff on duty as it only included christian names. The names and qualifications of the nurses on duty should be identified on the duty rota. Through observation and speaking to people , it was identified that there are generally sufficient staff on duty to meet the needs of the people living in the home. However at one point during the morning it was noted that one of the lounges was left unsupervised. A member of staff allocated to the other lounge, when passing, became aware of this and came in to attend to the residents needs. The National Minimum Standards Care Homes for Older People recommends that a Care Homes for Older People Page 20 of 27 Evidence: minimum of 50 of staff are trained to NVQ level 2 in care. Currently only six of the thirty six care staff have achieved this qualification. It is is acknowledged that there has been a significant amount of training since the last inspection, however it is recommended that the training programme continues with regard to NVQ in care. This will make sure that staff have the appropriate skills and knowledge to carry out their duties. The home had staff files in place, which provided evidence that the appointment of a new staff member is in the main made through proper recruitment processes. This includes the vetting of staff through the use of references, protection of vulnerable adults (POVA) first checks and Criminal Record Bureau (CRB) checks. A requirement from the April inspection was that staff must receive training to provide them with the skills and knowledge they need. This was to include safe working practices, the conditions and needs of the service user groups, and elderly nutrition to include the specific needs of dementia sufferers. Staff spoken to said that the training provided was good. One person, who had only been working for the company for approximately six months, said that in this time they had been provided with training in health and safety, moving and handling, protection of vulnerable adults (POVA) and a half day dementia awareness course. Other evidence seen confirmed that other recent training included fire safety, food hygiene, administration of medication, first aid, tissue viability, infection control and pain management. Some of the staff have had basic training in the needs of people with dementia. However none of the staff have had in-depth training to include nutrition, which is important given the home provides a service to people with this specialist need. The manager said that they have arranged for some of the staff to have this. It was identified during the inspection that incidents had occurred where members of staff had been injured whilst dealing with some of the people who live in the home when they had become agitated. Only eight staff have received training in challenging behaviour, this training should be progressed to ensure that staff are supported and competent when dealing with challenging behaviours. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately managed. However the lack of first aid training for some staff potentially places people at risk. Evidence: Since the last inspection a new manager has been appointed. She is a qualified nurse and holds a management qualification. She is aware that she must apply to be registered with the CQC. There was an open and friendly culture between the management team and staff working at the home and staff spoken with confirmed that they have found her to be approachable and supportive. There was evidence in staff files to show that supervision was taking place and that the staff were being appraised. Staff confirmed that supervision takes place on a regular basis. People living at the home and visitors who were spoken to during the inspection confirmed that the manager is approachable and that they would go to her if they had Care Homes for Older People Page 22 of 27 Evidence: any concerns. The home a number of quality assurance systems in place. Regular meetings are held and there are a number of systems in place to consult with people living at the home. Relatives and the people who live in the home can approach the staff at any time. The support manager carries out regular audits covering all environmental and care aspects which may result in improvements being made. Personal finances are kept in the home for people who request this. New procedures have been introduced. Signatures are obtained and receipts are kept to ensure peoples financial interests are safeguarded. The April inspection report contained a requirement about food records. The home were required to maintain records and include sufficient detail to demonstrate whether the diet is satisfactory. Those records seen were found to be acceptable. The inspection in June identified that accidents within the home had not been appropriately managed and resulted in requirements being made in this area. The first was to maintain adequate records of falls and treatment provided to service users. The second was to ensure that staff adhere to safe and appropriate management and emergency first aid procedures. The company were issued with a warning letter telling them what they must do. The training records were in disarray and it was difficult to establish which staff had been trained in first aid. Following discussion with the support manager it was identified that there was not always a first aider on duty. In addition in one set of records seen for one person, it was noted that the care records did not correspond with the accident records. The daily care records indicated that an incident had occurred, but there was no corresponding accident record. The care plan review entry was also different to the daily record as to what had actually occurred. The manager confirmed that all equipment in the home is regularly checked. The maintenance certificates that were seen at this inspection were found to be in order. Health and Safety checks are carried out regularly to safeguard people living and working at the home. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Ensure that revisions to care 30/11/2009 delivery are only made following in depth risk assessment reviews which are fully documented and agreed with management. So that staff know how to look after people on an individual basis. 2 30 19 Staff must receive in depth training on the needs of people with dementia. To make sure that they have the knowledge to meet this specialist need. 31/12/2009 3 38 13 Provide a first aider in the home at all times. To ensure that people receive the appropriate treatment. 11/11/2009 Care Homes for Older People Page 25 of 27 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The prescriber should be asked to provide information when medication has a dose of as directed or when required. This makes sure that the medication is given correctly. The activities programme should be developed to include trips further afield. Menus should be on display to help people remember what is for lunch. The manager should discuss the complaints procedure during meetings so that people are aware of their rights. All staff should receive regular training in safeguarding adults to make sure that people are protected from abuse. Continue to improve environment as planned so that it is suitable for people with dementia. Address the unpleasant odour in some of the toilets. Review domestic hours to make that the home is kept clean and odour free at all times. The current training should continue to achieve a minimum ratio of care staff having an NVQ Level 2 in Care as identified in th National Minimum Standards. The names and qualifications of the nurses on duty should be identified on the duty rota. The lounges should be supervised at all times as per homes policy. Progress staff training to ensure that all staff are supported and competent when dealing with challenging behaviours. Take action and implement systems which provide accurate, up to date and easy access to staff training records. Ensure that the information entered within care records and accident reports corresponds and that any variations are investigated. Continue to progress improvements in the recording of accidents to include evidence of the time last seen when an accident has not been witnessed. 2 3 4 5 6 7 8 9 12 15 16 18 19 20 26 27 10 11 12 13 27 27 30 37 14 37 15 37 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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