Inspection on 03/04/09 for Welland House Care Centre

This is the latest available inspection report for this service, carried out on 3rd April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Welland House Care Centre 08/02/06

Welland House Care Centre 22/09/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Welland House Care Centre Welland House Lime Grove Welland Nr Malvern Worcestershire WR13 6LY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Blake     Date: 0 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Welland House Care Centre Lime Grove Welland House Welland Nr Malvern Worcestershire WR13 6LY 01684310840 01684310848 sheila.smithtaplin@redwoodcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Welland House Care Centre Ltd Name of registered manager (if applicable) Mrs Sheila Smith-Taplin 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 physical disability Additional conditions: Date of last inspection Brief description of the care home Welland House Care Centre provides accommodation and nursing for 51 older people with care needs relating to old age, physical disabilities, dementia and mental health needs. The home is owned by the Redwood Care Home Group. Welland House is situated in a small village approximately five miles from Malvern. There is a local shop, public house and Church. The home is partly adapted and partly purpose built. It is on two floors and has a passenger lift and appropriately fitted handrails. The schedule of Care Homes for Older People Page 4 of 31 0 0 0 0 Over 65 51 51 51 51 care home 51 Brief description of the care home fees is available from the home. Extra charges are made for hairdressing, newspapers, transport, private medication, private chiropody and a TV licence at market prices. A copy of this inspection report can be viewed at the home. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection. One inspector spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for three people. This included observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The service had previously completed an Annual Quality Assurance Assessment Care Homes for Older People Page 6 of 31 (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. We also received completed survey forms from people who use the service, their relatives and health professionals who work with the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. 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 set out on page 4. Care Homes for Older People Page 8 of 31 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. The home provides good written information so that people can decide if it is the right place for them. Brief assessments of peoples needs are carried out before they move in, so that the home can provide the care and support they need. Evidence: The home provides written information to help people decide if they wish to move into Welland House. The manager told us that this information can be made available in a large print format if necessary. In our surveys, people told us that they had been given sufficient information before they moved in. We looked at the Service User Guide, which contained useful information about life at the home. The home also has a website at www.wellandhousecarecentre.co.uk, which explains more about the facilities provided at the home. In the AQAA, the manager told us viewings are encouraged, either booked or ad-hoc, Care Homes for Older People Page 11 of 31 Evidence: according to individual preference. One person told us in a survey we were made very welcome and had a good look around the home. We looked in detail at the care record for someone who had recently moved into Welland House. We saw that they had visited the home before moving in, and that an assessment of their needs had been carried out before they moved in. The assessment form did not have much space for staff to write in under each heading, and therefore there was not much detail about the persons needs in the form. For example, under the heading of continence, the only information given was catheter. There was no detail about how the catheter should be managed. This means that staff may not have the knowledge they need to provide the level of care that is required as soon as someone moves into the home. 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 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 their health and personal care needs will be met. The home manages medication safely. Evidence: We looked in detail at the care records for three people living at the home. We wanted to see how the home plans peoples care so that it is tailored to their individual needs. This approach is called person-centred care. The Alzheimers Society explains how person-centred care works: Instead of treating the person as a collection of symptoms and behaviours to be controlled, person-centred care considers the whole person, taking into account each individuals unique qualities, abilities, interests, preferences and needs. In the AQAA, the manager told us Person centred care reviews involving residents and family as able, appropriate care plans used and reviewed. We saw that each persons records contained care plans for all the activities of daily living, in the form of tick boxes, with a small amount of space to add comments. The use of care plans with Care Homes for Older People Page 13 of 31 Evidence: a tick box format does not promote person-centred care, as they reduce the person to a list of problems or issues to be managed. For example, we saw that the care plan for nutrition had a tick box plays with food: yes, no and throws food: yes, no. There was not enough space to explore the reasons why people might not wish to eat their food. In a specialist dementia care service, such as Welland House, we would not expect to see care plans which are based on numerous tick boxes. Phrases in some care plans showed that staff do have an understanding of each persons unique needs. We saw that one care plan stated: appears fearful of being rolled in bed keep rolling to a minimum and give reassurance. We discussed the issue of care planning with the homes manager and the Quality Assurance Manager from the company which owns Welland House. The home is beginning to use a format which includes each persons life history. At previous inspections of the home in April and September 2007, we had discussed these issues with the home, and we are disappointed that only minor changes have been made to the care plans, and they are still not fully person-centred. Although the written care plans do not always support person-centred care, we saw good examples during the inspection of staff supporting people in ways which showed that they valued each persons unique qualities. We saw that one person had become agitated, as they did not wish to take their medication. A member of staff sat down with them and held their hand, and explained calmly why the medication was necessary. The person eventually took the medication, but remained distressed. We saw that the member of staff took time to reassure the person and talked calmly with them as she supported them to their bedroom. Peoples records included assessment of their mental capacity for any area where decisions might need to be taken in the persons best interests. For example, one persons records included a mental capacity assessment, which clearly stated the reasons why the home needed to take responsibility for storing and administering their medication. This is good practice, and shows that the home understands its responsibilities under the Mental Capacity Act. Records showed that the home requests help from healthcare professionals when necessary. We saw that one person with an infected wound had been visited by the GP on several occasions, and that the home had called him in whenever there were concerns about any deterioration in the persons condition. Care Homes for Older People Page 14 of 31 Evidence: Some of the people who live at the home are looked after in bed, as they are very ill. We saw that one person who is being nursed in bed appeared to be very well cared for. Their hair was brushed and they had clean bedclothes and nightclothes. Their hands were clean and their nails had been trimmed. Their spectacles were close at hand, and the call bell was within reach. Because the person was at risk of not eating enough, the home was using a food chart to record how much they were eating and drinking. We saw that this had been fully completed. The manager told us that these charts are assessed, and if they show any deficiency, the home takes steps to ensure that people are given dietary supplements if necessary. Records showed that specialist nurses have been involved in decision-making and in care planning. One relative told us how well a family member had been cared for at Welland House. She said the care is really out of this world and I would recommend it 100 to anyone - theyll be looked after here. Staff at the home have worked hard to achieve the Gold Standard Framework Quality Hallmark Award for high quality end of life care. The Gold Standard Framework is concerned with helping people to live well until the end of life and includes care in the final year of life for people with any end stage illness. The home has recently begun to use a monitored dosage system (MDS) for the administration of medication. This system makes it easier to check if people have taken their medication. We saw that charts used to record the administration of medication (MAR charts) had been fully completed, and that medication was stored safely. The nurse in charge of medication showed an excellent knowledge of all aspects of medication management. Some people had been prescribed medication to be taken on an as required basis, such as painkillers and sleeping pills. There were no records to give staff clear instructions as to the circumstances when these medications should be given. The manager told us that she will make sure that these instructions are written out clearly and are kept in the care plans and with the MAR charts. Records showed that people are asked if they have any preference for male or female staff. Throughout the inspection, we saw staff supporting people in a way which promotes their privacy and dignity. We saw that staff always knocked before entering bedrooms, and always explained clearly when they were working with people. Although the staff were very busy, they never appeared rushed when supporting people, and they spoke calmly and did not talk down to anyone. Care Homes for Older People Page 15 of 31 Care Homes for Older People Page 16 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 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 range of social and leisure activities, and supports people to maintain links with their families and friends. Meals provide an appetising and nutritious diet. Evidence: The home employs a full time activities co-ordinator, and the manager told us in the AQAA that the activity records enable the home to review peoples preferences and patterns of activity, so that activities can be tailored to their individual wishes. The home involves families in gathering information about peoples life history and to find out what is important to each person. The home is divided into two units, and each unit has a photo book, with photos of staff members and of activities such as visits from a violinist and someones ninetieth birthday celebrations. Photos can help to trigger memories for people with a dementia illness. The noticeboard in the entrance hall includes information about how families and friends can get involved in the life of the home. We saw that the home is hoping to start a gardening project this Spring, and a notice asked for assistance and donations Care Homes for Older People Page 17 of 31 Evidence: of plants, compost etc to help get the project started. The manager sometimes brings her dog to work with her, and we saw how positively people responded to the dog, by patting and stroking him. The manager told us that she plans to have some chickens in the garden this year, and she explained in detail how she wants to make sure that people living at the home have as much opportunity as possible to access the natural environment. Records showed that the local Church of England and Roman Catholic priests visit the home regularly, and that people are supported to worship as they wish. Children from the local school had visited the home recently to sing Easter songs, and the home was planning an Easter party to include families and friends. We spoke with a specialist mental health nurse, who expressed concern that the social needs of people who were being cared for in bed were not being met. We discussed this with the manager, who assured us that staff spend time with people in their bedrooms talking with them. We spoke with two people, who were visiting family members, and they both spoke highly of the home and the way staff respond to visitors. One person said we are made to feel very welcome and always given a tray with drinks and biscuits and another said its a lovely atmosphere here, we enjoy coming. We saw breakfast being served in the Lodge unit of the home. We saw that there was a large choice of food available, including porridge, scrambled eggs, tomatoes, and a variety of cereals. Staff were serving people individually, and where people needed support to eat, this was done sensitively and in an unhurried manner. Lunch on the day of the inspection was fish with chips or mashed potato and peas. The menus were written on whiteboards in the dining rooms. There was no choice of alternative main course, but we saw people being offered alternatives. The pudding was coconut and jam sponge with custard. The food looked appetising and the menus showed that meals provide a nutritious and balanced diet. 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. People can be confident that any concerns will be taken seriously and will be resolved. Staff recruitment procedures protect people who live at the home, by making sure that only suitable staff are employed. Evidence: The home has a clear complaints procedure, which is contained in the Service User Guide. We saw that a copy of the procedure is displayed in the reception area of the home. There are comment cards beside the visitors signing in book, and a note encouraging people to complete them, so that the home can make any improvements that have been identified. We saw that the home keeps the completed comment cards with a record of how they have been managed. In our surveys people told us that they knew who to talk to if they had any concerns, and that they knew how to complain if they needed to. We spoke to two relatives of people living at the home, and they told us that they would feel confident that any issues raised would be dealt with by the manager. They both said that they found the manager very approachable, and that they had confidence that she would listen to them and take them seriously. Care Homes for Older People Page 19 of 31 Evidence: We looked at the records for two members of staff to check that their recruitment had been carried out safely. We saw that all the necessary pre-employment checks had been done. These include a Criminal Records Bureau (CRB) check and two written references, one of which is from a previous employer. These checks help to protect the people who use the service, by making sure that only suitable staff are employed. We spoke to staff about their knowledge of how to protect people from abuse or neglect, and they showed a good understanding of how this should be done, and how to report any concerns. The homes training records showed that staff receive training in the protection of vulnerable people. 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 provides a safe and comfortable environment for people to live, but some aspects of the hoem do not promote privacy and dignity. The staff have a good understanding of infection control. Evidence: The home is a large detached house which has been extended and adapted to the needs of the people who live there without losing its character. There is a friendly and welcoming atmosphere. The reception hall is a large area, which has recently been redecorated. It is comfortably furnished with armchairs and sofas. Plants and ornaments add to the homely feel. Classical music was playing quietly during the day. During the inspection, we saw that the reception hall is used by people wanting to sit quietly and by relatives visiting the home as a place to sit and chat. The home is divided into two units, known as Home and Lodge. Each unit has its own dining and lounge areas. Since the last inspection, the home has been redecorated and refurbished, so that it now appears fresh and light, with all the communal rooms painted in neutral colours. Care Homes for Older People Page 21 of 31 Evidence: The Lodge has a combined dining and lounge area. This is a light and spacious area. The armchairs in the lounge area were placed in a row along one side of the room. The manager told us that this was to prevent people bumping into the furniture. Placing chairs in a row does not promote interaction between people, and gives an institutional feel to the room. The lounge in the Home unit has armchairs and sofas grouped in a wide circle, which gives it a homely feel. There was a range of books and magazines, and a large television at one end of the room, which was on even when there was nobody watching it. In our surveys, one person commented the colour television is on all day every day. We saw that some people had brought their own furniture and ornaments to make their bedrooms more homely. We looked at one bedroom where two people share the room. There was a privacy screen in the room, which was of a type used in hospitals many years ago. This type of screen does not provide full privacy for people when they are being supported to wash or get dressed. We will be asking the home to provide more suitable screening. Toilet doors throughout the home were labelled clearly in large print, but there was no picture to show people that it is a toilet. People with a dementia illness cannot always recognise words, and the use of pictures can help them to find their way around the home. At the last inspection, we mentioned the homes practice of locking people out of bedrooms with a key from the outside. We saw that the manager locked a bedroom door where two people were being cared for in bed. Although the doors have single action locks so that people could theoretically get out, the people in this bedroom were not mobile, so in practice could not open the doors, and could become isolated from the life of the home. The manager said that the doors are locked so that unwanted visitors from among the other residents could not enter the room. She told us that the door is unlocked when there is no risk of unwanted visitors. Throughout the home, baby safety gates are used to close off areas where there may be risk. These are not very tall, at eighty centimetres high, which may pose a risk to people who could try to climb over the gates. The use of baby safety gates does not promote dignity, as it is not appropriate for the age of the people who live at the home. The home appeared fresh and clean throughout, and in our surveys, people told us that it is always kept clean. One person said you would go a long way to find a home Care Homes for Older People Page 22 of 31 Evidence: as clean and fresh as Welland Care Home. We saw that staff practised good infection control, using gloves and aprons where necessary. All washbasins were seen to have liquid soap and paper towels. We spoke to staff, who showed a good understanding of the principles of infection control. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are kind and caring, and have the skills and knowledge they need to support the people who live at the home. Evidence: People living at the home and their relatives were all positive about the staff at Welland House. In our surveys, people told us all the staff are marvellous and very kind and caring and nothing is too much trouble for the staff, whatever you ask them to do. One person who lives at the home told us as far as attention is concerned, we have it aplenty. On the day of the inspection, we saw that staff were kind and caring in their manner. We saw evidence of good practice in the ways in which staff interacted with people living at the home. One member of staff was preparing to support someone to move from a wheelchair into an armchair. She explained to the person what was going to happen, and when it was obvious that the person had not understood, she explained it again in a different way, and made sure that during the manoeuvre, she took time to reassure the person and make sure they were not distressed in any way. Many of the staff have recently had training in dementia care from a specialist in this area. Staff told us that they had learned a great deal about the types of dementia and Care Homes for Older People Page 24 of 31 Evidence: how to support people with a dementia illness. We looked in detail at the records for two members of staff. We saw that new members of staff complete an induction programme which meets the Skills for Care Common Induction Standards. Training records showed that staff receive all the required training, so that they have the skills and knowledge to carry out their roles. Staffing rotas showed that the staffing levels were sufficient to meet the needs of people who use the service, and in our surveys, people told us that staff are responsive, and are always or usually available when needed. Care Homes for Older People Page 25 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. The home is well run by the new manager. Health and safety is given a high priority. Evidence: A new manager has recently been appointed to the home, and has been registered with the commission. This means that she has been judged to have the skills and experience necessary to manage the home effectively. The manager is supported by the Quality Assurance Manager, who knows the home well. The accident records showed that the manager audits accidents monthly to identify any trends, and this information is used to try to prevent further accidents. The Redwood Care group of homes has achieved the Investors in People award, which recognises the high quality of staff management. We looked at the homes quality assurance records. These showed that the home sends out surveys regularly to people living at the home, their families and other people who have an interest in the home. Care Homes for Older People Page 26 of 31 Evidence: The results of these surveys are used to help the manager make plans for the future. The quality assurance surveys received by the home included the comments Welland House is a very well run care home she has been in three nursing homes, and this is the best one and I feel reassured to know that Mum is being well looked after. The manager completed the AQAA and sent it in to us when we asked for it. It contained detailed information about the service, and told us that the manager knows what the service needs to do in order to improve. In our surveys, people told us it is a better service than a 5 star hotel and just excellent from top to bottom. The improvements to the environment at the home have meant that it is easier to make sure that peoples health and safety are protected. The home employs a maintenance person to carry out minor repairs. The home does not take responsibility for peoples personal money, and invoices people for extra facilities such as hairdressing and toiletries. Care Homes for Older People Page 27 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 28 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 9 13 (2) You must ensure that, for any medication labelled for use when required, as directed or with a variable dose, there is always clear written direction for staff on how to make decisions about administration for each person and medicine and in accordance with the Mental Capacity Act 2005. This will help to make sure there is some consistency for people to receive the correct levels of medication in accordance with their needs and planned actions. 02/06/2009 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 You should ensure that pre-admission assessments contain detailed information about peoples care needs. This is so that staff know the care that needs to be provided. Page 29 of 31 Care Homes for Older People 2 7 You should develop care planning so that it is fully personcentred. This will help to ensure that peoples individual qualities, abilities, interests, preferences and needs are taken into account when planning their care. You should consider alternative methods of ensuring peoples safety within their bedrooms. This will ensure that they are not isolated from the life of the home. You should ensure that any barriers used to prevent access to parts of the home are age appropriate and have been risk-assessed to ensure that people are not able to climb over them. This is to promote the safety and dignity of people living at the home. You should ensure that, where screens are used for privacy, they screen the person fully. This is to ensure that peoples privacy and dignity are maintained. You should ensure that doors such as toilet doors are identified by the use of pictures. This will help people to find their way round the home more esaily. 3 23 4 23 5 23 6 23 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or 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. 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