Inspection on 22/06/10 for St Michael`s Care Home for the Elderly

St Michaels is a small home, which provides a family environment due to the small number of people who live there. Six bedrooms are single and one is a double, although this has been separated to ensure privacy is upheld. Staff working at St Michaels have been there for a number of inspections and there has been a low turn over of staff, which assists with continuity for the residents. Fifty percent of the present staff have achieved their NVQ training and have also been provided with training to enhance their skills and knowledge. This has helped to improve the quality of life of the residents and they are now more involved in making choices on how their care is to be provided.

What has improved since the last inspection?

Over the past nine months the home has shown gradual improvements and these have generally continued. Many of the requirements and recommendations that had been made have been actioned and the home is now more able to provide evidence to show that they are meeting the Care Home Standards and Regulations. As previously stated the home now has a trained work force who have the knowledge and skills to provide the care required. Records continue to improve in the home and many of the areas highlighted in previous reports have now been actioned.

What the care home could do better:

The assessment and care plans of new residents will need to be developed to ensure they contain all the required information. Activities still need to be developed. There are still limited activities for the residents within the home as a group or individuals. Some improvements have been made, but this still needs to be developed further. The home does not have a routine activities plan to advise residents and relatives of activities that have been organised. The environment of the home needs to be improved. Much of the decoration is beginning to look tired and some of the furniture needs to be replaced. St Michaels has not had a Registered Manager for over two years. This has been a repeat requirement, but has not been actioned.

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: St Michael`s Care Home for the Elderly 20 Meteor Road Westcliff On Sea Essex SS0 8DG 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: Sharon Lacey Date: 2 2 0 6 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 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) © 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 27 Information about the care home Name of care home: Address: St Michael`s Care Home for the Elderly 20 Meteor Road Westcliff On Sea Essex SS0 8DG 01702354735 01702301060 Kennethmgshpd@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Kenneth Ihuoma Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home St Michaels Care Home provides accomodation and care for eight older people with dementia. It is a small family style home. The lounge is situated at the front of the house and dining room overlooks the garden. Toilet and bathroom facilities are on both floors. The home offers six single bedrooms and one double, which has been separated to ensure privacy. Rooms vary in size, but none have ensuite facilites and some would be too small for wheelchair use. A shaft lift provides access to both floors where residents accomodation is provided. St Michaels Care Home is close to local amenities, including transport facilites. There is limited parking on site, but additional parking is available on Meteor Road. Care Homes for Older People Page 4 of 27 Over 65 8 8 0 0 Brief description of the care home The fees for St. Michaels range from £373 to £446, with an average of £424 per week. 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 that people who use the service experience adequate quality outcomes. This was a routine unannounced Key Inspection, which tool place over 6 hours. The inspection looked at the National Minimum Standards and outcomes for the individuals living at St Michaels Care Home. Two random inspections also took place on 9th February and 4th May 2010. This was to look at any improvements the home had made since the last Key Inspection and to also see whether these improvements had continued. As part of the site visit a tour of the home and an inspection of the environment was undertaken. Also records and documentation regarding the running and management of the home were viewed. Areas looked at included information given to prospective residents when they first come into the home, how information is given to staff on the Care Homes for Older People Page 6 of 27 care required, the facilities and environment of the home and any complaints that may have been received since the last inspection. Residents were spoken with during the inspection and their interaction with staff was also observed. Staff members on duty were spoken with informally and any feedback has been included as part of the report. Questionnaires were sent out to residents, relatives, staff and health care professionals. Comment from those returned have been incorporated into the report were possible. 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: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can now be sure that they will be provided with correct information about the home and the services it provides. New residents cannot be sure that they will be have their care needs fully assessed. Care will be provided by staff who now have the knowledge and experience needed to care for those who have dementia. Evidence: The Service User Guide and Statement of Purpose were found in the hallway of the home and both visitors and residents would be able to gain access to these. The Service User Guide had been reviewed on the 8th April 2010 and on viewing this document it was found that it now contained the information required. It was established that the Service User Guide would be given to new residents as part of the assessment process. The last inspection report was also on the wall in the hallway, which enabled residents and visitors to gain access to this information. Care Homes for Older People Page 10 of 27 Evidence: One new resident had been admitted to St Michaels since the last inspection and it was established that they were on a two week respite stay. An assessment form was found on the new residents file and this contained most of the information required. Further information could have been sought regarding the persons abilities and care needs, but it was acknowledged that this was the first assessment to be done since the Proprietor took over the home. This is an area that they will need to develope, to ensure sufficient information is gathered. Two resident files were viewed and these both contained a fully completed written contract/statement of terms and conditions of the home. Guidance on trial visits has now been added to the Service User Guide. Prospective residents, relatives and friends would be given the opportunity to visit St Michaels to assess the quality, facilities and suitability of the home. Intermediate care is not provided at this home. 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. People who use the service will have their personal care and healthcare needs met. Evidence: Over the last year the paper work at St Michaels has been developed to include the information required. All four permanent residents have separate folders, which contain details of their health and personal care needs. The care plans include details of the date of admission to the home, photos of the residents, a document called All About Me, details of the individuals daily routine including breakfast, lunch, tea and bedtime and also general risk assessments. The care plans also contain details of the care required and how the individual resident would like this to be provided. Care plans were regularly reviewed and updated to reflect any changes in care. The care plan of the resident who had recently been admitted had been started, but this needed further development to include all her care needs and how this was to be provided. The staff member in charge was advised to follow the same format as the other residents care files, as these now provided sufficient information about each individual and their care needs. Care Homes for Older People Page 12 of 27 Evidence: Two residents files were viewed and both contained documentation to support that their health care needs were being met. Visits from opticians and chiropodists had been arranged. During the inspection one resident received a visit from a paramedic to attend to a head wound, due to a fall. District nurses do not at present visit the home, due to none of the residents requiring any nursing care. The medication administration systems in the home were inspected at the last Key Inspection (October 2009) and found to be in good order. Medication was not fully inspected during this inspection, but the paperwork and systems for recording were viewed. Documentation had been correctly completed and where medication had been refused this had been clearly recorded. The medication folder contained a photo of each permanent resident, which would assist staff with identification. The medication folder also had examples of staff signatures to assist with any auditing completed or any anomalys found. It was noted that there was one signature on the list of a staff member who the person in charge stated did not at present work at the home. A positive comment from the local Pharmacist stated that St Michaels are never late in ordering their medication. The area around offering residents choice and providing person centered care has been an issue that had been discussed and requirements had been made at previous inspections. When visiting the home now, there is a pleasant atmosphere and staff were observed routinely offering residents choice and gathering their views on how they would like their care provided. Residents were seen being encouraged by staff on duty to participate and helped to make their choices known. During general observation it was felt that the care provided to the residents is now more individual and the staff members involve the residents in making choices where possible. They were asked if they needed the toilet, what drinks they would like with their lunch, whether they were ready for their dessert or if they wanted their lunch later. There was a good atmosphere in the home and the staff are now working to meet the individual residents care needs, rather than meeting tasks and the routine of the home. Staff were also observed spending time with residents, talking to them, holding their hands and encouraging interaction. Those residents with dementia who were unable to hold a conversation smiled, kissed the staff members hands and looked happy. 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. Residents can be assured that their needs will be met in relation to nutrition, but there is still limited ongoing activities arranged. Evidence: Over the last couple of random inspections that have taken place at the home it was assessed that staff are now offering choice and control to the residents over the care they receive. The care provided is not so task orientated and choice is being offered were possible. The issue of activities that are made available to residents has been discussed at previous inspections and requirements and recommendations have been made. Guidance has also been provided to staff on what could be offered. Over the last 6 months some improvements had been made, but there is still room for further development. A leaflet in the foyer of the home stated that a mobile library now visits each Tuesday between 9.55 and 10.25 and the hairdresser now visits on Sundays. Those files viewed had an activity forms, which listed any activities that the individual had been involved in. Evidence on one files showed 21/4/10 - identification of objects, 23/4/10 looked at husbands picture, 26/4/10 clapped hands and laughed, 28/4/10 baked a cake, 30/4/10 rubbed cream in hands, 3/5/10 - played with balloons, 5/5/10 Care Homes for Older People Page 14 of 27 Evidence: - current prime minister, 7/5/10 - parts of body, 10/5/10 - played hoopla and 16/5/10 - refused to participate. On viewing this one residents file, the activities being offered are very sparse and what is being provided is limited and not individual. This is still an area that needs to be developed, especially if new residents are going to be introduced to the home. There is not a set activities programme, which would inform the residents, visitors and family of what activities are to take place on which days. On the day of the inspection two residents chose to sit in the garden to enjoy the sunshine. Tomato plants and strawberry plants had been planted since the last random inspection and the residents were encouraged to participate in their care. The home has a four week menu, which offers a variety of meals to the residents and had been reviewed in February 2010. One the day of the inspection the menu stated that the lunchtime meal was sausage toad, vegetables and gravy and this was confirmed by the staff member on duty. Jelly and ice cream was for dessert. The dining area is pleasant and looks out on to the garden. Tables had been laid with table clothes, there were flowers in vases, paper napkins, salt and pepper, jugs of juice and table mats. The meal was dished up hot and comments included I like it, that looks nice, nice and hot and its very nice. Napkins were provided for those residents who wanted to keep their clothes clean and staff provided assistance where needed with cutting food and encouraging residents to eat. Residents helped themselves to juice. One resident did not want to eat at lunchtime, so her meal was saved until she wanted it later. Nutritional sheets available showed what had been provided and the amount each resident had eaten. These also showed that the residents had been provided with a variety of meals and this included pasta with cheese and ham, beef burgers and roast chicken. When checking the kitchen and freezers and fridges for stocks of food, it was found that there was a good selection of meats, dairy products, dried foods and some fresh fruit and vegetables. It was confirmed that the staff member in charge now does the shopping on a weekly basis and more stocks and choice of food was available. There is a visitors book to sign when entering the home. Visitors are made welcome to the home and it was established that most residents have regular visitors. 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 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 confident that there are systems in place to help keep them safe. Evidence: The complaints procedure could be found in the foyer of the home. This document contained details of the process and also timescales in which the home will deal with any complaints received. Details of the complaints procedure could also be found in the Service User Guide and Statement of Purpose. The home now has a complaint folder and a set form to record details of the complaints, the investigation, any action taken and the outcome. It was confirmed that no complaints had been received since the last Key Inspection in October 2009. Staff had attended safeguarding training and those on duty had an understanding of the issues around whistle blowing and the protection of vulnerable adults. The home also has policies and procedures on safeguarding and whistle blowing. The financial records of two residents were viewed and both were found to be correct. Details of the Southend Advocacy service could be found in the foyer of the home for any residents or relatives who may wish to use this service. Care Homes for Older People Page 16 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. Residents live in a small family home, but it is not at present well maintained and a number of the fixtures and fittings need to be replaced. Evidence: St Michaels is a small family style home. Residents have use of a front lounge, which has a television set and also a music center. Meals are eaten in the dining room at the back of the house. Most rooms are single and have the use of a hand washbasin. During a tour of the home it was noted that some residents bedrooms were personalised with items that they had been able to bring with them, such as photographs, ornaments etc. There is a downstairs shower room and toilet and a separate toilet for resident use. The bathroom on the first floor has an assisted bath chair, and this was in working order on the day of the inspection. A separate toilet is also available on the first floor. There were hand-washing facilities in the toilets and alcohol gel around the home to assist with infection control. The garden is generally tidy and it is now a pleasant area for the residents to sit. Staff have planted tomato and strawberry plants, which residents are involved in their care. Care Homes for Older People Page 17 of 27 Evidence: The general maintenance of the home has not improved since the last Key inspection. This has also been highlighted in the last Random Inspection and no action has been taken. On touring the home it was noted that the decoration is tired in places, skirting boards are chipped, wallpaper is coming away from the walls, paint work is dirty and dusty and there are cobwebs on the ceiling in some rooms. In the upstairs bathroom the staff member in charge was shown the dust hanging from the wallpaper, but when wiping a disposable paper towel over the wall the dust and dirt that came away and on to the cloth. Comment received from the questionnaires included The cleanliness is questionable and the home could do with a redecoration. It was noted that some of the furniture in the residents bedrooms was in a poor condition and some of the wardrobes had not been fixed to the wall; which could be a health and safety issue to any new residents admitted who may be more mobile. Curtains in the residents bedrooms were often still closed when entering and this made the rooms very dark and uninviting. The issue of net curtains in the bathroom was discussed with the person in charge, as they presently have a curtain, which is permanently closed and makes this room dark. The home does not have an ongoing maintenance programme and essential maintenance is only done when a problem arises. Due to no audit of the premises being kept, it is not possible to establish when requests have been made by staff or action taken by management. The person in charge confirmed that no maintenance or decorating had been done since the last CQC visit to the home. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that staff at St Michaels have received training, and there will be cared for by staff who have an understanding of dementia care. Evidence: It was confirmed that there has been a change of person in charge since the last Random Inspection and the previous Manager now only works nights at the home. The Deputy Manager has taken over the responsibility of managing the home, but has not yet applied to be Registered with the Care Quality Commission. St Michaels has been without a registered manager for over two years and this is an on going outstanding requirement. Two staff members were on duty and this consisted of the Deputy Manager and one new staff member. The staffing rota for the week was viewed. The rota was correct on the day of the inspection and on questioning staff on duty they were able to confirm the days they had previously worked. There is now more than one staffing rota kept in the office, so it is possible to establish working patterns of staff. The rota showed that two staff were on duty until 8.00 pm each day. It was noted that some staff were working long hours, which consisted of an 8.00 am to 8.00 pm shift and then a sleep in. This was brought to the managements attention. The person in charge advised that there are two staff on duty at night - one awake carer and one a sleep. Care Homes for Older People Page 19 of 27 Evidence: All staff now have separate files and these contain details of their personal data, training and supervision. One new staff member had been recruited since the last inspection. On viewing the file it was found that all the correct documentation was in place. This included an application form, a medical questionnaire, a POVA first check, references x 2 (friends) and a declaration of criminal convictions. A second member of staff was in the process of being recruited, but had not yet started. It was confirmed that new staff are still completing a two day induction course in London, and documentation was available to confirm this. Documentation was also available to show that the new staff member had started to complete their Skills for Care induction. Looking at the information recorded on the training matrix it was clear that all staff have up to date training and had completed courses on health and safety, safeguarding, infection control, fire safety, medication and first aid. Individual staff had also attended a course on Deprivation of Liberty, dementia activities, challenging behaviour, nutrition of the elderly, the Mental Capacity Act. The Deputy manager had just completed a Developing Positive Management and Leadership Skills workshop. From the evidence gained from the training matrix, this showed that staff were well trained and had the knowledge and skills to do the job required, although two staff required updates on moving and handling. It was confirmed that one staff member had achieved their NVQ3 and another their NVQ 2. One other staff member was working towards their NVQ 3. The Deputy Manager was working towards her NVQ4, but was in the process of changing colleges. Taking this into consideration over 50 of the staff working at St Michaels have now achieved their NVQ training. Care Homes for Older People Page 20 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 management of the home has improved over the last 12 months and this reflects in the care residents will receive. Evidence: At the last inspection is established that the Proprietor planned to make the Deputy Manager the Registered Manager of the home. At the last random inspection it was confirmed that previous manager of the home had now changed her position and did not have the responsibility of the day-to-day running of the home. She was still employed by the home, but was working nights and the occasional day shift. The Deputy Manager has been present for the last two random inspections and also this Key Inspection. She confirmed that she is now in charge and it is intended that she will apply to be the Registered Manager of St Michaels. St Michaels has been without a Registered Manager for over two years, there is an outstanding requirement regarding this and is an area that needs to be urgently addressed. At the last random inspection the Inspector was advised that the Proprietor was Care Homes for Older People Page 21 of 27 Evidence: spending less time at the home, due to other work commitments. The Deputy Manager explained that the Proprietor still oversees the running of the home and finances; but she is in day-to-day control. She confirmed during this inspection that she is now also taking on the role of doing the weekly shop. Two Random Inspections and one Key Inspection has been completed over the last nine months. This was to assess any improvements made to the home and to check that these improvements had been sustainable. During these visits there has been clear evidence that further improvements have been made and the recommendations made at the last two random inspections had been acted upon. It was felt that the home is now meeting many of the Standards and Regulations, but concerns were identified at this inspection around the assessment and care planning process. This is an area that the Management of the home will have to develop, due to no new residents having been admitted previously. The staff are working well together and have been observed offering choice and encouraging residents to do things for themselves. They have also shown that they are aware of the residents care needs and encourage them to be independent where possible. There were details of the quality assurance process in the foyer of the home and a copy of the 2009 QA report was also available. Questionnaires for 2010 have been completed, but the report had not yet been written. Minutes of the last Resident meetings was made available and this took place on the 8th May 2010. The home has a system in place for the financial interests of the residents. Two residents monies were requested and checked; no anomalies were found. It was established that there are systems in place to supervise both the Deputy Manager and also the care staff. The last staff meeting took place in May 2010 and minutes were made available. The Deputy Manager had produced a supervision matrix and when looking at staff files there was clear evidence that regular supervision had taken place. Individual records are now available for both staff and residents. There have been ongoing improvements for record keeping over the past 12 months and deputy manager has introduced systems to ensure that there is documentation available to evidence practice and procedures within the home. The home is now able to supply written documentation to show that the National Minimum Standards are being met. Discussion took place with the Deputy Manager on how she can ensure that the relevant documents are available on future inspection visits, especially when shes not on duty. Care Homes for Older People Page 22 of 27 Evidence: The Home now has a folder, where the safety certificates for the home are stored. On viewing the file this contained documentation to show checks had been carried out on fire alarms, fire extinguishers, the lift, insurance, fire drills, emergency lighting, water temperatures, risk assessments, Legion ella checks, gas certificate and fire visits. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 33 Regulation 24 The registered provider shall 30/09/2010 (1)(a)(b)(2)(3 appoint an individual to ) manager the care home. This is to ensure that residents live in a home that is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. They should be qualified, competent and experienced to run the home and meets its stated purpose, aims and objectives. This is a repeat requirement, previous timescales of 30/09/09 and 18/01/10 have not been met. New timescale set. 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 19 23 The premises must be of a good state of repair externally and internally. All parts of the home must be kept clean and reasonably decorated. This is to ensure that residents live in a safe, well maintained environment. 31/01/2011 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 3 This assessments process of new residents needs to be developed. The assessment form completed must gather sufficient information about the individuals abilities, health needs and care needs, so that an appropriate plan of care can be written for the individual. Care plans need to be continually developed, updated and ensure they reflect the care required and how it is to be provided. Any new residents admitted will need a care plan that reflects their needs and provides all the required information. Activities is still an area that needs to be developed within Page 25 of 27 2 7 3 12 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 the home. Residents should be offered individual activities that are relevant to their interests and also offer stimulation. 4 12 Recommend an activities programme is produced so that staff, residents, relatives and visitors are aware of the activities that are to take place and when. Please ensure that staff do not work too many consecutive hours as this may cause health and safety risks to both themselves and also to the residents. 5 27 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. 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