Inspection on 08/01/10 for The Fearnes

This is the latest available inspection report for this service, carried out on 8th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Fearnes 13/08/07

The Fearnes 25/07/06

The Fearnes 22/02/06

The Fearnes 06/10/05

The Fearnes 18/01/05

The Fearnes 01/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 11/04/2010.

Key inspection report Care homes for older people Name: Address: The Fearnes 26 Knyveton Road Bournemouth Dorset BH1 3QR     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: Jo Johnson     Date: 0 8 0 1 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 31 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 31 Information about the care home Name of care home: Address: The Fearnes 26 Knyveton Road Bournemouth Dorset BH1 3QR 01202296906 01202310065 fearnes@care-south.co.uk www.care-south.co.uk Care South care home 40 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 40 in the category OP including up to 30 in the category DE(E) and up to 10 in the category MD(E) Two named service users (as known to the CSCI) in the category LD may be accommodated. Two named service users (as known to the CSCI) in the category LD(E) may be accommodated. Date of last inspection Brief description of the care home The local County Council built The Fearnes as a residential care home over 20 years ago. It is now part of Care South formerly known as The Dorset Trust. The home is located in a residential area of Bournemouth close to the central shopping area and the travel interchange. The Fearnes is registered to provide care and accommodation for Care Homes for Older People Page 4 of 31 Over 65 30 10 40 0 0 0 Brief description of the care home 40 older people and this includes 30 residents with dementia. The home is divided into four separate houses - Oak Way, Beech Way, Willow Way and Lilac Way. The three houses with residents who experience dementia have magnetic keypads fitted to the entrance to minimise the risk of wandering. Each unit has 10 bedrooms, a lounge, and a dining room and kitchen area. Assisted bathing and shower facilities are available and separate toilets are located close to residents bedrooms. The accommodation is available over two levels - ground floor and lower ground floor. Accommodation is provided in single bedrooms with vanity unit style washbasins fitted for use in each room. The home is decorated in a homely way and is comfortably furnished.The Fearnes is gradually being extensively refurbished and developed, current improvements include upgrading the laundry, relocating the homes hairdressing room and improving the assisted bathing facilities in some bathrooms. The spacious and inviting entrance hallway has additional seating and a piano and provides a useful central focus to the home. The home has a passenger lift to enable easy and level access to both floors. The home has front and rear gardens with raised flower borders, mature shrubs and garden seating. A driveway to the front of the home provides off road parking. Care Homes for Older People Page 5 of 31 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 focus of inspections undertaken by us is upon outcomes for people who live at the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The manager supplied the commission with an AQAA (Annual Quality Assurance Assessment). Information from this has been used to make judgements about the service, and have been included in this report. Surveys were distributed by the manager to people who live at the home. Seven surveys were returned and six of Care Homes for Older People Page 6 of 31 which were completed by relatives. The findings of these surveys have been included in the report. This inspection visit was unannounced (we did not let the home know that we were coming) and took place on 8th January between 10 am and 4.30 pm. The manager was present throughout the inspection. The inspection was conducted by two inspectors and involved observations of and talking with people who live or were staying at the home, the staff on duty and the manager. Four people were identified for close examination by reading their care plan, risk assessments, daily records and other relevant information. This is part of a process known as case tracking, where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. Because people with dementia and/or complex needs and ways of communicating are not always able to reliably tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this Short Observational Framework for Inspection (SOFI). This involved our observing up to five people who live at the home for two hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. We observed five people with dementia and/or communication needs in the lounge and dining area of Lilac living unit. The two-hour period included lunchtime. This inspection was carried out by two inspectors, but throughout the report the term we is used, to show that the report is the view of the Care Quality Commission. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care and support monitoring records for people need be completed and regularly reviewed. Action needs to be taken when records show that peoples health or well being is not being maintained. The medication recording systems need to be made safe. This is so that staff record that people have received their medications as prescribed. Staff need to acknowledge people as individuals and with respect at all times. People need to be given choices in all aspects of their lives. This is to make sure that people Care Homes for Older People Page 8 of 31 are acknowledged and are given the respect they deserve. Some people need to be provided with suitable stimulation and have the opportunity to be occupied. The impact of the poor dementia care skills of one of the staff and one of the agency staff need to be closely monitored by the manager and management team to make sure that people are receiving the right care and support to maintain and enhance their well being. 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 31 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 31 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. People who are considering moving into or staying at the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: The statement of purpose and service user guide have been recently updated and are available in the entrance area of the home. The manager told us that people and or their families come and visit the home before making a decision about moving in. The manager or deputy manager undertakes a pre admission assessment before determining whether they can meet someones needs. A fuller assessment, risk assessments and a social history assessment are completed with people as soon as they move in. From this a care plan is developed. Care Homes for Older People Page 11 of 31 Evidence: The assessment for the last person to move into the home was seen. Information was sought from care management assessments, and where appropriate other health professionals. All of the surveys from people told us that they had enough information about the home and have a contract. The home does not offer intermediate care. Care Homes for Older People Page 12 of 31 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. The health and personal care that people receive is based on their individual needs and is in the main detailed in care plans. The shortfalls in medication management potentially put people at risk of harm from non administration or mis administration of medication. The care and support people get from some staff is not given in a way that maintains their individuality and dignity. Evidence: We looked at four peoples care records, one person from each living unit. The care plans seen were of a good quality and detailed how staff were to meet peoples needs. They included assessments for any areas of risk and the action staff need to take to minimise these and the how often to monitor for any changes. Risk assessments were completed for falls, tissue viability, mobility, and nutrition. People were weighed on admission to the home and this was recorded in their plans. There was additional Care Homes for Older People Page 13 of 31 Evidence: information available on medical conditions. Three of the four care plans had been reviewed on a monthly basis and as and when peoples needs have changed. Short term care plans were implemented when people had urine infections or other short term needs. However, one person who moved into the home at the end of November 2009 had not had their care plan reviewed. As the care plan had not been reviewed it had not been picked up that the individual had lost 5 kilos since their admission. Two of the people being case tracked had fluid monitoring charts in place. Some were incomplete or the individuals fluid intake had not been totalled. There was no obvious system or way that showed how these records were being monitored to ensure that people had sufficient fluids each day. Peoples care plans included a brief life history and pen picture so that staff have some basic information about people and who is important to them. One persons care plan included a very detailed written life history. Staff told us this was very useful in understanding the individual and their life history. They said that most people had photograph albums in their bedrooms. The daily care records for people seen were mainly task focused and did not all reflect how people are spending their time at the home. Staff should record how people have been spending their time. This is so records give a more accurate reflection of peoples day to day lives and not just the care and support provided to them. The surveys from people told us that they always (6) or usually (1) receive the support and care they need. Discussion with the staff, a relative, surveys and observation of care plans and daily records tell us that people living in the home have access to health professionals such as GP, dietician, dentist and specialist consultants and chiropodist. One inspector observed people for two hours in one living unit and the other inspector observed people for short periods on two other living units. The findings of the observations were very different. In the main staff supported people in a sensitive way communicating with people and involving them. However, during the two hour observation on one living unit overall we observed very poor practice in the way that staff supported and cared for people. The two staff working within this unit did not interact with individuals, explain to them what was happening when they provided support or personal care, they did not Care Homes for Older People Page 14 of 31 Evidence: acknowledge peoples requests of cues. For example; when one individual turned their head away and said no to any more food the staff continued to feed them without talking to them. Staff did not speak to people or acknowledge them when they moved them from one place to another. Staff did not speak to people whilst they were being fed and one person was fed cold food. There were long periods of time when the staff did not interact with people and continued with tasks such as making drinks and laying the table. There are a number of people who have bed rails in place for their safety. There are risk assessments in place for these rails. The Registered Provider has advised us that there are appropriate systems in place to monitor and ensure safe use of bed rails throughout the home. The medication and the records for the four people being case tracked were seen. The home uses a monitored dosage system for medication. There are no controlled drugs in use at the home. Staff have been trained in the administration of medication. Staff who administer insulin have been trained by the district nurses. There were PRN as needed medication plans in place. There were gaps in both cream charts and insulin administration records within peoples care plans. These recording systems need to be reviewed so that there are accurate records of administration and people have their medication and creams as prescribed. Care Homes for Older People Page 15 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people who live at the home are able to participate in social activities and are given choices to maintain their quality of life. Some people with dementia who live at the home have very little opportunity to participate in daily living or stimulating activities. Evidence: There is an activities co-ordinator employed to work at the home 20 hours a week. The manager told us that they work flexibly. There was a range of activities displayed for the week this included crafts, bingo, individual stimulation and scamp the dog visiting. On the day of the inspection there was a game of Bingo in one of the living units. Some people from other living units joined in. There are photographs albums of the activities that have been held at the home. The surveys from people told us that the home always (2) or usually (4) or (1) sometimes arranges activities that they can take part in if they want. There a a number of people on one living unit who are at the later stages of dementia and are very physically frail. There was not any sensory environments or tactile and Care Homes for Older People Page 16 of 31 Evidence: sensory activities freely available for these individuals. During the two observation staff interactions with the five people being observed were only related to the task being undertaken. There was no conversations with people. As previously identified there were a number of poor interactions from staff. This included not acknowledging and ignoring people, giving people food or drink without talking at all and tapping people on the arms without saying anything. However, all of the good or neutral interactions related to tasks either drinking, hoisting, mobilising or lunch. Overall people during the observation were in a passive or withdrawn state of being. It was unusual not to have more positive states of being linked to staff interactions. This may have been due to the interactions being task focused and staff not communicating with people. The only positive reaction to staff were when the deputy manager or care team manager spoke with people. At all times during the observation there was at least one member of staff in the lounge. However, the level of staff interaction remained very low. Photographs of meals have been produced so people can make a visual choice of meals. However,some staff did not remind people what they had ordered for lunch or what they were eating. One one living unit, people were sat at the table from 12 pm and lunch was not served until 12.30 pm, except for one person whose pureed/soft meal was placed in front of them at 12.10 pm. This person was still being periodically fed spoonfuls of this meal at 1.10 pm by which time it would have been cold. Staff did not sit with this individual so assist them to eat but walked over and just fed them spoonfuls of food without explanation. People were not involved in the preparation for lunch such as laying the tables and glasses of juice were just put in the tables before people were seated. On the same unit staff just put on peoples aprons without explaining what they were doing or checking whether they wanted to wear an apron. Current good practice recommends that serviettes or napkins be used to protect peoples clothes rather than tabards which can appear institutional. The meal times on the other living units was much more relaxed with staffing sitting Care Homes for Older People Page 17 of 31 Evidence: with people and talking whilst they supported them to eat. They were given choices of drinks and reminded what they were eating. People actively participated in the clearing up after the meal and one person swept the floor. The surveys from people told us that they always (6) or usually (1) like the meals at the home. Care Homes for Older People Page 18 of 31 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. Complaints procedures make sure that peoples, relatives and representatives concerns and complaints are listened to and acted upon. A staff team who have a good knowledge of how to respond to any suspicion of abuse and to keep people safe from harm support the people living at the home. Evidence: The home has a formal complaints policy which is accessible to people and their families. People are encouraged to raise their concerns with the manager. Relatives spoken with and surveys told us that people know who to speak to if they are unhappy and they know how to complain. We looked at the complaint records kept at the home. There has been five complaints since the last key inspection. There were good clear records for all of the complaints including the investigation, the outcome and the actions taken to reduce any recurrence. Staff have attended training in the Protection of Vulnerable Adults (POVA) so that they are aware of the different ways vulnerable people are at risk of abuse, and would know how to respond. Staff spoken with told us that they were confident on how to whistle blow and how to report any allegations of abuse. There have been no safeguarding referrals or investigations undertaken by the local Care Homes for Older People Page 19 of 31 Evidence: authority since the last key inspection. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained and furnished so that people live in a relaxed, homely and comfortable environment. Evidence: The home is divided into four separate units three of which are for individuals who have dementia. Each unit has its own dining area and lounge with facilities for the making of refreshments and snacks. We looked at some of the bedrooms of the people involved in case tracking. They were clean and well furnished. The rooms were personalised with their own belongings. Some of the bathrooms were clinical looking and may not be inviting relaxing areas for people with dementia. The manager told us in the AQAA that the following work has been undertaken since the last key inspection; We had a room that was a little dark and we have worked to resolve this through redecorating and new lighting. We have made the home a brighter environment by redecorating all corridors in particular changing the dark wood doors to a bright white this is still a work in progress. We have introduced more pictures onto the lounges including those of Hollywood stars which are changed from Care Homes for Older People Page 21 of 31 Evidence: time to time so as to generate renewed interest from the residents. We have had our conservatory redecorated and new blinds fitted. A number of hot surfaces (radiators) have now been covered. A risk assessment has been completed and radiators identified as posing a high risk have been covered. There is now a plan for all of the radiators to be covered throughout the home. The manager told us that the bedroom radiators are being prioritised. Equipment is available to assist people and staff in the delivery of personal care, which includes assisted baths, profiling beds, accessible showers and moving and handling equipment including hoists. The laundry room was clean, tidy and well organised. All of the washing machines were in working order. Systems are in place to reduce the risk of infection. Disposable gloves, aprons are available and used by staff when handling soiled linen and when supporting people with personal care. Care Homes for Older People Page 22 of 31 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. The people living in the home are in the main protected by suitable recruitment practices and supported by a competent and managed staff team. Some staff practices mean that people are not always treated as individuals and they do not always receive person centred care from staff. Evidence: On the day of the inspection there were 32 people living at the home. During the mornings there are seven care staff on duty plus a senior carer and and care team manager. This reduces to Six in the afternoon and evenings with a senior carer and a care team manager. During the night there is a night shift leader and two night carers. The manager told us that this staffing would increase is the home was full and is dependent on the needs of the people living at the home. There were sufficient staff to meet the physical and personal care needs of people living at the home. The shortfalls of social and emotional support and stimulation identified in the report were not due to staffing levels. As identified throughout the report we observed poor practices by two staff that show Care Homes for Older People Page 23 of 31 Evidence: a lack of understanding of privacy, dignity, person centred care and equality and diversity. Improving these areas of staff practice and culture should be prioritised. Since the last inspection there are specific teams of staff for each living unit. This means that staff and people get to know each other well. The surveys from people told us that there are always (5) or usually (2) staff available when they need them. They told us that staff always (5) or usually (2) listen to them and act on what they say. One survey included the comments Agency staff do not seem to help enough and dont seem to communicate with the residents. Three staff files were looked at including the most recently recruited staff members.All of them included CRB(Criminal Records Bureau) and PoVA (Protection of Vulnerable Adults) checks. Two references had been received before staff started working at the home. The home uses regular agency staff and the manager told us that they have significantly reduced the use of agency staff as they recruit more permanent staff. The manager has ensured that he has information from the agency that demonstrates that they are trained and are recruited safely. The AQAA, discussion with staff, surveys and the staff training records demonstrate that staff complete an induction programme. The training matrix shows that staff attend a range of training programs to be able to meet the needs of the people living at the home. A majority of staff have attended dementia awareness training. A number of staff have been identified to undertake further dementia care training. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main people benefit from living in a well managed home. The shortfalls in care support for people on one living unit compromise the overall quality of service and the wellbeing of people living at the home. People and others are able to express their views and these are listened to and acted upon. Evidence: The manager was present throughout the inspection. He has worked at the home for a number of years and is registered with us. The requirements from the last key inspection have been met. The impact of the poor dementia care skills of one of the staff and one agency staff need to be closely monitored by the manager and management team to make sure that people are receiving the right care and support to maintain and enhance their well being. Care Homes for Older People Page 25 of 31 Evidence: The manager completed the AQAA (Annual Quality Assurance Assessment) and was able to identify where they had improved the home over the last year and identify some further areas for improvement. There is a quality assurance system in place that includes clinical audits, monthly monitoring of accidents and incidents. However, there has been no specific analysis of the falls that people have. This should be completed to make sure that any patterns are identified and the risks minimised where possible. Surveys and regulation 26 visits are also undertaken. An annual quality assurance report is produced by an independent consultant. Regular meetings are held with people who live in the home and their relatives and friends. We checked the personal monies held at the home for people we case tracked and the monies and records balanced. Information provided in the AQAA shows that relevant Health and Safety checks and maintenance are being carried out at the home. A number of Health and Safety records were checked, including the fire safety log. These records showed that health and safety matters are well managed. There are organisational systems in place for the routine servicing of equipment and fire, heating and electrical systems. Equipment seen during the inspection was in good order. Staff training in mandatory areas, including fire safety, health and safety, moving and handling, emergency aid, and basic food hygiene, is ongoing and fully up to date. Staff receive regular supervision from their line manager. Care Homes for Older People Page 26 of 31 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 31 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 17 Care and support monitoring 01/03/2010 records for people must be completed and regularly reviewed. Action must be taken when records show that peoples health or well being is not being maintained. This is to make sure that health and well being is monitored and people received the care and support they need. 2 9 13 The medication 01/03/2010 administration and recording systems must be made safe. This is so that people receive their medications as prescribed. 3 10 12 Staff must acknowledge people as individuals and with respect at all times. People must be given choices in all aspects of their lives. 01/03/2010 Care Homes for Older People Page 28 of 31 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 This is to make sure that people are acknowledged and are given the respect they deserve. 4 12 12 People must be provided 01/04/2010 with suitable stimulation and have the opportunity to be occupied. This is to ensure that people have a good quality of life and well being. 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 7 Staff should record how people have been spending their time. This is so records give a more accurate reflection of peoples day to day lives and not just the care and support provided to them. People should be given choices of drinks at all times. Staff should sit and talk with people when assisting them to eat and drink. This is so mealtimes are a relaxing and dignified experience and people know what they are being given to eat and drink. Current good practice recommends that serviettes or napkins be used to protect peoples clothes rather than bibs or aprons which can appear institutional. Bathrooms should be personalised and be made to be more inviting and relaxing environments. Improving areas of staff practice and culture including privacy, dignity, person centred care and equality and diversity should be prioritised. 2 3 15 15 4 15 5 6 19 30 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 33 The impact of the poor dementia care skills of some of the staff and agency staff need to be closely monitored by the manager and management team to make sure that people are receiving the right care and support to maintain and enhance their well being. The formal monitoring of falls should be part of the quality assurance system. Falls should be reviewed on a monthly basis to establish the times, causes and frequency, and whether they relate to staffing or health factors. 8 33 Care Homes for Older People Page 30 of 31 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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