Inspection on 02/10/08 for Abbey Grange

This inspection was carried out on 2nd October 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbey Grange 16/11/09

Abbey Grange 14/10/09

Abbey Grange 06/08/09

Abbey Grange 20/05/09

Abbey Grange 24/02/09

Abbey Grange 11/03/08

Abbey Grange 10/10/07

Abbey Grange 23/10/06

Abbey Grange 18/10/05

Abbey Grange 21/06/05

Abbey Grange 15/10/04

Abbey Grange 23/07/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Abbey Grange 47 Venns Lane Hereford Herefordshire HR1 1DT     The quality rating for this care home is:   zero star poor 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 2 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Abbey Grange 47 Venns Lane Hereford Herefordshire HR1 1DT 01432271519 01432271519 ubheedave@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Bissessur Ubhee Type of registration: Number of places registered: Mrs Aileen Ubhee,Mr Bissessur Ubhee care home 29 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: All residents must be at least 50 years of age on admission. That Mr Ubhee works a minimum of 30 hours a week at Abbey Grange in order to fulfil his responsibilities as the Care Manager. Date of last inspection Brief description of the care home Abbey Grange is situated in a residential area on the outskirts of Hereford city. There is a drive-in parking area at the front of the home and local buses pass within easy reach. The original part of the premises has been adapted for its current use. It carries Care Homes for Older People Page 4 of 31 Over 65 29 29 29 0 29 29 0 29 Brief description of the care home a listed building status. This places some restriction for making desired alterations. The original building has been extended to provide additional, purpose-built accommodation. The home is registered to provide care to 29 people who are over 50 years of age and who have needs arising from old age, dementia or mental disorder. Information about the service is displayed in the main entrance hall of the home. A copy of the most recent inspection report is also displayed. A schedule of fees is available from the home. Additional charges are made for hairdressing, transport, escort, chiropody, toiletries and newspapers. A copy of this 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: zero star poor 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: We 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. These include records relating to the care of people who use the service. The service had previously completed an Annual Quality Assurance Assessment (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. 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 Care Homes for Older People Page 6 of 31 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to visit the home to help them decide if they wish to live there. The home provides written information to help people decide. The home usually carries out assessments before people move in, so that staff know what care is needed. However, the manager should make sure that staff know how to proceed when people are admitted as an emergency. Evidence: We spoke to relatives of two people who live at Abbey Grange. They told us that they had been given enough information to help them decide that the home was suitable for their relatives needs. One person told us that she had visited the home with her mother, and had been made very welcome. We looked at the homes Statement of Purpose and Service User Guide. The Service User Guide is confusing in parts, as it refers to the proprietor and Care Manager as Care Homes for Older People Page 11 of 31 Evidence: being two separate people, when in fact the proprietor, Mr Ubhee, is also the Care Manager. The home is required to provide up to date information in its Service User Guide, so we will be asking Mr Ubhee to update the Guide to reflect the current management situation. We looked at records for two people who live at the home to see how their admission had been managed. We saw that one person had had a full assessment of their needs, which included a meeting between a senior member of the homes staff, a reablement nurse and the prospective resident and family members. This assessment gave the staff useful information so that they could provide the care that is needed, as soon as the person moved into Abbey Grange. However, another person who had moved into the home recently had not had an assessment carried out before they moved in. Mr Ubhee told us that this person had been admitted as an emergency. At the last inspection of Abbey Grange a year ago, we recommended that the home should have a procedure for addressing the needs of people admitted as emergencies. This has not been done. Mr Ubhee only works at the home for three days a week, and therefore the senior staff need to know how to manage emergency admissions. The senior staff member on duty on the day of the inspection told us that she was not aware of any such procedure. If senior staff are not aware of the procedure for emergency admissions, then there is a risk that the home may not be able to meet the needs of people who are admitted unexpectedly. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not always have accurate and up to date records of the care that needs to be provided for the people who live there. Medication is not stored securely, and the arrangements for administering medication could put people at risk of harm. Evidence: In the AQAA Mr Ubhee told us we review all care plans at least every six months, but we found evidence that this is not done. We looked at records for three people who live at Abbey Grange. Two of them had lived at the home for longer than a year, and we saw that their care plans had not been reviewed within the last year. One of these people cannot now get out of bed, and the care plans did not reflect the care that is needed. For example, the person is at high risk of developing pressure sores, but there was no evidence to show that this is being monitored. We spoke to staff, who had a good understanding of the persons needs, but it is important that staff can refer to a care plan, so that everyone knows exactly what care should be provided. We looked at records for one person who had moved into Abbey Grange four weeks Care Homes for Older People Page 13 of 31 Evidence: previously. The records did not include any risk assessments or care planning. We asked Mr Ubhee why this persons needs had not been assessed. Mr Ubhee did not appear to know much about the person and was unable to inform us why no care planning had been carried out. The file contained an assessment by the Local Authority, which clearly indicated that the person uses walking aids. If staff are not aware of the persons needs and how to meet them, the person could be at risk of harm or injury. Another persons records showed that they had a history of falls, which indicates a high risk of falling again. The home had started to fill in a falls risk assessment, but this had not been completed, and there was no way of knowing what the home had done to try to prevent the person falling again. We spoke to a District Nurse, who told us that she visits the home twice a week, and is confident that staff will telephone her if they need advice. She told us that the home provides very good care for people at the end of their lives, and that staff are sensitive and caring. When we checked the arrangements for storing and administering medication, we saw that the keys for the medication trolley and cupboards were kept in an unlocked drawer in one of the communal areas of the home. These keys included the keys to the Controlled Drugs cupboard. Controlled Drugs are drugs which have strict legal requirements as to their storage, administration and record-keeping. This is because they are potentially dangerous drugs which can be misused. We looked at the storage of a Controlled Drug called Oramorph. Oramorph is a liquid morphine preparation used for severe pain. We saw that the bottle had not been securely closed and the Oramorph liquid was leaking out of the bottle. Therefore it is not possible for the home to account fully for the amount of Oramorph which has been used. The equipment for administering the Oramorph had not been cleaned thoroughly and contained some residue of the medication. This means that bacteria could multiply in the equipment and cause a risk of infection. We looked at records of how medication is administered, and these were accurate and showed that staff complete the record sheets fully. Care Homes for Older People Page 14 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. The home does not provide a range of social and leisure activities which meet the needs of the people who live there. The food provided by the home is appetising, but it is not assessed for its nutritional value, and there is no choice of main meal at lunchtime. Evidence: Mr Ubhee told us that the home provides a range of opportunities for social and leisure activities. We spoke to three people who live at Abbey Grange, all of whom told us that they get bored at the home. One healthcare professional told us in a survey that there is a lack of activities for people. She said they just seem to sit around in the sitting room. We looked at the homes records of activities, and these showed only six activities since June this year, including reading the paper, catching a ball and karaoke. One person who lives at the home told us that she would like to go into town occasionally, but that the opportunity has never been offered to her. The home does provide some opportunities for people to enjoy social activities. One relative told us in a survey about their mother: on her birthday, Abbey Grange arranged an excellent birthday party for her which was enjoyed by residents, relatives Care Homes for Older People Page 15 of 31 Evidence: and friends. On the day of the inspection, we saw visitors coming and going throughout the day, and they were made welcome by the staff. The home holds meetings for residents, and we saw notes from some of these meetings. The notes showed that people who live at the home had been asking if it would be possible to have an exercise class occasionally. Nothing has been done about this so far, even though the records show that this has been requested at every meeting since June 2007. We saw that the days menu was written on a board in the lounge. The lunch menu for the day was liver and bacon, with mashed potato, peas and sweetcorn, followed by fruit and cream. We saw that the food looked appetising and was well presented. The menu offered no choice of main course, although staff told us that they will provide other food if requested. Notes of residents meetings showed that people had been asking for more choice at lunchtime for over a year. We looked at menus for the week, and there was some variety of food, but not many fresh vegetables or fresh fruit. One person who lives at the home told us I wouldnt say we get fresh fruit. We asked Mr Ubhee if fresh fruit was provided, and he told us I buy bananas and grapes for them sometimes. I dont buy apples because they cant manage them. Oranges are too chewy for them. We looked at food stores and noted that there were many packs of dried puddings and tinned convenience foods. There was no evidence that meals are checked for nutritional value. The home achieved a rating of good for Food Hygiene from the Environmental Health Department in June this year. We saw that one person had got up late and had missed breakfast. Staff offered her some breakfast and willingly prepared tea and toast for her. Care Homes for Older People Page 16 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 poor 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 cannot be confident that complaints will be responded to satisfactorily. Staff do not always understand how to protect people from abuse. Evidence: Out of the four people who completed survey forms, only two knew how to make a complaint. We spoke to relatives of two people living at the home, and they both said that they would speak to a senior carer if they had a complaint. Since the last inspection, we had been made aware of a complaint against the home. We asked Mr Ubhee to show us the documentation about this complaint. We saw that Mr Ubhee had not responded to the person who made the complaint to explain the outcome of his investigation. We also saw that Mr Ubhee had not responded to a senior manager from the Local Authority who had written to him asking for specific information. Mr Ubhee told us in the AQAA all complaints are dealt with as per the policy and procedure. The evidence does not support this claim. We looked at the homes training records to see if staff had received training in the protection of vulnerable people. There were no records to show that this had been done. We asked a member of staff who had worked at the home for eighteen months about his knowledge of abuse. He was only able to demonstrate a very limited knowledge of the signs of abuse, saying that he would report any bruises to a senior Care Homes for Older People Page 17 of 31 Evidence: member of staff. He told us that he had not received any training in the protection of vulnerable adults, and he was unaware of local procedures for reporting possible abuse. The homes recruitment procedures are not sufficiently robust to ensure that unsuitable staff are not employed. This is explained in detail in the Staffing section of this report. Care Homes for Older People Page 18 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 adequate 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 clean and comfortable environment for people to live in, but infection control is not being managed in a way which fully protects the people who live at the home. Evidence: The home was clean and tidy on the day of the inspection, and this was confirmed by comments from people who live at the home and their relatives. The home has two lounges for residents use: one quiet lounge and one with a television. We saw that people were sitting in armchairs which were arranged around the edge of the quiet lounge. Mr Ubhee told us that he hopes to extend the quiet lounge by building a conservatory to the side of it. The home has two dining rooms, both of which are homely, with vases of silk flowers on the tables and photos of Mr Ubhees family on the sideboard. The tables were laid with linen napkins and china cups, and plastic tumblers for cold drinks. We saw that bedrooms were comfortably furnished, and that people had brought some of their own furniture and ornaments to make the rooms more personal. We spoke to one relative, who told us that her mother had recently been provided with new bed linen and curtains. All the bedrooms have appropriate locks, and we saw that some Care Homes for Older People Page 19 of 31 Evidence: people have their own keys to their bedrooms. All external doors have sensors and are connected to an alarm system. This means that people who live at the home have to ask a member of staff if they wish to go into the garden. We saw that used gloves had been discarded into an open bin in one bedroom. It is good practice to discard used gloves in closed bins, such as pedal bins, so as to limit the spread of infection. We saw a member of the care staff coming out of the kitchen wearing a kitchen apron, which they took off and stuffed into their pocket before entering a bedroom. Aprons for kitchen use should not be worn in other areas of the home, as this increases the risk of infection being spread. When we looked at the training records for this member of staff, we saw that there was no record of them having received training in Food Hygiene or Infection Control. Care Homes for Older People Page 20 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at Abbey Grange are kind and caring, but they are not well supported by the manager. There are enough staff on duty to meet the needs of the people who live at the home. Training is not given a high priority, and some staff are not trained to provide care which meets the needs of the people who use the service. Evidence: We received many positive comments about the staff at Abbey Grange. People told us how kind the staff are, and on the day of the inspection we saw staff looking after people in a sensitive and caring manner. One person told us the carers are always very cheerful and polite and another said they are all kind and willing. People told us that, at night, the staff answer the call bells quickly. A relative said shes only got to ring and theyre there. Some staff carry out more than one role in the home. We saw that a member of the care staff was working in the kitchen during the morning, and the cook does care work in the afternoon. Staff rotas showed that there are always sufficient staff on duty to meet the needs of the people who live at Abbey Grange. We spoke to relatives of two people who live at the home, and they told us that there are always enough staff. Care Homes for Older People Page 21 of 31 Evidence: We looked at the records which the home must keep to show that staff are recruited in a way which protects the people who use the service. This includes checks such as a Criminal Records Bureau (CRB) check and two written references, one of which should be from a previous employer. We looked at records for three members of staff. All had satisfactory CRB checks. One member of staff had no references in their file. Mr Ubhee told us that he had been unable to request references because the staff member is young and had not worked previously. In this situation, we would expect references to be obtained from a school or college. Another member of staff had two references, one of which was from a member of staff at Abbey Grange, and the other was signed illegibly and had no name on it, or any way of identifying who the reference was written by. This places people who live at the home at potential risk, as employment references are an important factor in ensuring that unsuitable staff are not employed. Staff training records were incomplete, and Mr Ubhee was not able to tell us with any certainty what training had been provided, including National Vocational Qualifications (NVQ) training. He told us that staff often travel to Swansea for training, which includes Fire Safety training. Two members of staff told us that Mr Ubhee does not pay them whilst they are on training, so that they lose a days pay if they have to travel to Swansea. Mr Ubhee stated that he ensures that training at Swansea is provided on staff members days off so that they do not lose a days pay. He told us that he does not pay staff while they attend training. Our expectation is that Health and Safety training should be provided within normal working hours. The Local Authoritys Department of Mental Health for Older People (DMHOP) offer training to care staff who work with people with a dementia illness. They told us, that despite being offered this training, Mr Ubhee has not taken up the offer. We saw no evidence that staff are trained in the specific needs of people with dementia, and one social worker told us in a survey some of the staff do not have an understanding of the way to communicate and deal with people with a dementia. Care Homes for Older People Page 22 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not managed in a way which promotes the interests of the people who live there. The manager is often absent from the home and this means that staff do not always have the information they need to make decisions. Evidence: Mr Ubhee is both the proprietor and the registered manager of Abbey Grange. He told us that he works at the home for three days a week. However, when we telephoned the home on a day that Mr Ubhee was supposed to be working from 8 a.m until 8 p.m, he was not there and staff were not expecting him until 4 p.m. A member of staff told us I barely see him from one week to the next: he pops in and he pops out. It is clear that the home is lacking an effective management presence for at least four days of the week. There is no deputy manager in post, so the senior carers take responsibility for the day to day running of the home when Mr Ubhee is not there. When we asked Mr Ubhee why someone who had recently been admitted to the home Care Homes for Older People Page 23 of 31 Evidence: as an emergency did not have any assessments of their needs, Mr Ubhee said That wouldnt have happened if Id been here. On the day of the inspection Mr Ubhee was not working at the home, although he arrived later in the morning. The senior carer on duty was not able to provide us with some of the information we required. For example, she did not know where to find a copy of the homes complaints procedure. It is important that whoever is deputising for Mr Ubhee in his absence has a clear understanding and knowledge of the management of the home. Abbey Grange employs two part-time administrative staff, who work in a small office on the top floor of the home. We saw that the administrator on duty on the day of the inspection was working hard to try to put a large amount of paperwork in order. The home stores money used for day to day expenses on behalf of the people who live at the home. The money is stored securely in a safe in the office, and the key holders are Mr Ubhee and one of the part-time administrative staff. When we asked to check some of the money against receipts, we were told that nobody on the premises had a key until Mr Ubhee arrived. This means that if someone living at the home wishes to use some of their money, it may not be available to them when they want it. Mr Ubhee completed the Annual Quality Assurance Assessment (AQAA) and sent it to us promptly. The information in it was brief and gave us very little information about the service. Mr Ubhee showed us some satisfaction surveys dated June 2007. He told us that these have not been done since then, but showed us a quality assurance document which he said that he will be implementing soon. We saw notes of residents meetings, the most recent of which had been held in September this year. Common themes from the three most recent meetings were the wish to have more choice at lunchtime, and requests for more activities such as physical exercise. There was no evidence that there had been any action arising from these points. Records showed that staff had not received supervision or appraisal sessions this year. Mr Ubhee told us that he has been too busy to do this. Supervision sessions help to ensure that staff are working safely and are carrying out their duties correctly. Staff who are new to care work should receive regular supervision to ensure that they are learning good practice. We looked at the records of fire safety, which must be kept by the home to show that the correct checks have been made. These showed that most checks had been carried Care Homes for Older People Page 24 of 31 Evidence: out regularly, but the fire equipment check, which should be carried out monthly, had not been done since March 2008. Care Homes for Older People Page 25 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 26 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 14 You must ensure that assessments of each persons care needs are reviewed and amended as required. To ensure that peoples needs are assessed as they change, so that the correct care can be provided. 31/12/2008 2 7 14 You must ensure that care plans are sufficiently detailed and include accurate information about peoples care needs. To ensure that staff know the care that is required and are able to provide the right care. 31/12/2008 3 9 13 You must ensure that 31/12/2008 medication is stored securely and safely, and that equipment used for the administration of medication is kept clean. Care Homes for Older People Page 27 of 31 This is so that the people who use the service are not put at risk of harm. 4 15 16 You must consult with the people who use the service about their choice of social activity, and provide opportunities for exercise. This is to ensure that people who live at the home can exercise choice and control over their lives. 5 16 22 You must ensure that you inform anyone making a complaint of the outcome of your investigation. This is so that people can be confident that complaints will be investigated thoroughly. 6 18 13 You must ensure that staff are trained to know how to protect people who use the service from the risk of abuse. This is to ensure that people who use the service are protected from abuse. 7 26 13 You must ensure that staff take precautions which will limit the chance of infection spreading. This is so that people who live at the home are not at risk of harm from infection. 8 29 19 You must ensure that all the information specified in this Regulation is secured to 31/12/2008 31/12/2008 31/12/2008 31/12/2008 31/12/2008 Care Homes for Older People Page 28 of 31 determine the fitness of employees working at the home. This will help to prevent unsuitable staff being employed. 9 30 18 You must ensure that staff 31/12/2008 have the knowledge and skills required to meet the needs of the people who use the service. This will ensure that people receive the care that they need. 10 31 18 You should ensure that, in 31/12/2008 the absence of the registered manager, suitably qualified and experienced staff are on duty to take responsibility for the home. This is to ensure that the home is run to meet the needs of the people who live there. 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 1 You should ensure that the Statement of Purpose and Service User Guide contain accurate information. This will ensure that people are fully aware of the service and how it is managed before they move in. You should ensure that there is a procedure for emergency admissions, and that senior staff know and understand it. This will help to ensure that people are not admitted unless the home is sure it can meet their needs. You should ensure that people who live at the home have a choice of main course at lunchtime. This has been 2 3 3 15 Care Homes for Older People Page 29 of 31 requested by the people who live at the home, and will enable them to exercise freedom of choice. 4 30 You should ensure that training which relates to the health and safety of employees is provided free of charge and within working hours. You should ensure that people who live at the home can access their personal money whenever they wish. You should ensure that staff receive regular supervision and appraisal, so that they are supported to provide a good standard of care. You should ensure that arrangements are in place to comply fully with Regulation 24(a), in particular that all fire safety checks are carried out with the frequency specified in the fire risk assessment. 5 6 35 36 7 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) 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. 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