Inspection on 21/10/09 for Abercarn Residential Home

This inspection was carried out on 21st October 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abercarn Residential Home 29/07/09

Abercarn Residential Home 04/11/08

Abercarn Residential Home 15/11/07

Abercarn Residential Home 19/01/07

Abercarn Residential Home 27/01/06

Abercarn Residential Home 11/11/05

Abercarn Residential Home 11/03/05

Abercarn Residential Home 06/07/04

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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 13/03/2010.

Key inspection report Care homes for older people Name: Address: Abercarn Residential Home 56 High Street Pensnett Dudley West Midlands DY5 4RS     The quality rating for this care home is:   zero star poor 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: Ann Farrell     Date: 2 2 1 0 2 0 0 9 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 47 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 47 Information about the care home Name of care home: Address: Abercarn Residential Home 56 High Street Pensnett Dudley West Midlands DY5 4RS 01384480059 01384480059 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cotdean Nursing Homes Limited care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 8, Old age, not falling within any other category (OP) 32, Physical disability (PD) 8, Date of last inspection Brief description of the care home Abercarn is a located in the heart of Pensnett on a main road between Kingswinford and Dudley, served by a bus route. There is car parking at the front and side of the property. Care Homes for Older People Page 4 of 47 Over 65 0 32 0 8 0 8 1 1 1 1 2 0 0 8 Brief description of the care home The home provides accommodation for a maximum of 32 people on two floors, accessed by a lift. On the ground floor, there is a communal lounge, and the office is in the corner of the dining room. In the enclosed garden there is a covered area for people who smoke and a laundry building. Bedrooms are on the ground and first floor, have washbasins, and a few of these are double rooms. There are communal toilets located throughout the home and near communal areas, but these cannot accommodate a wheelchair and hoist. There are two assisted bathrooms; a bath on the ground floor and a shower on the first. The service user guide was available and it stated fees for residential care were £369 per week. However, information should be sought from the care home at the time of making enquiries. Care Homes for Older People Page 5 of 47 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: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last key inspection was undertaken on 11th November 2008 when they were given a one star rating. A random inspection was undertaken on 29th July 2009 to follow up on the requirements and recommendations from the key inspection. At this time there was noted to be improvements in the medication system, but there were shortfalls in aspects of health and personal care especially in the use of bed rails. Further Care Homes for Older People Page 6 of 47 requirements were made for action to be taken to address the areas of concern. This inspection found that the concerns had not been addressed and the requirements had not been met. As a result of the findings an immediate requirement was made in respect of bed rails and the gas equipment. A further inspection will be undertaken in the near future to follow up on areas of serious concern. Prior to the fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies and an Annual Quality Assurance Assessment (AQAA) plus the findings of the random inspection. The AQAA is a questionnaire that is completed by the manager and it gives us information about the home, staff, people who live there, any developments since the last inspection and their plans for the future. Surveys were also forwarded to staff, people who live in the home, their relatives and health professionals. In addition, people were spoken with at the time of the fieldwork visit. One inspector undertook the fieldwork visit over two days. The acting manager was available for the duration of the inspection. The home did not know that we were visiting on the first day of inspection. At the time of inspection it was stated there were twenty six people living in the home. Information was gathered by speaking to and observing people who lived at the home. Three people were case tracked and this involves discovering their experiences of living at the home by meeting or observing the care they received, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. At the time of inspection six people who live in the home, three visitors and four staff were spoken with in order to gain comments. Care Homes for Older People Page 7 of 47 What the care home does well: What has improved since the last inspection? What they could do better: The service user guide should be available in alternative formats, to ensure it is accessible to everyone considering moving into the home. A review of the admission assessment should be undertaken to ensure it provides accurate information about the person at the time of moving into the home. Also the process should involve the person moving into the home or their representatives to enable a person centred care plan to be drawn up and documents should demonstrate this. Action needs to be taken in respect of care plans to ensure they are person centred and provide detailed information about the support required by staff to meet peoples needs, so thier needs are met effectively. Daily records should not contain gaps to ensure they are accurate and contemporaneous. Also daily records and evaluations of care plans need to be developed further to provide details about peoples health, social, psychological welfare, progress and follow up of any concerns, so that care can be followed up. Risk assessments must be undertaken where bed rails are in use or staff are considering thier use to determine if they are appropriate. If they are deemed to be Care Homes for Older People Page 8 of 47 appropriate suitable equipment must he put in place to ensure people are protected from harm. Also staff should be provided with training in respect of the use and care of bed rails and systems implemented to ensure they are checked regularly and are fit for use. Staff should be provided with training in a number of ares to ensure peoples well being is maintained e.g. blood glucose monitoring, medical conditions, challenging behavior, pressure area care, continence management, nutrition, risks assessments, care planning and medication etc. This will provide staff with the knowledge to meet [peoples needs effectively. Systems must be in place for the effective management of continence in order to prevent complications and ensure peoples comfort. Effective systems must be put in place to ensure people at risk of pressure sores receive regular pressure relief and it is recorded, to reduce the risk of pressure sores developing. Appropriate beds must be in place to ensure the correct equipment to meet peoples needs. An objective tool should be used to determine if peoples weight is within normal limits, so that action can be taken where appropriate. There must be robust systems in pace for infection control to reduce the risk of cross infection to include the appropriate use of aprons, gloves and hand washing facilities in bedrooms where personal care is undertaken and so forth. The manager should liaise with GP surgeries about the follow up and monitoring of chronic diseases such as diabetes, asthma, high blood pressure and so forth, to ensure peoples well being. Records of any follow up must be retained in the home. Robust systems must be in place to ensure follow up of any concerns or instructions from health professionals to ensure peoples well being. There must be robust medication systems in the home to include the correct administration and recording of medication, creams must be dated on opening, the correct storage and prescribing of oxygen, care plan for the use of when required (PRN) medication plus recording of the minimum and maximum fridge temperature to ensure medication is stored at the correct temperature and people receive the medication prescribed for them. Robust systems must be in place to ensure recording of all accidents in peoples daily records and accident reports. Auditing of accidents should be more comprehensive, so that any contributing factors can be identified and action taken to prevent further reoccurrences. There must also be systems in place for follow up of accidents and this must be clearly recorded in records to demonstrate appropriate follow up occurred. Systems must be in pace to enable people living in the home to make and receive telephone calls in private. Also everyone living in the home must be consulted about locks to bedroom doors and lockable facilities and these should be provided where Care Homes for Older People Page 9 of 47 requested, so that facilities for privacy are improved. Systems must be in pace to ensure the cook has a varied range of food items in stock in order to provide a varied nutritious diet for people living in the home. Also a review of the menus and dining arrangements should be undertaken and appropriate action taken to ensure ensure people receive a varied, nutritious balanced diet that meets thier needs and preferences in a congenial dining atmosphere. Systems must be in place to inform people living in the home and thier relatives of the complaints procedure to ensure they are aware of the procedure to raise any concerns or complaints. Systems must be in place to ensure the investigation of all complaints is fully recorded and fed back to the complainant to determine if they are satisfied with the outcome of the investigation or further action is required. Systems should also be implemented to record any concerns or informal complaints to demonstrate an open and proactive approach to complaints with continuous improvement. All staff should be provided with training in respect of safeguarding, the Mental Capacity Act and the Deprivation of Liberty safeguards, commensurate with their position, to ensure people are protected effectively. Also the whistle blowing policy should be developed further with details of external bodies who staff can raise issues with if necessary, so people are safeguarded. Some ares of the environment need to be improved to ensure people are safeguarded and include; the clinical waste bin must be locked when not in use, the slabs in the rear garden must be even, the damaged patio table should be replaced, the smoking room must be fit for purpose and cleaned effectively, hoists must be fit for purpose, the window frame in WC 8 should be repaired or replaced, the milk fridge must be maintained at the correct temperature and there should be effective heating in the laundry. The recruitment procedure should be more robust and include exploration of gaps in peoples work history to ensure people are safeguarded by the recruitment of new staff. There must be robust procedures in place to safeguard peoples money with receipts for all deposits and withdrawals, robust record keeping and money from the residents fund must not be used to buy food and hardware etc for the purpose of the home. An application must be made to us for registration of a manager. Also the management systems need developing further to ensure effective systems are in place to meet peoples needs and support staff effectively. The quality assurance system needs to be developed further with feedback from staff, robust audits, regular meetings with staff, people who live in the home and thier relatives plus staff supervision. Following feedback a development plan should be drawn up and implemented to ensure continuous development. Robust systems must be put in place to protect people in the event of a fire and include regular checking for fire stops on individual doors, updating of the fire risk assessment, individual evacuation plans for everyone living in the home plus follow up Care Homes for Older People Page 10 of 47 of the gas warning notice that was issued in March 2009. 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 11 of 47 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 12 of 47 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. Information is made available to people before they move into the home enabling them to make an informed decision about moving into the home. The assessment process should be reviewed to ensure accurate information is obtained at the point of admission, so peoples needs can be met effectively when they move into the home. Evidence: The home had copies of an updated service user guide in the office. The service user guide is provided in size 14 front to make it more accessible to people. Consideration needs to be given to providing it in alternative formats for people with disabilities. The document gives people information about the services, facilities and fees to enable them to make an informed choice about moving into the home. This document should be made more freely available for people visiting the home. Care Homes for Older People Page 13 of 47 Evidence: The home provides care for people who require long term or respite care. People can visit the home before moving in, so they can view the facilities, meet staff and other people who live there, in order to sample what it would be like to live there. The people who were spoken with stated they had visited the home with their relatives before moving in. Documents indicated staff undertake pre-admission assessments for people before they move into the home, so they can determine if peoples needs can be met appropriately. On inspection of the records for one person who had moved into the home recently it was found the document had been completed. The assessment was based on physical needs and was of an adequate standard. There was evidence of an assessment from Social Services and it was noted there were some differences in the information provided in the homes documents and the assessment from the social worker. Also the homes document did not indicate who was involved in the process to ensure a person centred approach. The acting manager is advised to review the assessment process to ensure accurate information is recorded at the point of admission, so appropriate systems can be put in place to meet peoples needs upon moving into the home. There was no evidence of a letter indicating the home would meet the persons needs as part of the admission process. However, the acting manager did produce one for another person to show that it does occur on some occasions. The manager must ensure a letter is forwarded to everyone following assessment to advise them of the outcome, so they can be assured their needs can be met when they move into the home. Following admission to the home there is a trial period of one month and a review is held at the end of the month with the person and their relatives. This provides an opportunity to discuss whether the person is happy to continue living in the home and if their care needs are being met or any changes are required. Care Homes for Older People Page 14 of 47 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. A more pro active approach with attention to detail is required to ensure peoples health and personal care needs are met in a person centred manner. The medication system needs to be more robust to ensure people receive medication that is prescribed for them. Evidence: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individuals needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Following admission to the home a care plan is drawn up based on the pre admission assessment. The AQAA stated, Care planning and risk assessments had improved significantly and there was pro-active and positive ongoing responses to issues or concerns raised by service users. There was no change in care plans since the previous inspection and they were found to be pre printed documents for all areas of care with the exception of one the acting manager was in the process of completing. Care Homes for Older People Page 15 of 47 Evidence: They had not been personalised to provide detailed information for care staff as to the action required to meet peoples individual needs. The acting manager confirmed no changes had been made to care plans or risk assessments since the last inspection. On discussion with a senior member of staff they stated they simply get the pre printed plan for any area of need and add specific comments such as needs two staff for personal care. The acting manager was in the process of completing a person centred care plan, but the person had been admitted to the home three months previously and there were a number of areas in the care plan that had still not been completed. Therefore, staff would not have the specific information to meet this persons needs. Care plans need to be completed in a timely manner, so staff have the information about the support people require. Three peoples care files were looked at in detail. There was evidence risk assessments had been completed in respect of manual handling, nutrition, skin etc. for all the files looked at. Risk assessments are completed in order to identify any areas of risk to enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well-being is promoted. Generally it was found that the planning of care was inconsistent and therefore we could not be certain that each person had care plans that were up to date, accurate and addressed their needs. All care plans need to be personalised and provide detail of the action to be taken by staff to support people, as this could result in poor care practices and evaluation of care may not be accurate. On inspection some irregularities were found in risk assessments and when areas of concern had been identified no action had been taken. For example a risk assessment for one person indicated they were at low risk of pressure sores, but another for the same person indicated they were at high risk. One indicated they had a neurological deficit, but the other indicated there was no neurological disturbance. In another case the nutritional risk assessment for one person indicated they had lost weight each time it was reviewed, weight records indicated loss of weight, but no action had been taken and no care plan was in place. This person had lost 16 Kgs over the past year. In another case a person had lost weight and the information was not included in the risk assessment. On discussion with a senior member of staff who undertook care planning and risk assessments she was unable to explain the risk assessments, the links between them and how they fitted into the care planning process. She stated she had not received any training in completing them. At the random inspection in July 2009 issues were identified with the use of bed rails Care Homes for Older People Page 16 of 47 Evidence: as no risk assessments were in place, the equipment was not suitable and staff had not received any training in respect of bed rails. A requirement was made that where bed rails were used risk assessments must be completed and action taken to ensure people had the appropriate equipment to ensure their safety. At this inspection we found no changes had occurred. The acting manager acknowledged there had been no change in respect of risk assessments or equipment and staff confirmed they had not received any training. This is concerning as it places people at risk. Following a visit and advice from the Commissioning unit recently the acting manager had made contact with the social worker and district nurses in order to review each person who had bed rails, as she lacked knowledge about the management of bed rails. On the day of inspection one person had been seen by the district nurse and it was identified the persons bed needed to be changed before a risk assessment could be completed, as pressure relieving equipment was in place. Other people were still waiting to be reviewed by the district nursing teams. The acting manager informed us new beds had been ordered by the company. Following inspection an immediate requirement was made in respect of bed rails and this will be followed up within one month. If appropriate action has not been taken at that stage the matter will be referred to the enforcement team for enforcement action, as this places people at risk. Staff were monitoring peoples bowel actions. Records indicated that some people who required support for toileting had not had their bowels open for several consecutive days and there was no evidence that any action had been taken. On discussion with the manager she did not indicate any action had been taken. Where aspects of care are being monitored by staff appropriate action should be taken when there are issues, so peoples well being is maintained. Odour was noted in one area of the home and this could be due to the management of continence as the person was found to be incontinent on entering their room. Effective systems must be put in pace to manage incontinence to ensure peoples needs are met complications prevented. The care plan for one person stated they had challenging behaviour, but it was not dated, signed or evaluated. Also staff had not received any training in this area to ensure they were suitably qualified to manage the situation. Care plans in respect of diabetes were not comprehensive and did not give guidance to staff on the optimal blood glucose range for each person to ensure their well being. On discussion with staff they stated they were not made aware of this information, but care staff did undertake blood glucose monitoring. There was no evidence that staff Care Homes for Older People Page 17 of 47 Evidence: had received any training in undertaking blood glucose monitoring and deemed competent to undertake the procedure. On discussion with staff about various conditions that people had e.g. Diabetes, Parkinsons disease and so forth they lacked general knowledge of how to manage the conditions and complications, but were aware of how to respond if some ones blood sugar level dropped too low. It is recommended staff receive training in respect of clinical conditions, so they have an adequate understanding and are able to meet peoples needs effectively. There was evidence the district nursing service had provided pressure relieving equipment for people who were at risk of pressure sores. Although the mattresses were in use on beds and working effectively, pressure relieving cushions were not consistently in use. As identified earlier one pressure relieving mattress was not on the correct type of bed. The manager stated people at risk of pressure sores had pressure relieved regularly and would be moved at the time of toileting and meals. However, it was noted people at risk of pressure sores were not moved from lounge chairs at meal times and there were no records of regular pressure relief. On discussion with one member of staff they stated one person did not need pressure relief, but this person could move independently and would be at risk of developing pressure sores, so would require regular pressure relief. There was no evidence staff had received any training in relation to pressure area care and related issues. It is recommended staff are provided with such training to ensure they have a greater understanding and can meet peoples needs effectively. Staff record daily records for each person and it was found a new sheet of paper was used for the beginning of each month, which resulted in large gaps at the end of the sheet. Also gaps had been left by staff where staff had not completed a record for a particular day. These records should be recorded at the time as they are legal documents. Gaps allow for the possibility of things to be added at a later date. This area will need to be reviewed and action taken to ensure all records are contemporaneous. Also it was noted that a carer on night duty undertook evaluations of care plans. The manger stated this practice had just changed, as a night carer would not be able to comment appropriately about aspects of care during the day. Daily records and evaluations were generally lacking in detail and should provide details about peoples health, social and psychological welfare and progress etc. At the last inspection it was identified staff were not recording accidents/incidents. This had improved and accidents were being recorded in the accident records. However, they were not consistently recorded in peoples daily records and there was Care Homes for Older People Page 18 of 47 Evidence: no evidence of monitoring after incidents such as head injuries. The auditing of accidents consisted of recording the number of accidents for each person each month, but it did not consider any patterns/similarities to determine if there were any contributory factors that could be addressed to reduce future risks. During the inspection staff were observed to be walking around the home with white apron and gloves on, leaving peoples room after providing personal care with the protective equipment on and handling furniture. This is poor practice in respect of infection control and increases the risk of cross infection. Action must be taken to ensure correct procedures are followed to reduce the risk of cross infection. Everyone living in the home was registered with a local General Practitioner (GP) who visits the home on a weekly basis. People moving into the home have the option of retaining their own GP. (If the GP is in agreement). There was some evidence of visits by Health and Social Care professionals such as chiropodist, dentist and optician. There was no evidence available in files to demonstrate monitoring of chronic diseases by health professionals such as diabetes, high blood pressure, asthma etc. Such follow up ensures peoples health and well-being. Advice will need to be sought from health professionals about such monitoring and clear records should be kept in the home to demonstrate this is occurring. On reviewing one file the GP had visited and ordered a urine test for one person, but it had not been followed up by staff. This was concerning as we cannot be assured that peoples health needs are being met effectively. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. Medication was stored in locked cupboards in a locked room ensuring the safety of drugs. An inspection of the current months medication was undertaken with a senior carer, who administered medication. It was found that audits for blistered and boxed medication were not correct in a number of instances. In some instances blistered medication had been signed for and not administered. Cream was found in one persons bedroom with no date of opening. Creams should be dated on opening and discarded within specified timescales to reduce the risk of infection. Care Homes for Older People Page 19 of 47 Evidence: Details of handwritten medication were on one persons MAR chart and the audit indicated the person was being given double the dose of medication that was recorded on the MAR chart. Medication for Parkinsons disease had not been given because the person was asleep and alternative arrangements had not been made to ensure they received their medication. One person was on an inhaler for prevention of asthma twice a day. The instructions on the MAR chart stated it should not be stopped without speaking to the GP. Records indicted it was not offered in the evening and it had been refused on several occasions during the day. There was no evidence the GP had been consulted. On discussion with the staff they did not have a knowledge and understanding of the medication. One medication had been broken into half in the bottle ready for administering as it was prescribed for half a tablet. Where medication is broken it should be returned to the pharmacist after one month. Oxygen was not prescribed and the homes policy stated it should be prescribed. It was not stored properly and on discussion with the senior carer they were not aware of specific instructions for the storage of oxygen. The minimum and maximum fridge temperature was not being recorded. This needs to be implemented to ensure medication stored in the fridge is kept at the correct temperature at all times. One person was prescribed lorazepam PRN and there was no care plan or instructions of how/when it should be used. Staff were observed to assist people and they were fairly well supported in respect of personal care and choosing clothing appropriate for the time of year, which reflected their individual culture, gender and personal preferences. However, there was a lack of attention to detail in some instances e.g. spectacles were not on; stocking/tights and footwear were missing. Bedroom doors did not have locks in place and lockable facilities were not available in bedrooms to store valuables/medication if required. It was noted the acting manager had started to ask people if they would like this facility. This needs to be rolled out to everyone, so they are given the option of having these facilities and privacy arrangements enhanced. There was no telephone for people to make or receive a call Care Homes for Older People Page 20 of 47 Evidence: in private, as the only telephone was in the office and was in use by staff. These areas will need to be addressed to improve arrangements for privacy. Care Homes for Older People Page 21 of 47 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for visiting the home were flexible, so people were able to maintain important relationships. Arrangements in respect of activities need further development to ensure people are stimulated and their well being maintained. The meals and dining arrangements need to be reviewed to ensure people receive a varied and nutritious menu that meets their dietary needs and preferences. Evidence: There was no evidence of any rigid rules in the home at the time of inspection. People who live in the home can go outside on their own or with friends and family as they choose, depending on their abilities. On discussion with people living in the home they stated they could get up/go to bed when they wanted. People are able to bring personal items of small furniture, pictures, ornaments etc. into their bedroom, providing a home from home atmosphere reflecting their personality. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. On discussion with the acting manager about activities she stated movement to music occurred once a fortnight, which people really enjoyed. An entertainer visited last week, some people went out shopping or to the local pub, one person attended a day Care Homes for Older People Page 22 of 47 Evidence: centre three times a week and one person attended a stoke club once a month There was a green house and some flower pots in the garden and one person living in the home enjoyed gardening. They have televisions in each part of the lounge for people to watch and they are currently organising a Halloween party. There are plans for a Christmas party and a Fete next year as they were unable to hold one this year. Feedback from people and surveys indicated people did get bored at times and would appreciate more activities. I am bored to death More entertainment required during the day There was a four week rotating menu on the notice board and the AQAA stated improvements included new varied and improved menus. On inspection it was found the four week menu was for the main course at lunch time only, which only gave one choice and was revised in February 2008. There was a separate list of desserts that had 27 choices on and instructions that it was left to staff to decide which dessert was most suitable to follow the main course, but to try and use every dessert over the 28 day period so people had as much variety in their diets as possible. The record of food showed that on occasions people did have an alternative to the main meal if they did not like the meal on the menu. It was found that only six of the dessert choices were used and four had been repeated on two occasions. The remaining twenty days people were given either fruit and cream, mousse, fruit jelly, fruit and ice cream or similar. On discussion with the cook she stated the decision in respect of desserts was based on what was available in the pantry. Evening meals consisted of sandwiches every night. On six occasions soup was also given, on occasions there was also sausage rolls, quiche or malt loaf, but there was only one occasion when a hot alternative of fish fingers and chips was served. The evening meal was served to the majority of people in the lounge chairs where they had been sitting all day and it was only people who could move unaided who sat at the dining table. Feedback about the food included; Food aint too bad, you have to be grateful. I get fed up with sandwiches. The food is OK. Care Homes for Older People Page 23 of 47 Evidence: A review of the catering, menus and dining arrangements needs to be undertaken to ensure everyone receives a choice of nutritious meals that meets their needs and preferences. There was one dining room close to the kitchen and re-decoration was occurring at the time of inspection. Care Homes for Older People Page 24 of 47 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems for listening to people and protecting them from harm need further development to ensure people are adequately protected. Evidence: A complaints procedure was on display in the hallway and details of how to make a complaint were in the service user guide. On discussion with people living in the home they were not aware of the procedure to make a complaint and the acting manager stated she had received similar feedback from surveys. The AQAA stated meetings were held with people in the home ensuring problems were dealt with promptly and efficiently. The record of meetings indicated a meeting was held in September 2008. On discussion with the manager she confirmed there had been no meetings since she took up post, but stated she spoke to people informally. There was a complaints book where staff recorded any complaints received and one formal complaint had been recorded. The record indicated that feedback had not been provided to the complainant about the outcome. There was no record of any informal complaints/concerns in the home. This could suggest staff only record formal written complaints and concerns are not recorded. It is recommended that suitable systems be developed to record informal complaints and concerns and the action taken in order to demonstrate a pro active approach and continued improvement. Care Homes for Older People Page 25 of 47 Evidence: The home had made one safeguarding referral as a result of concerns in the home. One had been made by us following the random inspection in July 2009 due to concerns about aspects of care and the case is still open. Records indicated only half the staff had undertaken training in respect of safeguarding in March 2009 and no training had been provided in respect of the Mental Capacity Act (MCA) or the Deprivation of Liberty Safeguards (DOLS). On discussion with staff they were aware of the safeguarding procedure in the home, but were not aware of whistle blowing and confirmed they had not received training in respect of MCA and DOLS. The policy in respect of whistle blowing did not advise staff where they could raise concerns apart from direct management and this should be reviewed. Care Homes for Older People Page 26 of 47 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. Some re-decoration is taking place, so the environment will be improved for people living in the home. There are a number of areas that need attention to ensure health and safety in the home. Evidence: Abercarn is a large traditional, detached, extended, double fronted, care home, with parking to the front of the building. There was a large receptacle on the front drive for the disposal of clinical waste, but it was not locked as required under legislation for safe storage. There is a large garden to the rear with patio area and paved walk areas. However, some of the paving slabs are uneven and are potentially a trip hazard. There was one wooden bench plus a plastic patio table and chairs for use when the weather permits. However, the table was damaged and will need to be replaced, as it could cause damage if someone moved near it. On entering the home there is a reception area with a notice board that leads into a dining room, which is adjacent to a large lounge. The home does not have a visitors room, though people can take visitors to their bedroom if they wish. A partial tour of the home was undertaken and it was found to be warm and cleaned to an satisfactory standard. There was evidence of some re-decoration at the time of the inspection to enhance the environment for people living in the home. Some new Care Homes for Older People Page 27 of 47 Evidence: chairs were seen in an empty bedroom and the acting manager stated they would be put into use when the decorating was completed. The home was generally odour free with the exception of one area. The manager was advised that this would need to be reviewed and she should ensure appropriate management of continence in the home. There was a separate smoking facility in the garden area that could be accessed by people via a ramp from the dining room. The area was in need of cleaning and the extractor fan was not working. The acting manager was advised to contact the environmental health officer about the cleaning and ventilation of this facility to ensure people are safeguarded. The home had communal WCs and bathing facilities on each floor with a flat floor shower on the first floor providing people with a choice of bathing facility. The manager stated flooring in bathroom 1 was to be replaced. It was noted the bath temperature was only 39.4 and the hoist was showing signs of wear on the side and could cause damage to a persons skin. Also the window frame in WC 8 was warped and remains outstanding since previous key inspections. All bedrooms were single occupancy and had a wash hand basin. A call bell facility was available in each bedroom, so people could call for assistance if required. Commodes were available in some bedrooms and the covering was damaged. The manager stated six new commodes and sixteen new beds had been ordered. Bumpers for bed rails were on the floor when not in use. This is not appropriate due to the risk of infection and should be stored off the floor. Also it was noted there was no liquid soap or paper towels in bedrooms for staff to wash their hands after supporting people with personal care. This should be in place in all bedrooms where personal care is provided to reduce the risk of cross infection. Bedroom doors did not have locks and lockable facilities were not available in bedrooms, so people could store medication/ valuables. The manager has started a process of consulting people to determine if they would like such a facility, so enhancing privacy. Bedrooms were personalised and reflected individual tastes, gender and cultural preferences. A passenger lift enables people to access all areas of the home and the home has a range of equipment to assist people with reduced mobility e.g. portable hoists, hand rails, toilet seats etc. The main kitchen was clean, very orderly and adequately equipped for its purpose. The manager stated they had been working with the environmental health department Care Homes for Older People Page 28 of 47 Evidence: and they expected an inspection in the near future. Temperatures of fridges and freezers were being recorded on a regular basis to ensure food was stored at the correct temperature. It was noted the milk fridge was not at the recommended temperature. This was raised with the member of staff and she was advised to contact the company for advice. The laundry is situated in an out building. It was adequate and had processes to prevent cross infection. Laundry equipment was adequate, but there was no evidence of any heating. On discussion with the health and safety officer of the Environmental Health Department he stated heating should be provided and the temperature monitored to ensure a minimum of 16 degrees centigrade is achieved. The management should take action in consultation with the health and safety officer under the Health and Safety Work Place Regulations. Care Homes for Older People Page 29 of 47 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedure was adequate for the employment of new staff, so people were protected. Further staff training is required to ensure staff have the range of knowledge and skills to meet peoples needs effectively and in a person centred manner. Evidence: The duty rota indicated there were three care staff and a senior on duty during the morning; two care staff and a senior during the afternoon/evening and three care staff overnight. From the rotas seen this was usually achieved with the use of agency staff on most occasions. Ancillary staff such as domestic, laundry, catering, and maintenance staff supports care staff. At the time of visiting there were twenty six people living in the home and on discussion with the acting manager she stated at least nine people needed two staff for assistance during the day. Feedback indicated staff are usually/sometimes available when needed. At times during the inspection it was noted there were no staff supervising people in lounges. Comments included; Staff are OK If I ask them for anything they do it Care Homes for Older People Page 30 of 47 Evidence: The information provided by the home indicated there had been a low staff turnover and only one member of staff had been employed during the past year as a kitchen assistant. Inspection of the recruitment file indicated a satisfactory recruitment process and Criminal Record Bureau Checks had been completed before they commenced work. There was a record of interview, but there was no evidence that gaps in the person employment history had been explored. This is an area that needs to be followed up to ensure robust recruitment procedures. We were unable to assess induction training as no new care staff had been employed since December 2007. The homes training matrix demonstrated that most staff had completed mandatory training in respect of basic food hygiene, Health and safety, Fire prevention and infection control this year. Some training in respect of manual handling was occurring at the time of inspection. Senior staff had completed training in respect of medication in January 2009. The manger stated they were now using an external provider for training and they also joined with staff from the sister home. Records indicated that sixteen of the eighteen staff had completed National Vocational Training (NVQ) Level 2 in care. As identified in other parts of the report training is required in a number of areas to develop staff knowledge and skills, so they are better equipped to meet peoples needs effectively. Care Homes for Older People Page 31 of 47 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 current management arrangements in the home are not robust enough to ensure the health, safety and protection of people living in the home. Evidence: The acting manager commenced work in the home at the end of last year and works on a full time basis. She is supernumerary on some days, averaging two days per week and the remaining time she works as a member of staff on the floor. When she is supernumerary she is supported by a senior carer. The acting manager stated she has not applied to us for registration yet as she is waiting for a medical report. This will need to be addressed as soon as possible and an application made for registration with us. People have the choice to manage their own finances, but some people deposit money in the home for safekeeping. The home does not act as appointee/agent for people in the home, but assists with personal allowances. Individual records were maintained for people where the home held money on their behalf. Receipts were not available for Care Homes for Older People Page 32 of 47 Evidence: deposits made and were not available for all withdrawals. It was noted that a withdrawal was made that did not correlate with the receipt available. Also some of the receipts were not dated and did not indicate the name of the person who the money was going to. An audit was undertaken regularly and in one case it was found that two people had signed to say it was correct, but in fact it was noted straight away that the calculations were wrong. This does not guarantee that peoples money is managed safely. Money is raised in the home for a fund to support people with activities such as outings etc. On inspection it was found the records were not up to date and money had been used to buy food and hardware items for the home. This is not appropriate and action must be taken to repay the money and put systems in place so there is sufficient funds in the home to buy such items. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was forwarded to the home in order to gain information about the home, staff, people who live there and the improvements over the past year and the plans for the future of the home. It was brief, gave vague statements and some of the areas where they claimed improvements had occurred were found to be inaccurate. The organisation has a quality assurance process that consists of a range of audits in respect infection control, jewellery, money, medication. However, it was found that one of he audits in respect of a persons jewellery had changed and no action had been taken to follow it up. When staff were asked about it they could not give an explanation and the manger made inquiries on the day of inspection. In other cases areas of development had been identified, but there was no evidence that action had been taken e.g. the acting manager stated she had had identified the lack of staff hand washing facilities in peoples bedrooms. Questionnaires had recently been forwarded to people who live in the home, relatives and visiting professionals in order to gain feedback and they were in the process of being returned. In order for the quality assurance process to be effective staff must take note of any changes or shortfalls and take action to address them in order to achieve continuous improvement. There had been two staff meeting in the past year and no meetings with people living in the home or relatives. Ten out of twenty one staff had received formal staff supervision once in the past year and the acting manager acknowledged she was not up to date with them. Care Homes for Older People Page 33 of 47 Evidence: There was evidence that a senior manger had visited the home between one and two monthly in order to audit the quality of the service. as required under the regulations. Records indicated the last one occurred on 6th October 2009 and the records checked were money, jewellery and medication and all were up to date and no issues were identified. It is concerning that we found shortfalls in all these areas when the inspection was undertaken. Throughout the inspection shortfalls were identified in care planning, risk assessments, staff knowledge, medication, money, management systems etc. A number of areas need development, to ensure everyone receive a consistent standard of care that meets their needs in a person centred manner. The acting manger has only been supernumerary for approximately two days per week and has been unable to develop the systems during the past year of employment. It is recommended that a review of the management arrangements is undertaken and positive action taken with appropriate support for the acting manger to ensure effective systems are developed and put in place to ensure the well being of everyone living in the home. There was evidence that health and safety maintenance checks had been undertaken in the home to ensure equipment was in safe and in full working order. These were found to the satisfactory with the exception of a warning/advice notice that was issued in respect of the ventilation for the gas equipment, as there was no mechanical input or gas interlock. There was no evidence that this had been addressed and this was very concerning as it was issued in March 2009. An immediate requirement letter was sent to the home to highlight the concern and request information about the action they will be taking to ensure the safety of people living in the home. Checks were completed on the fire system regularly, but there was no evidence the individual fire stops on doors were checked, plus the fire risk assessment had not been updated since 2007 and there were no individual evacuations plans for people in the event of a fire. It is recommended that advice be sought from the West Midlands Fire Brigade and action taken to address the shortfalls to ensure the safety of people in the home in the event of a fire. Care Homes for Older People Page 34 of 47 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be person centred and outline in detail the support required by people. So their needs are met. 29/08/2009 2 8 12 Where people are deemed at 29/08/2009 risk of pressure sores systems must be put in place to prevent pressure sores developing. To ensure peoples well being. 3 8 13 Where people require bed rails a risk assessment must be fully completed. To determine if it is the most appropriate method of safeguarding the person. 29/08/2009 4 8 12 Where people are deemed to 29/08/2009 be at risk nutritionally suitable systems must be put in place to ensure they receive adequate nutrition. To ensure peoples well being. 5 8 13 An audit of all bed rails must 29/08/2009 be undertaken and action taken to ensure they are suitable and safe at all times. Care Homes for Older People Page 35 of 47 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 To ensure people are safe. Care Homes for Older People Page 36 of 47 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 1 8 13 An audit of all bed rails must 21/11/2009 be undertaken and action taken to ensure they are suitable and safe at all times To ensure people are safe. Outstanding from 29/08/2009 2 8 13 Where people require bed rails a risk assessment must be fully completed. To determine if it is the most appropriate method of safeguarding the person. Outstanding from 29/08/2009 21/11/2009 3 38 13 Action must be taken to 21/11/2009 address the outstading issue identified in the warning/advice notice in respect of ventilation for gas equipment. To ensure the safety of people in the home. Care Homes for Older People Page 37 of 47 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 5 Care plans must be person centred and outline in detail the support required by people. So their needs are met. Outstanding from 29/08/2009. 20/01/2010 2 8 12 A review of all risk assessments must be undertaken for everyone living in the home. Where any concerns are identified appropriate action must be taken with referal to professionals if required. To ensure peoples well being. 21/11/2009 3 8 13 Robust systems must be in place for infection control. 21/11/2009 In order to reduce the risk of cross infection. 4 8 12 Where people are deemed at 21/11/2009 risk of pressure sores systems must be put in place to prevent pressure sores developing. Care Homes for Older People Page 38 of 47 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 To ensure peoples well being. Outstanding from 29/08/2009 5 8 12 Appropriate beds must be in place to meet peoples needs. To ensure the comfort, safety and needs of people are met effectively. 6 8 12 Where people are deemed at 21/11/2009 be at risk nutritionally suitable systems must be put in pace to ensure they receive adequate nutrition. To ensure peoples well being. Outstanding from 29/08/2009 7 9 13 Oxygen must be prescribed and stored in accordance with the homes policy and health and safety regulations. To ensure safe practice 8 9 13 Creams must be dated on opening and used within specific time frames To reduce the risk of infection. 9 9 13 There must be clear instructions in place for the use of PRN medication. 21/11/2009 21/11/2009 21/11/2009 21/11/2009 Care Homes for Older People Page 39 of 47 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 To ensure consistency in the use of such medication 10 9 13 Robust medication systems must be in place to ensure people receive the medication prescribed to them and accurate records of administration are maintained to demonstrate this. 21/11/2009 To ensure people receive the correct medication. 11 9 13 The minimum and maximum 21/11/2009 temperature of the fridge must be recorded daily. To ensure medication is stored appropriately. 12 16 20 The manager must ensure 21/11/2009 the record of complaints is fully completed and systems are in place to inform complainants of the outcome of the investigation. To determine if they are satisfied or alternative action is required. 13 19 13 Action should be taken to ensure paving slabs to the rear of the home are even. 21/01/2010 Care Homes for Older People Page 40 of 47 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 In order to reduce the risk of injury. 14 19 13 Systems must be in place to ensure the clinical waste receptacle is locked at all times when not in use. To ensure safe storage. 15 26 13 Staff should liaise with the provider of the milk fridge and take appropriate action to ensure the fridge is maintained at appropriate temperatures. For the safe storage of milk. 16 31 24 Review of the management arrangements must be undertaken and the Commission informed of the action to be taken to ensure robust managment systesm in the home. To provide robust management systems and ensure peoples well being. 17 31 8 A manger must be registered with the Commission. To meet the regulations and provide effective leadership. 18 35 12 Accurate records must be maitnained of all money 21/11/2009 21/01/2010 21/11/2009 21/11/2009 21/11/2009 Care Homes for Older People Page 41 of 47 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 deposited and withdrawn from the residents fund and money must not be used to buy items for the home such as food and hardware etc. To ensure money raised for people living in the home is used appropraitely. 19 35 12 The money form the 21/11/2009 residents fund that has been used to purcahse items for the home should be repaid to the fund. So people living in the home benefit from the funds raised. 20 35 12 There must be robust systems in place for dealing with peoples personal money. REceipts must be in palce for all deposits and withdrawals and accurate records must be maintained reflecting information from the receipts. So people can be guaranteed their money will be safeguarded. 21/11/2009 Care Homes for Older People Page 42 of 47 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 Consideration should be given to providing the service user guide in alternative formats, so it is accessible to everyone. Ensure a letter is forwarded to everyone following assessment, so they are aware of the outcome of the assessment and appropriate arrangements can be made. A review of the assessment process should be undertaken to ensure the information is accurate at the time of moving into the home, so peoples needs are met effectively in a person centred manner. Daily records and evaluations of care plans need to be developed to provide details about peoples health, social and psychological welfare and progress etc. Carried forward from random inspection July 2009. There should not be any gaps in daily records to ensure they are accurate and contemporaneous. Ensure a robust system for completion of risk assessments is in place ensirign they are consistent, all documents are completed and action is taken to ensure peoples well being. Staff training should be provided where required. Auditing of accidents should be expanded so that any contributory factors/trends can be taken into consideration for future prevention of accidents. Staff must ensure all accidents are recorded in peoples daily records and suitable monitoring systems put in place following accidents to ensure the safety of people. It is recommended an objective tool such as body mass index is used to assess peoples body frame, so that appropriate systems are put in place to meet peoples nutritional needs. Records of regular pressure relief should be in place for people who are at risk of developing pressure sores to demonstrate effective systems are in place in order to prevent pressure sores. All staff should receive training in respect of nutrition, so they have the knowledge and skills to support people whose dietary intake is poor and ensure their needs are met. Outstanding from random inspection July 2009 Page 43 of 47 2 3 3 3 4 7 5 6 7 7 7 8 8 8 9 8 10 8 11 8 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 12 8 Staff should receive training in respect of tissue viability and prevention of pressure sores, so they can ensure appropriate care is given and pressure sores prevented. Outstanding from random inspection July 2009 All staff should receive training in managing challenging behaviour, so they have an adequate understanding and can maintain peoples safety whilst ensuring their needs are met. Staff should receive training in respect of bed rails and how to undertake the daily checks required to ensure they are safe and fit for use. Outstanding from random inspection July 2009 Staff who undertake blood glucose monitoring should receive training to ensure they are competent to undertake the procedure. The training should be updated on a regular basis and records of training maintained. A robust system should be in place for monitoring peoples bowel actions where necessary and appropriate action taken to ensure their well being. Staff should receive training in respect of health conditions to enhance their knowledge and understanding of peoples needs and ensure systems are in place to meet peoples needs. It is recommended the GP surgeries should be contacted about monitoring of chronic diseases to ensure peoples well being. Staff should ensure clear records are maintained to demonstrate where this is occurring. Staff should be provided with training in respect of care planning, so they have an understanding and knowledge about the process and are able to complete care plans that outline in detail the support people require to meet their needs. Carried forward from random inspection July 2009 Staff knowledge in respect of the medication they administer needs to be developed, so they have a basic understanding of the medication use and common side effects etc, so peoples well being is maintained. Everyone should be consulted about their wishes in respect of locks on bedrooms doors and lockable facilities to Page 44 of 47 13 8 14 8 15 8 16 8 17 8 18 8 19 8 20 9 21 10 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 enhance the arrangements for privacy. 22 10 A telephone where people can make and receive telephone calls in private should be available. Further development of the activities programme is required in order to provide people with a suitable range of activities, so they are appropriately stimulated and their well being maintained. Systems must be in place to ensrue there are adequate food stocks in the home to provide people with a varied and nutritious diet. Dining arrangements should be reviewed to provide people with a pleasurable dining experience that ensures good digestion of meals. Menus should be made available to people in suitable formats, so they are aware of what the meals and choices are on a daily basis The menus should be reviewed and updated to offer people a choice of meals at all times and changed seasonally, so people receive a varied balanced, nutritious diet that meets their needs and preferences. Systems should be implemented to record informal concerns/complaints and the action taken to address them to demonstrate continued improvement. All Staff should undertake training in respect of the Mental Capacity Act and Deprivation of Liberty Safeguards, commensurate with their position in the home, so they are aware of how to support people who lack capacity to make decisions All staff must undertaken training in respect of safeguarding and whistle blowing to ensure they have the knowledge to protect people living in the home. Replace the damaged patio garden table to reduce the risk of injury to people living in the home. Liaise with the environmental health officer about suitable arrangements for the cleaning and ventilation of the smoking area to ensure the safety of people entering. 23 12 24 15 25 15 26 15 27 15 28 16 29 18 30 18 31 32 19 19 Care Homes for Older People Page 45 of 47 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 33 19 Suitable heating should be provided in the laundry and the temperature monitored to ensure a minimum of 16 degrees centigrade is achieved for health and safety purposes. Replace or repair the warped window frame in WC 8 to ensure there is no draught. It is recommended that gaps in peoples employment history be explored at the time of interview and records maintained in order to demonstrate a robust recruitment process. The quality assurance system needs to be developed further with appropriate action where any improvements are identified to ensure continuous improvement. All staff should receive formal supervision at least six times per year to ensure they are appropriately supported. The fire risk assessment should be reviewed and updated, fire stops on doors checked regularly and fire evacuation plans developed for everyone who lives in the. It is recommended the fire safety department of West Midlands Fire Service be contacted for advice. 34 35 19 29 36 33 37 38 36 38 Care Homes for Older People Page 46 of 47 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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