Inspection on 31/12/09 for St Marys Nursing Home

This is the latest available inspection report for this service, carried out on 31st December 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Marys Nursing Home 15/04/08

St Marys Nursing Home 09/08/07

St Marys Nursing Home 05/06/06

St Marys Nursing Home 10/11/05

St Marys Nursing Home 18/04/05

St Marys Nursing Home 26/10/04

St Marys Nursing Home 26/05/04

St Marys Nursing Home 07/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: St Marys Nursing Home 327 Main Rd Sidcup London DA14 6QG     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: Rosemary Blenkinsopp     Date: 3 1 1 2 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 30 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 30 Information about the care home Name of care home: Address: St Marys Nursing Home 327 Main Rd Sidcup London DA14 6QG 02083027289 02084607393 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: St Mary`s Care Home Ltd care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care home with nursing (CRH - 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 Date of last inspection Brief description of the care home St Marys Nursing Home is registered with the Commission for Social Care Inspection to provide nursing care for 20 Older People. The home is situated on a main road in a residential area of Sidcup close to local shops and bus routes. The detached two-storey house was not purpose built. It has five double and one single bedroom on the ground floor and nine single bedrooms on the first floor. One of the bedrooms has en suite facilities the remainder have washbasins with hot and cold water. Communal areas include a lounge, separate dining room, kitchen and laundry area. Care Homes for Older People Page 4 of 30 Over 65 20 0 0 3 0 3 2 0 0 9 Brief description of the care home Adequate bathing, toilet and sluicing facilities are provided. At the rear of the building there is a garden for residents. use, which is wheelchair accessible. Visitors can park on the front drive or in the side roads. The current fees ranged from £572.00 - £600.00. Residents paid privately for personal items, hairdressing and chiropody services. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection visit and was carried out over a one day period by one inspector and one Regulation Manager. The inspection covered all the key standards in the National Minimum Standards. Following the inspection the manager had completed the AQAA and forwarded this to the CQC. The AQAA contained good information regarding the service. Six comment cards were received all from residents living in the home. During the visit we met with several relatives and residents. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. Care Homes for Older People Page 6 of 30 A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. The manager and all the staff were very helpful and they are to be thanked for their assistance over the course of this inspection visit. The homes Registration Certificate with the Commission was seen displayed appropriately. There have not been any changes in the ownership of this Care Home since the last inspection. No enforcement activity has occurred since the last inspection. An overview of the site visit was provided to the manager at the end of the inspection. Six requirements have been made as a result of this inspection. Five recommendations have been made. Feedback on the requirements and the recommendations was given verbally to the manager above at the end of the inspection visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents needs are assessed before any decision is made about placement at St Marys Nursing Home. Information is available to staff from which an initial care plan can be developed. Evidence: We inspected several of the residents files over the course of this inspection and found that for all these people their needs had been assessed before moving into the home. The assessments, we were told, are usually carried out by the manager- Mrs Lallchand or a senior staff member. Standard assessment formats had been used that identify the persons physical, mental and social care needs. The assessment information we saw was signed and dated by Mrs Lallchand. The information was to a reasonable standard, and from which an initial care plan could be drawn up. One file contained the pre-assessment Care Homes for Older People Page 10 of 30 Evidence: information but the observational chart and the manual handling assessment were not completed, these need to be completed within 48 hours of admission. Files contained an admission details form which gives personal and contact details relating to the residents next of kin etc. There were copies of the Community Care Assessment retained for each resident who is funded by the Local Authority. There was little in the way of records relating to trail visits of overnight stays which enable residents to sample the service beforehand. The Manager did say that many relatives visited the home prior to admission although the frail condition of residents prevented many from taking up these opportunities. The Service User Guide was available and contained information about the home, including the philosophy of care. Within the complaints section the information was not current and needs to be amended to reflect the correct address and organisation namely the CQC. The Statement of Purpose will also need to be amended. Standard 6 does not apply to this home. The AQAA told us the following about their procedures : A pre admission assessment is undertaken for all new residents by the manager or by a designated qualified nurse. Information is obtained from the care manager or commissioning team regarding summary of any assessment undertaken and a care plan. Residents who are privately funded are provided with a contract and a statement of terms and conditions of the home. Information about fees and extra charges are explained and reviewed and kept up to date. Contracts are provided for all residents placed by social services and placement are reviewed after four to six weeks. Where both parties are satisfied, an annual review takes place to monitor progress. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents may be assured that their health and social care needs will be set out in an individual care plan and that their health needs will be met. The practice and recording of medications, introduces an element of risk to residents. Evidence: Inspection of the residents files showed that for these residents, a care plan has been drawn up that set out how their individual needs were to be met. Standard format care planning documentation has been used that is appropriate and fit for purpose. Care plans were sampled. The home has introduced a new system for care planning and this was more comprehensive than the previous system. The care plans covered the activities of daily living and the interventions to address the identified issues were good. There was a separate sheet covering social and psychological needs. Daily records and care plan evaluations were also recorded. Risk assessments covered areas relating to manual handling, nutrition and skin Care Homes for Older People Page 12 of 30 Evidence: integrity. Each resident has their observations checked monthly as well as their weight. On the majority of those charts viewed, no significant weight loss was indicated. In one care plan however, we found that there was evidence the resident had lost weight gradually and sustained, yet there was no further information on the action taken, including referral to dietitian, although the manager said the daughter had been advised of the situation. All action must be taken and recorded to ensure residents health issues are addressed. One care plan was without the date it was formulated and the staff signature was omitted. There is as separate sheet in the files which is a Care plan Agreement and this had the residents and relatives signatures to confirm agreement with the care plan. There were records of health professional visits, which indicated who attended and when. In addition there were letters relating to hospital appointments and domiciliary visits by the optician. The clothes we saw were in many cases marked with black marker pen some of the marker pen was used on the item of clothing itself. An alternative method of marking clothes should be found to ensure residents are afforded dignity. The AQAA told us the following : A key worker is allocated to provide support to the individual resident, keep the care plan up to date and make sure that other staff are aware of current changes in the care plans. The care plans are reviewed monthly. The residents are informed that they can view their records any time and made aware of their rights and advocacy services are encouraged. As we arrived the morning medications were being addressed by the qualified nurse on duty. The medication trolley was located in the ground floor office as was the qualified nurse. We stood outside of this office as there was limited space, and the nurse was observed to sign all of the medication charts at one time instead of after each medication that had been administered. We observed this for some while and she continued with the practice for all of the charts. On checking the medication administration charts some were without the residents allergies completed. It is important that allergies are completed as this may pose a danger to the residents. Care Homes for Older People Page 13 of 30 Evidence: On one chart the paracetamol was indicted as two tablets every six hours yet only two times, in the 24 hour period, were identified for administering the medication. If it is the case that a GP prescribes the medication every six hours, it should be administered as such. In the event that the resident does not require the medication that frequently then it should be reviewed by the GP and reduced. Records for medications received into the home were in place. There was a lot of confusion over the Collagen supplement which was in use. It appeared that the resident was prescribed 30 mls three times a day. The bottle was dated 21/11/09 as issued yet it still had about half left. This supplement should be used within 14 days of opening. It was unclear if the resident was receiving the appropriate amount of the supplement and whether the Collagen was fit still to be used, if it was opened longer than fourteen days. Other bottles of Collagen were also in stock. Eye drops in use were dated on opening. We were advised that no residents self medicate nor have the home any controlled Drugs in use. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged to maintain contacts with their friends and families. The meals and food provided to residents is varied, although the condition of the kitchen needs to be improved. Evidence: In the lounge there were 11 residents the TV was playing. The room was decorated with Christmas decorations. Several residents in the lounge were sleepy even though the TV was playing. There was a selection of daily newspapers for residents to read. Fluids were available and several residents had knee blanks and had knitted bed socks on. The hairdresser was in she attends the home weekly and has done for some time. She said she enjoyed coming to the home and the residents were always pleased to have their hair done. Apart from the hairdresser there were no other activities taking place. One residents comment card suggested more afternoon activities would be beneficial. The manager said a review of activities, involving residents and relatives was taking place. Care Homes for Older People Page 15 of 30 Evidence: We met with two residents, a husband and wife, who were in their bedroom. They had fresh fruit biscuits and drinks at hand. This room had a view of the garden and a ramp to access it. They were very satisfied with the level of care they received saying,wonderful staff they have. Relatives were seen to come and go throughout the day spending time with the residents either in the communal areas or their bedrooms. We interviewed relatives,one stated that he found the staff very caring and the manager was attentive and concerned. The relative visits the home daily. The AQAA told us the following : Residents interests are recorded and they are given opportunities for stimulation through leisure and recreational activities in and outside the home to suit their needs, preferences and capacities. A Priest visits on weekly basis and some residents receive weekly communion. Records are kept on activities undertaken by residents. The menu was on display. There was a choice of a hot meal at lunchtime, the evening main meal seemed to be soup and sandwiches, which we were advised, residents prefer and any other food request can be accommodated. The menu should be kept under review was this may not be to everyones liking. The lunch was served, and three residents had it in the new dining room. The meal looked appetizing and a glass of sherry was served with it. We looked at the kitchen after the serving of lunch, crumbs and detritus were evident on the floor both in the morning and in the afternoon. The previous inspection of the kitchen by the Local Authority mentioned a similar problem when they inspected last year. A deep cleaning is required and it must be maintained in a hygienic condition. The manager stated that extra cleaning hours had been allocated specifically for cleaning of this area, however this had not rectified the situation. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that the home will deal with complaints appropriately, information about the complaints procedure is readily available, although records relating to complaints need to be more comprehensive. Residents cannot be assured that the processes in the home will protect them from potential abuse by staff or others. Evidence: There was information available throughout the home on how to make a complaint in the form of the complaints policy, and this was included in other documents. This policy covers all the essential areas required for a complaints policy, including a staged process with timescales and contacts for other agencies, in the event of dissatisfaction with the internal process of investigation. The Regulatory Authority has now changed to the CQC, this needs to be updated as does the contact details in these documents. The last complaint on file was dated January 2009, and no further records of recent complaints were available. The manager said there had been no complaints since that time. The actual records needed to be more comprehensive to ensure a full audit trail can take place starting with the initial complaint, through to the investigation and outcome. In addition, there needs to be a record to indicate if the complainant is satisfied with the outcome or not. Care Homes for Older People Page 17 of 30 Evidence: Relatives and visitors indicated that they would speak to staff in the event they had any issues that needed dealing with. Staff were asked during interviews how they would action suspected or actual abuse and what they thought whistle blowing was about. The level of knowledge was variable some staff having a working knowledge, whilst others had very little. However, overall the staff who we asked were unable to demonstrate sufficient knowledge of the policies and procedures to afford proper protection to the residents. Not all those staff asked indicated that they would report incidents of abuse and they only had limited knowledge on external organizations whom they would contact. When this was fed back to the manager she was surprised as extra training on the subject had been provided following the last inspection. Two staff interviewed said that they had not received training on abuse or whistle blowing. Staff need to be updated regularly to ensure their knowledge is up to date. The AQAA told us the following : The service has a complaints procedure and this is displayed in the hallway. A copy of the complaint procedure is supplied to every new resident on admission. There has been a low level of complaints, mostly expressed as minor concerns which have been addressed immediately. Residents reported through the survey that they feel happy and safe. All complaints made were recorded and investigated and action taken. Some of the residents with mental capacity know who to make the complaint to and relatives are aware of the complaint procedure. Policies and procedures regarding safeguarding adults and whistle blowing are available to staff and give clear guidance about what action should be taken. Training is provided and documented. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with comfortable, homely accommodation in which to live. The recent upgrading of all areas has significantly improved the home to benefit the residents who live there. Evidence: The service is a large detached house located in Sidcup on a main road. It is well served by buses, and the high street and train station are both a bus ride away. The home is located over two floors with communal space on the ground floor and bedrooms on both. There are 5 shared bedrooms all on the ground floor. Shared bedrooms have curtain dividers. Residents are able to personalise their bedrooms and this was evident. The environment had significantly improved since the last inspection. New carpets, re decoration and replacement furniture had all been addressed. There were new four seater dining tables and chairs which replaced the larger dining tables they had previously. We were advised that new curtains and soft furnishings were on order. There were clocks and calendars in several areas which are a good prompt to orientate residents. Care Homes for Older People Page 19 of 30 Evidence: Perhaps because of the refurbishment some of the bathrooms were congested with equipment, for example bathroom 9 had three wheelchairs, zimmer frames and a chair in it which would make access very difficult. The majority of the areas were clean although the level of hygiene in the kitchen was not adequate and is referred to earlier in the report. The AQAA told us the following : There is a maintenance programme and the home is decorated and painted regularly. Bedroom furniture has been replaced with new furniture. Residents are encouraged to personalise their bedrooms. Bedrooms are shared by agreement with the people concerned. They are given the choice of moving into a single room when one becomes available. Screens are provided for privacy and there is evidence of personal belongings in the rooms. Care Homes for Older People Page 20 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that the numbers of staff and the skill mix that they provide at St Marys Nursing Home, will meet their needs. The recruitment policy and procedures protect residents living in the home. Staff are being offered training, and when the new training package is operational residents will be able to be assured that the staff are fully competent to do their jobs. Evidence: The duty rota showed that one qualified nurse and three care staff worked during the day time period. One of the qualified staff was doing long days, which when interviewed, she said she prefers. The qualified nurse said that she had been working in the home for many years. She confirmed she had received training and updates on the statutory topics. In addition she had attended externals training including updates on wound care and tissue viability. Supervision was conducted by Mrs Lallchand. She felt that there were enough staff to provide care and sufficient equipment provided. The home has just purchased a new training package through an independent company. This was seen and looked to provide training on the mandatory topics as Care Homes for Older People Page 21 of 30 Evidence: well as that specific to care of the elderly. All staff will receive training through this company and they will receive certificates once they have completed topics. One care staff interviewed had completed NVQ level 2 and was hoping to start level 3. They confirmed that they received updates on mandatory topics such as fire, manual handling and infection control. The staff member had a good knowledge of infection control procedures. The manager advised us that 50 of staff had completed NVQ level 2 training, with four staff due to start level 3, early 2010. In addition two staff were going for first aid updates and the manual handling trainer on night duty, was going for his update refresher course. One ancillary staff interviewed said they had completed the basic food hygiene course, although was unable to confirm that she had done any other training. All staff must be kept updated on the mandatory topics including abuse and have sufficient skills to do their job. Six residents surveys were received and several were very positive about the staff. Comments such as the care staff are helpful and caring and we are well looked after were two such comments. Staff personnel files were sampled including those staff with whom we had met. The files contained relevant documents, although as with all records we viewed they needed organising. We did comment that one employee, a care assistant from India had some evidence that she had leave to remain in the UK, although Mrs Lallchand needs to be aware of any conditions attached to the work permit, for example if she is a student she would only be allowed to work a limited number of hours. Records need to be retained to evidence and restrictions on working. The files contained checks on identity, Criminal Record Bureau clearance and some training certificates were retained. The home must retain the POVA first check which is obtained when staff first start and before the CRB is obtained. In addition CRBs should be repeated every three years. References must be authenticated by way of a company stamp or on an official letter head, and written by an appropriate person. The AQAA told us the following : There is a staff development training programme in place. Staff receive relevant training that is focused on delivering improved outcomes for residents. All mandatory training is provided and staff are updated regularly. Care Homes for Older People Page 22 of 30 Evidence: Supervision of staff, and staff meeting takes place regularly. Staff are encouraged to undertake external qualifications beyond the basic requirements. Over 50 of care staff are NVQ level 2 and some have completed level 3. All staff employed have police checks and satisfactory references. The home has an in house trainer for manual handling and infection control. The home recognised a good recruitment procedure to be followed for the delivery of good quality services and for the protection of the individuals.All new recruits have an induction programme. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced individual who promotes an open ethos. Health and safety practices introduce an element of risk to residents. There are policies and procedures of this home regarding residents financial affairs and records are retained for transactions. Supervision practices are limited and need further development and improvement. Evidence: Mrs Lallchand is the manager and she and her husband own the home and have done for many years. Mrs Lallchand is a professional person with many years of looking after elderly residents, in this type of setting. She has an open door policy and relatives are encouraged to speak with her at any time. The health and safety service certificates were inspected . The employers liability Care Homes for Older People Page 24 of 30 Evidence: certificate was on display. Service certificates for the hoists were current. The lift was being repaired as we arrived and the last routine service was September 2009. There were some certificates which we were unable to locate and immediate requirements were left. In particular, the certificates for the safety of the gas appliances, boilers and pipe work as well as the legionella certificate needed to be provided. Immediate requirements were left as follows: The certificates need to be provided to confirm gas safety and legionella testing have take place. The home needed to tell us in writing by 04 January 2010, what they would do to meet the requirements described above, to date no certificates have arrived although the owner has telephoned the CQC telling us that the certificates have been sent to the central office in Newcastle and these confirm the works have been completed. The ground floor cupboard locate under the stairs was unlocked and this had items in it. The cupboard remained unlocked for some time and it was easily accessible. Fire records showed weekly fire alarm testing as well as emergency lights. Fire drills were conducted November, July and January 09, all those attending signed to that effect. Fire servicing of extinguishers and the fire panel was undertaken September 09. The fire risk assessment needed updating in light of the building work taking place. In the kitchen next to the boiler was a tin of white spirit . The surface of the boiler was hot and this may easily have caused combustion. This was pointed out to the manager and it was removed immediately. It was of concern because at this point there was no cook in the kitchen, and possibly it may not have been detected if we had not gone back to check the cleanliness of the kitchen. Mr Lallchand advised that he had developed an annual quality assurance survey. These had been sent out to staff residents and relatives. A sample of the surveys was available as were some of those completed. The report on the findings of the responses was not yet available. In addition, the owner plans to put a communication boarding each room for comments and queries to be written down by relatives, and which the staff will Care Homes for Older People Page 25 of 30 Evidence: answer. Staff meetings are held every three months. Residents and relatives meetings are also arranged although the minutes of these were not on site to view. Supervision records indicated regular sessions took place and the two parties signed them. The notes relating to the discussion were very brief, one simply said Fire lecture, it is recommended that more records be made. Residents finances are safely stored in the homes safe. Each resident has an individual book for records to be kept. The chiropodist produces one receipt with residents expenditure individually itemised. The hairdresser signs the book and the amount, although no receipt is produced. Two staff sign transactions. The receipts were disorganized,and in those checked it was difficult to cross reference them with the records. All records must be retained in an orderly fashion so information is easy to access. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 Medication records must be signed immediately after each resident has taken them. To ensure records are accurate. 28/02/2010 2 9 13 Medications must be signed immediately after administration. To ensure records are accurate . 28/02/2010 3 9 13 Medications must be used before their expiry dates. To ensure that residents receive medications which are safe to take. 28/02/2010 4 14 23 The kitchen must be kept clean and free from debris. To make sure that food served to residents is safe. 28/02/2010 Care Homes for Older People Page 28 of 30 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 5 16 22 Records relating to 28/02/2010 complaints must be retained in a comprehensive manner. To ensure all information is accurate and complete. 6 18 13 All staff must be trained and 30/04/2010 have sufficient knowledge on dealing with abuse. To afford protection to residents. 7 38 23 All aspects of health and safety must be addressed. To ensure residents live in a safe home. 28/02/2010 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 2 3 10 12 18 Clothes should be marked in a way that affords residents dignity. More activities should be provided to ensure residents recreational needs are met. Regular training and updates on adult protection and whistle blowing should be provided, as changes in practice occur frequently, and staff need to have up to date knowledge to take appropriate action. CRBs should be repeated every three years. Supervision records need to be more comprehensive relating to the points of discussion and cover all aspects of standard 36.3. 4 5 29 36 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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