Inspection on 02/03/10 for The Maples

This is the latest available inspection report for this service, carried out on 2nd March 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: The Maples First Avenue Newcastle Staffs ST5 8QX     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: Joy Hoelzel     Date: 0 2 0 3 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 32 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 32 Information about the care home Name of care home: Address: The Maples First Avenue Newcastle Staffs ST5 8QX 01782636129 01782710880 harvey@themaples.fsbusiness.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Maple Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Maximum number that can be accommodated is 28. The registered person may provide the following category of service only Care Home Only (Code PC) to service users of the following gender Both Whose primary care needs on admission to the home are within the following categories Older People (OP) 28 Dementia (DE) 28 Date of last inspection Brief description of the care home The Maples is a privately owned social care home providing care and accommodation for up to 28 older people. The home is located in First Avenue, Porthill, and provides a pleasant location with good access to local community facilities and services. The home is set in its own Care Homes for Older People Page 4 of 32 Over 65 0 28 28 0 Brief description of the care home grounds with attractive mature gardens and lawns. There are a selection of lounge and dining areas and are comfortably furnished. There are single and double occupancy bedrooms of which some have an en suite facility. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have been reviewed for 2010. The service user guide specifies the range of weekly fees of £450:00 - £391:00. Care Quality Commission reports for this service are available from the provider or can be obtained from www.cqc.org.uk Care Homes for Older People Page 5 of 32 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 home did not know that we would be visiting to inspect the service. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting Care Homes for Older People Page 6 of 32 outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The acting care manager completed this document and returned it to us. Comments from the AQAA are included within this inspection report. We asked for our Have Your Say, surveys, to be distributed to people living in, working in and visiting the home. Seven were returned from people living in the home (all indicated that they had help to complete the form) and seven were completed by members of staff. The responses and comments are included in this report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The care plans, risk assessments and monitoring tools are currently being reviewed, action should be taken to ensure that all details of a persons health, personal and social care needs are documented. All staff should be aware of the care needs. Amendments are needed to the administration of medicines. This will ensure that people receive their medications in line with the prescribing instructions. External medicines (creams and ointments) that have short shelf lives upon opening should be dated so the risk is reduced of giving out of date medication. All care staff administering these creams and ointments should be suitably trained to do so. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. The service should continue to increase the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. For the continuing safety and protection of people living at the home staff should continue to have regular updates and training in the protection of vulnerable adults. The audit of all the staff personnel files of people working at the home must be completed with action taken. This will ensure that people living at the home are supported by suitable people. The programme for staff training and development should continue and should include both mandatory and specialist topic areas. This will ensure that staff are well trained and competent to do their job and fully meet the needs of people living at the home. A formal application for the position of registered manager of the service should be submitted a soon as possible. This will ensure that the home is led and managed by a suitably qualified person and will provide some stability to the home. The quality assurance and monitoring systems should be improved and expanded to ensure the service operates as it states it does and is run in the best interests of the people living at the home. Care Homes for Older People Page 8 of 32 Arrangements should be made to ensure that regular checks are completed for the safekeeping of peoples personal monies and cash. This will reduce the risk of errors occurring with peoples money and give the added peace of mind to the people living in the home. Staff must be instructed in all safe working practices to ensure their safety and for the safety of the people living at the home. 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 32 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 32 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 can be confident that the care home can support them because assessments of their care needs have been obtained. Evidence: The AQAA completed by the acting care manager tells us about the way people have their care needs assessed prior to them moving into the home - We ensure that every prospective resident has their needs expertly assessed before a decision of admission is taken. To do this we complete a full and comprehensive assessment prior to admission and family members, carers and relative are present when ever possible. This enables us to compile a care plan that is person centred and individual. We looked at two case files of people who had recently moved into the home. We saw that information from specialist social workers, previous social care placements and discharge letters were in the individual files. We did not see that the service had completed its own full and comprehensive assessment as described in the AQAA. The Care Homes for Older People Page 11 of 32 Evidence: acting care manager stated that careful consideration is given to offering people a placement this then ensures that the service can fully meet the care needs. Prior to this inspection we asked for the service to distribute our surveys to people living at the home. Seven were returned to us and all seven indicated that they had been completed by either a family member or representative of the person in residence. Six people indicated that they received sufficient information to help them with deciding to move into the home. The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is some basic information necessary to deliver the persons care, there are gaps in important information and does not consistently reflect the care being delivered. Evidence: Information about care planning is recorded in the AQAA - All individuals have their cultural, religious, sexual, emotional and other needs accepted and respected at all times, and all of the above is documented in the individual care plans. Any disabilities, physical or mental impairment are documented in the individual care plans and are reviewed regularly, any changes are documented and if necessary new risk assessments are carried out. The service user guide 2009 includes a section on care plans - Each care plan sets out the individual residents aims and objectives for receiving quality care and the way in which everyone involved hopes to meet them. Care plans are regularly reviewed, with the close involvement of the service user and their family and friends. The Statement of purpose 2009 records that At least once a month, we review each Care Homes for Older People Page 13 of 32 Evidence: residents plan, setting out whatever changes have occurred and need to occur in future. Each resident is encouraged to participate as fully as possible in the care panning process. This information provided by the service is not entirely correct; we found some inconsistencies and omissions when we looked at records. A computer programme is used to record the individual care needs of people living at the home. Limited paper records are also available. We looked at the documentation and records of three people in depth. We also looked at other peoples records briefly to follow up any observations we made during the day. The care plan for one person had not been updated to record details of the care needed when the persons physical health had substantially deteriorated. The care plan did not provide staff with the information needed to enable them to support this person to meet their current needs. A risk assessment had been completed in July 2009 indicating that the person was at high risk. There was no information, in the risk assessment or in a care plan, of the action staff should take to reduce the potential risk to this person. The acting manager stated that all care staff are informed verbally of each persons care needs. There was limited information recorded in the care plan and no risk assessments for one person who was resident at the home on a short stay basis. This persons care could be compromised because the care plan did not tell staff how to meet their physical and mental health needs and ensure their wellbeing. We were aware of a recent incident of the safety and welfare of one person; we looked at the care plans and risk assessments for this person. We found very limited information of the persons care with some of the information being not quite correct. We spoke with the acting manager about this. They confirmed that action had been taken to ensure the ongoing safety of this person and that all staff had been verbally informed of the actions they should take. We did not see any monitoring or recording documents of the observations staff were instructed to take. We did not see the involvement of the person or their representative in the care planning and assessment processes in any of the records we looked at. We spoke with several care staff about the care they provide. They told us that generally they do not rely on the care plans to deliver the care to people, but that the information is verbally passed to them by the senior staff. They said that generally Care Homes for Older People Page 14 of 32 Evidence: they do not refer or look at the plans. However, they described the diverse care needs of the people living at the home and the way they helped and assisted each person with daily life. The acting manager offered an explanation of the lack of current, concise and person centred information and told us of the plans for all care plans and associated assessments to be reviewed. They were unable to confirm a date of completion of the reviews. The acting manager and owner of the service told us of the difficulties and problems that they had recently identified. They told us of their plans of how they are to rectify the situation. Relatives and visitors at the home told us that they are fully satisfied with the care provided and that it was second to none. All seven people indicated in our surveys that they always receive the care and support they need. Nevertheless, without detailed, accurate person centred care plans and documentation there is no guarantee that the care is being provided and delivered in a consistent and reliable way. We looked at the systems for administering medication to people, staff explained the procedures and we looked at the medication administration records (MAR) for a selection of people. We saw that some of the MAR had not been fully completed when it was necessary to hand write the charts. The medication supply for one person had run out, the acting manager explained that a repeat prescription had been ordered, but did not confirm when the medications would be available. This person may be at risk by not having sufficient prescribed medication readily available. We discussed the administration of creams and lotions, the acting manager explained that the care staff apply and administer these preparations. The mar is not completed, it was not possible to establish when or if the person is receiving the treatment as required. We spoke with the acting manager and suggested that a separate record for care staff to sign could be used in conjunction with the MAR. Care staff would need training in the safe administration of creams and lotions to ensure they have sufficient knowledge and are competent to do so. During the tour of the building we saw that the creams and lotions are kept in the individuals rooms. These preparations that may have short shelf lives upon opening were not being dated so there was a risk that some residents may be given out of date medication. Care Homes for Older People Page 15 of 32 Evidence: Some people are fully dependent on staff to help them with maintaining their dignity and personal appearance. We observed staff discreetly helping and supporting people with their care needs during the day. Information signs are positioned on toilet and bathroom doors to help people find the facilities. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will be supported to follow personal interests and activities. Evidence: The AQAA includes information on daily life and social activities and records - We employ an activities coordinator who works with individuals and in groups. Time is taken to ensure interests are recorded and that people are given the opportunity for stimulation through recreational and leisure activities- both inside and outside the home. People told us that the coordinator works for nine hours per week mainly during the mornings but sometimes during the afternoons. At other times the care staff organise and facilitate the activities in addition to their care duties. The surveys that were completed by staff and returned to us contained some additional comments and observations.- It would be beneficial to residents if there was more that one activity coordinator who could then assist with residents and possibly organise more outings. It would be good if we could go into town or just to the local pub for lunch. More outings/day trips for clients. More outings, local trips. Care Homes for Older People Page 17 of 32 Evidence: More days out or even a singer. The surveys that were completed by relatives/representatives on behalf of people living at the home indicated that three people thought activities were always arranged. Three people thought that usually activities are arranged with one person telling us that sometimes activities are arranged. A group of people told us that they would like to participate in religious observance occasionally at the home. They explained that for various reasons they are unable to use the places of worship within the community. The owner of the service contacted us after this inspection to inform us that opportunities for religious observance for people has been arranged. The acting manager told us of the plan to have a reminiscence room available for people to use and enjoy. People visiting the home told us that they are very satisfied with all aspects of the service; they can visit at suitable times and are always welcomed by the staff. We observed good professional relationships between staff and visitors, all seemed to be very relaxed with each other. The main front door to the home is kept locked at all times for the security of the premises. Staff answer the door and allow access. We saw that people have free access to all parts of the interior of the home. People wishing to go into the gardens and grounds are escorted by a member of staff. All seven of the surveys completed on behalf of people living at the home indicated that people always like the meals that are provided for them. Excellent choice of good food. The food is fresh, well prepared and presented. Comments included on the surveys completed by staff - We provide good home cooked food. People told us that they enjoyed the meals and have sufficient to eat. One person told us of the increase of weight since their admission to the home and stated that The food is good and I enjoy it. Care Homes for Older People Page 18 of 32 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. If people have concerns with their care, they or people close to them know how to complain. Evidence: The AQAA tells us that it has a very simple and clear complaints procedure and that they welcome complaints and suggestions so they can use them positively and learn from them. The complaints procedure is on display in the hall and information is included in the Statement of purpose and service user guide. People told us that they had no concerns or complaints of the service at the moment; but if they did, they would be confident that the acting manager would sort it out for them. We, the commission, received three concerns directly regarding the service. All three concerns were passed to the owner of the service to respond to. We were satisfied with the responses and explanations offered. The home identified an area of concern regarding the safety of one person living at the home. A referral was made to the inter agency adult protection team for consideration into the concerns. The concern was looked at by the team, a visit was Care Homes for Older People Page 19 of 32 Evidence: made to the service and the referral reached a satisfactory conclusion with no further action being taken. The AQAA identifies that within the next twelve months it will Ensure that all staff have a greater knowledge of safe guarding adults and understand how to react and respond in any event. The acting manager confirmed that training sessions in safe guarding vulnerable adults, the Mental Capacity Act and the deprivation of liberty safeguards has been arranged for March 2010. We looked at the procedures for the safekeeping of peoples personal monies and cash for sundry expenditure. One person has the responsibility for dealing with this. They explained that computer records are maintained for each individual person on which all transactions are documented. For the accuracy and safety of the cash and records it is recommended that regular audit checks by another person are completed. Care Homes for Older People Page 20 of 32 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 provides a physical environment that is satisfactory to the specific needs of the people who live there. Evidence: The Maples is a large detached property in its own grounds situated in a quiet residential area. It is in keeping with the local community. The accommodation is spacious, well decorated, well furnished and comfortable. There is a selection of communal areas, this means that people have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. People told us that they are comfortable and very satisfied with the accommodation provided. We looked at a selection of private rooms and saw that many contained the personal possessions of the resident. All were very clean and well furnished. The owner of the premises told us that work is in progress for all bedroom doors to be fitted with a suitable locking facility. This will then offer people the choice to lock their private room when they are out if they so wish. Care Homes for Older People Page 21 of 32 Evidence: The acting manager explained the procedures in place for the effective control of infections. Additional hand washing equipment is being installed in all private rooms and hand gels are provided around the home. Care Homes for Older People Page 22 of 32 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. People using this service can be assured that checks are being made to ensure that only suitable people care for them. Evidence: People living at the home told us - We are very well looked after; everyone is very good to us. People who did not wish to comment looked comfortable. People visiting the home told us - The staff are excellent nothing is too much trouble we are very satisfied with the care that is provided. We observed the care staff attending to their care duties in a calm and proficient way. They appeared very busy but someone was always available when a person requested some help and support. Information in the AQAA documented that of the 15 permanent care staff, 7 are trained to National Vocational Qualification level 2 or above in care. The acting manager confirmed that the service is committed to extending the opportunity for staff training at this level. Care Homes for Older People Page 23 of 32 Evidence: The acting manager and the owner explained the recent audit of the personnel files for all staff. They have found, through the audits, that some important and essential checks on staff had not been completed or the information was missing from the files. Both people gave an assurance that work is in progress to ensure that all staff have the necessary checks, so that people are being cared for by suitable people. We saw that application forms and requests for information have recently been completed and actioned. All seven staff members completing our survey indicated that the service had carried out checks prior to starting to work. The acting manager and owner have identified that there are gaps in the training and development programme for staff. They explained and confirmed the plans to address the shortfalls. Staff told us that recently there have been more training opportunities, with plans for March for training in safe guarding adults, Mental Capacity Act, Deprivation of Liberty safeguards and dementia awareness. Care Homes for Older People Page 24 of 32 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. People using this service can be assured that the management team have highlighted areas where they need to make improvements and has an action plan for undertaking the work. Evidence: Since the last key inspection the previous acting care manager has resigned. A decision is still to be taken regarding the registration of a care manager. The homes deputy manager is currently working as the acting care manager. They work in a supernumerary, full time capacity and have identified areas where improvement to the service is required. The AQAA was completed by the deputy manager and gave us a reasonable picture of how the service operates, the improvements that have been made and the plans for making further improvement. People told us that the current acting manager is approachable and available for Care Homes for Older People Page 25 of 32 Evidence: support and advice. There have been many improvements since the deputy has been in charge; we now work as a team. We spoke with the owner about the quality assurance systems for the service. They agreed that this is an area identified as needing improvement and expansion. We looked at the procedures for the safekeeping of peoples personal monies and cash for sundry expenditure. One person has the responsibility for dealing with this. They explained that computer records are maintained for each individual person on which all transactions are documented. For the accuracy of the records and safety of the cash, it is recommended that regular audit checks by another person are completed. We saw some health and safety checks of equipment are being completed on a regular basis, for example, checking the temperature of the hot water outlets, the fire alarm, emergency lighting etc. The owner acknowledged that some safety checks are overdue and are now required, for example the water, gas and electrical safety. They confirmed that work is in progress for these checks to be completed. Bed rails have been positioned on a bed, for the safety of the person. No risk assessment has been completed or consent for the use of the rails has been sought. The acting manager confirmed that no safety checks have been made since the rails have been in use. The acting manager stated that the staff check visually and assess that they are safe and in working order. Care Homes for Older People Page 26 of 32 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 32 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 15 The care plan must set out 05/05/2010 in detail all aspects of a persons health, personal and social care needs. This will ensure that the care is provided in a consistent way and to the preference of the person. 2 8 12 Risk assessments must be completed when a person is identified as a risk of harm. This will ensure that staff have the information of how they can help with reducing the risk to the person. 05/05/2010 3 9 13 Systems must be in place to 05/05/2010 ensure that all prescribed medication is available to be administered in line with the prescribing instructions. This will ensure that people are not at risk of ill health because their medications are not available. Care Homes for Older People Page 28 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 29 19 The audit of all the staff personnel files of people working at the home must be completed with action taken. This will ensure that people living at the home are supported by suitable people. 05/05/2010 5 38 13 People who need bed rails 05/05/2010 must be assessed for the risks associated with the use of bed rails. This is to ensure bed rails are used appropriately, safely and in accordance with guidance provided by the Health and Safety Executive and Medicines and Healthcare Regulatory Agency. 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 The care plan should be reviewed at least monthly and updated. This will ensure staff have the current details of a persons care needs to provide the care in an effective and individual way. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. All people living at the home should have their nutritional 2 7 3 8 Care Homes for Older People Page 29 of 32 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 needs assessed and kept under review. 4 9 External medications (creams/ointments) that have short shelf lives upon opening should be dated and discarded within the guidelines. Mar charts that are handwritten should be fully completed to include full details of the person and their prescribed medications. The charts should then be checked for accuracy. Amendments should be made to the recording of the administration of external creams and lotions. Staff who are applying such preparations should be suitably trained to do so. To ensure that the privacy and dignity of people is preserved suitable vacant/engaged indicators should be positioned on toilet and bathroom doors. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. For the continuing safety and protection of people living at the home staff should continue to have regular updates and training in the protection of vulnerable adults. The home should achieve a ratio of 50 of trained care staff to ensure that suitably qualified, competent and experienced staff are working at the care home at all times. The programme for staff training and development should continue and should include both mandatory and specialist topic areas. This will ensure that staff are well trained and competent to do their job and fully meet the needs of people living at the home. A formal application for the postion of registered manager of the service should be submitted a soon as possible. This will ensure that home is led and managed by a suitably qualified person and will provide some stability to the home. The quality assurance and monitoring systems should be improved and expanded to ensure the service operates as it states it does and is run in the best interests of the Page 30 of 32 5 9 6 9 7 10 8 12 9 18 10 28 11 29 12 31 13 33 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 people living at the home. 14 35 Arrangements should be made to ensure that regular checks are completed for the safekeeping of peoples personal monies and cash. This will reduce the risk of errors occurring with peoples money and give the added peace of mind to the people living in the home. All staff should be made aware of guidance documents on the safe use of bed rails. This is so staff are able to recognise the correct fitting of bed rails. 15 38 Care Homes for Older People Page 31 of 32 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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