Inspection on 30/04/09 for Alde House

This inspection was carried out on 30th April 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alde House 02/05/07

Alde House 03/10/06

Alde House 08/02/06

Alde House 22/06/05

Alde House 17/12/04

Alde House 06/07/04

Alde House 16/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Key inspection report Care homes for older people Name: Address: Alde House Alde House Church Road Penn High Wycombe Buckinghamshire HP10 8NX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Barbara Mulligan     Date: 3 0 0 4 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Alde House Alde House Church Road Penn High Wycombe Buckinghamshire HP10 8NX 01494813365 01494814154 Noneavailable Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Stumpwell Housing Association Limited care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 15 The registered person may provide the following category of service: Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Alde House is a care home for older people situated in Penn, Buckinghamshire. It has fifteen places. The home was opened in 1972 and is managed by Stumpwell Housing Association Limited. The home has been adapted for its present use and comprises the original house and an extension. There is a large and pleasant garden to the rear with views over the surrounding countryside. The home is on two floors and there is a passenger lift to the first floor for service users with impairment of mobility. The home Care Homes for Older People Page 4 of 31 Over 65 15 0 Brief description of the care home is mindful of its origins in Penn and priority is given to people who either live in the village, have lived there in the past, or still have family or friends in the area. The home endeavours to meet a range of needs and draws on the resources of health and social care professionals and other services in the local community as required. The fees range from £530 to £695 per week. Services such as hairdressing and chiropody are at additional cost to the service user as are personal items such as toiletries. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account. The inspection officer was Barbara Mulligan. The registered manager is Vi Bassam. The inspection consisted of discussion with the registered manager and other staff, opportunities to meet with some people who use the service, examination of some of the homes required records, observation of practice and a tour of the premises. A key Care Homes for Older People Page 6 of 31 theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Pre-admission/care plan documents have been supplemented with details of service users background history and other significant matters such as family composition, to provide a more rounded picture of the person. Details of complaints and actions taken are promptly recorded in the log book, to make Care Homes for Older People Page 8 of 31 sure that an up-to-date record is kept. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. Evidence: Four completed needs assessments were examined, including those most newly admitted to the home. The manager will complete a basic needs assessment on her initial visit to the potential service user. This may be in hospital or in their own home. This initial assessment contains limited information but the registered manager said it forms the basis of a more comprehensive needs assessment which is completed on the day of admittance or during a visit to the home by the potential service user. The registered manager said the initial assessment provides adequate information to assess whether the home would be able to meet the needs of the individual. Care Homes for Older People Page 11 of 31 Evidence: The second and more comprehensive assessment was seen in each file and these were fully completed and contain information about the person and their care needs in sufficient detail to provide care. At the previous inspection it was recommended that the pre-admission/care plan documents be supplemented with details of service users background history and other significant matters such as family composition, to provide a more rounded picture of the person. It is pleasing to see a personal history in each file, some have been completed by family members and some during discussions with individuals. It is noted that the service users have been asked their preferred name which is indicated throughout any further documentation seen, this is noted as good practice. The assessment demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. The home does not admit service users for intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of people who use the service are not adequately identified in the care plans, preventing the home from meeting all the needs of the individual. People who use the service feel that they are treated with respect and dignity and that their right to privacy is upheld ensuring personal care is delivered appropriately. Evidence: The care of four service users was case tracked and their care plans examined, including those new to the service. These provide limited information for staff to follow in the provision of personal care. Many entries lack specific detail. For example, under the heading of personal care and hygiene entries in all four care plans read, requires assistance from one staff with washing and dressing and bathing and showering. This is a vague statement and should contain specific details for staff to follow. This is a recommendation of the report. In the four care plans examined specific needs have been identified but there is no plan of care in place to provide staff with the details of how these needs are to be Care Homes for Older People Page 13 of 31 Evidence: managed and fully met. For example in one care plan it has been identified under the heading of communication that sometimes it is difficult to understand what X is saying when they are confused. There is no action plan or guidance recorded in the care plan as to what support staff need to provide to this individual to meet their needs. A further entry records under the heading of mental state that X can become confused and anxious at times. Somedays X will wander about the home and is very muddled. Again there is no action plan or specific guidance in place that details how this will be managed by staff or what support the individual needs. In one file examined an entry has been written that states X has been hitting residents and staff. X has made some residents cry. There is no plan of care in place on how this is managed. A requirement is issued for improvement in this area. Daily notes are completed by staff but numerous entries are difficult to read and some are not legible. Some staff had completed a detailed account of how the service user had spent their day but some entries were very brief and need further detail. This is recommended. Risk assessments are in place covering areas such as falls, moving and handling, fracture risk assessment and pressure area care. These were mainly up to date but the fracture risk assessments were not signed and the falls risk assessments were not signed or dated. This should be addressed. The inspector was told that all service users are registered with the same GP practice. Tissue viability assessments are in place for service users and these were seen to be reviewed on a monthly basis and pressure relieving equipment is in place for individuals who need it. The registered manager said a domiciliary optical service visits the home and service users receive an annual eye test and referrals for a hearing test go through the service users G.P. Weight monitoring is undertaken on a monthly basis and recorded. This was evident in the four files examined. Chiropody services visit the home every eight weeks. Records of health screening was noted in multi disciplinary notes and feedback from service users on the day was positive about how they access medical treatment and healthcare services. The procedures for the administration of medicines were examined during this inspection. At this visit we looked at the medication administration record (MAR) charts, medication supplies and care plans for the four people whose care was being case tracked as part of this inspection and at the MAR charts for the rest of the people using this service. The MAR charts for all people using this service show no ommissions and tell us that Care Homes for Older People Page 14 of 31 Evidence: people are receiving their medicines as they were prescribed by their doctors. The MAR charts showed that there are numerous hand written entries on them. These should be signed and dated and it is strongly recommended as good practice that when it is necessary to handwrite on a medication administration record chart in the home, the member of staff writing the chart signs and dates the chart and a second carer checks the entry for accuracy and then initials the chart. In addition the entry should include a reference to where this information was sourced, such as the prescribers name. There are no written guidelines for many as required (PRN) medicines and this is often left up to individual care staffs discretion to administer. A requirement is issued for the home to implement a system to be put in place that ensures service users plans include guidelines for the administration of all when required/when needed medicines. These guidelines must include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. The medication is safely stored and there are facilities for the storage of controlled medication. There is a controlled drugs register in place if controlled drugs are used in the home. The inspector observed staff assisting people who use the service in a kindly and respectfull manner. Staff are obviously aware of the importance of privacy and dignity and were seen to knock on doors before entering. Preferred terms of address are identified at the initial assessment and the inspector saw evidence of this in care plans and noted that staff were addressing the individual by their preferred term of address. The homes induction programme includes training regarding privacy and dignity. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in the home do not always ensure that people who use the service are supported to exercise choice and control over their lives. People are able to receive visitors at the home, with no restrictions imposed on visiting and the presentation and standard of food is good ensuring people receive a well balanced diet. Evidence: There is some information recorded in the care plans about peoples preferred routines but these are not detailed. Comments received from people who use the service were mixed. Two people who use this service said they are woken early in the morning but would like to have a lie in bed sometimes. Several people told the inspector that the homes staff do not wash their hair and this is only done by the hairdresser which individuals have to pay for. Another person said that they would prefer to have a shower in the morning but staff only bath in the evenings. Details of peoples preferred routines must be recorded in the care plans and must take into account peoples preferences and not decided upon for the convenience of the homes routines. Several people spoken to said they thought that if they asked to do something it would be done, but they had never asked. A requirement is issued for improvement in this area. Care Homes for Older People Page 16 of 31 Evidence: On the day of the inspection staff were observed to undertake several activities with service users. This included an exercise group with a beach ball and basket weaving.The registered manager was asked who facilitates the activities and who decides which activities are undertaken weekly. The registered manager said that the deputy and herself decide upon the activities that will occur weekly and put a timetable up in the Sun Lounge.This was viewed by the inspector and showed activities such as tic tac toe, bowls and toss the ring, carpet balls and basket making, connect 4 and ball games. One relative spoken to on the day of the visit said I have never seen a list of activities displayed before, I wish it could be like this every day. Care plans generally contain good information about the individuals past history , including main interests and hobbies, recreational and leisure activities. However this isnt always reflected in the care plans when describing the individuals social care needs and how these are to be met. Foe example, in two files examined it states, encourage X to participate in the home activities. It does not detail what activities these individuals prefer to take part in. Another visiting relative said that although they had seen activities taking place they didnt feel they catered for or were suitable for their relative. It is recommended that activities reflect the service users preferences and meets their social care needs. One visiting relative said it would be nice if people could go out sometimes. Examples of involvement in the home by local community groups and individuals are visits by a hairdressers, various visiting entertainers and a church service. Service users are able to receive visitors in the privacy of their own rooms and are able to choose whom they see and do not see. Family and friends are invited to participate in some of the social event organised. Relatives and friends are welcome at any time and two visiting relatives spoken to on the day was able to confirm this. The inspector was able to join service users for a lunch time meal. The dining area was attractive with tables laid with attractive tablecloths and napkins and a small plant. The lunch served was attractively presented and tasty. The meal for the day was written on a notice board for all to see. However there was no choice of meal recorded on the notice board. The inspector asked if service users were offered a choice of main meal. The registered manager said that staff will talk to each person during breakfast and inform them of the main meal for lunch. Then if this is something they dont want then an alternative meal is offered. Small glasses of water were given to everyone during the meal. The inspector asked why only water was available and why there was no choice of drink. The registered manager said that everyone preferred water. However if residents are not offered a choice they may not ask for one. This should be addressed and is strongly recommended. Care Homes for Older People Page 17 of 31 Evidence: Comments made during lunch include,the food is lovely, its good home cooking and they try really hard with the food,there is always a choice if you want. There is no evidence of nutritional screening in files and the AQAA tells us the home does not carry out nutritional screening on everyone admitted to your service and do not repeat the screening for people at risk malnutrition. This needs to be addressed by the home and should consider staff training in this area. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures for managing complaints are in place but the home must obtain up-to procedures for Safeguarding Vulnerable Adults to ensure staff have accurate information to hand. Evidence: The home has a complaints procedure dated May 2008, which is accessible to service users and their representatives. There was a list of complaints and compliments held in the home and the inspector examined the complaints log. This shows that one complaint has been received by the home and was a safeguarding issue. The registered manager was asked if this was reported to the Safeguarding Vulnerable Adults Team and the registered manager said it had been. However,the AQAA states that there have been no safeguarding referrals. Most residents and their families who returned the questionnaires said that they knew who to complain to and found the management of the home to be approachable. The Commission for Social Care Inspection has not been notified of any complaints since the last inspection. The Annual Quality Assurance Assessment document indicates that there has been no safeguarding adult referrals in the last twelve months. However, when examining the complaints procedure the one complaint recorded was a safeguarding issue which the registered manager said had been referred to the Buckinghamshire Safeguarding Vulnerable Adult Team. The Commission was notified of this by the local authority but not by the home. The Safeguarding policy is dated 2005. This is not in line with the Care Homes for Older People Page 19 of 31 Evidence: local authority Safeguarding policy, which the home did not have a copy of. A requirement is issued for improvement in this area. Staff records show that staff have completed up to date Safeguarding training. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within the home is good, providing people who use the service with an attractive and homely place to live. Evidence: Alde House is a detached property on the Penn to Beaconsfield Road. It consists of single room accommodation on two floors, some rooms have en-suite facilities and those without are close to shared toilets and bathrooms. There is one small lounge and a larger lounge on the lower floor. One of these lounges is called the sun lounge and looks out onto stunning views of the garden and beyond. There are many personal touches around the home such as pictures, side lamps, books, plants and ornaments. The internal decoration of the home is mainly in good repair, however some redecoration is needed in certain areas and corridors were being re decorated on the day of the visit and new carpets were to be fitted. There is a small dining area which was a little crowded during the lunch time meal. The laundry room doubles as the hairdressers and the home need to sure there is no risk of cross infection in this area. Care Homes for Older People Page 21 of 31 Evidence: The standard of cleanliness in the home is good and the home is odour free. One visiting relative spoken to on the day of the visit said, we chose this home because it was clean, it didnt have any nasty odours and the rooms are cleaned regularly. Another relative said, We liked this home straight away because it is small and cosy and homely. Adaptations are in place to enable service users to use toilets and baths and there is a shower suitable for people with disabilities to use. The garden is well maintained and provides a restful outlook from the lounge, dining room and bedrooms. There is seating and tables on the patio and an awning that can be opened to shade both the patio and the sun lounge. There is parking at the side and rear of the property. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing numbers and skill mix is satisfactory and staff training is sufficient and up to date to ensure that people who use the service benefit from staff who are who are competent to do their job. Recruitment procedures are undertaken to ensure staff have the right skills and competencies to support the people who live there. Evidence: Staff rotas confirm that there are adequate staff on duty to meet the needs of service users. The registered manager confirmed that there were additional staff on duty at busy times of the day. She also said that they have a regular staff team and do not need to use agency staff frequently. There are additional staff providing housekeeping, maintenance and catering support to people using the service. The home continues to support staff on NVQ training and the AQAA tells us that the home employs eight full time staff and six of these have obtained NVQ 2 level 2 or above in Care or Health and Social Care. The recruitment files for a selection of staff were examined including those new to the service. All files looked at contain the necessary documentation as detailed in schedule 2. There is evidence that all staff CRB checks had been obtained and references had been undertaken before the staff member started work. Two of the staff files contained CRB checks that were dated 2003 and 2004. It is recommended as good Care Homes for Older People Page 23 of 31 Evidence: practice that these are renewed every three years. There is an induction programme in place and this covers the common induction standards and and ensures new staff are familiarised with their roles and responsibilities. Confirmation that staff have completed the induction was seen in each file examined by the inspector. All mandatory training is completed as part of the induction and there are training certificates in each file looked at. There is specialist training available for staff, and an example of this is an introduction to stoma care, the mental capacity act, equality and diversity and oral hygiene. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Evidence: The home has a registered manager who started working in the home as a deputy in 1994. She then became the manager in 2000. The registered manager said she has a City and Guilds qualification in care of the elderly. Further training in the previous twelve months includes all mandatory training, equality and diversity training and the mental capacity act. Visiting relatives spoken to during the visit spoke highly of the registered manager and said she was very approachable and helpful. Staff meetings take place regularly and staff spoken to confirmed this. Quality assurance systems have been developed in the home and the inspector was told that service satisfaction questionnaires were sent out to people who use the service, and their relatives or representative in January 2009. The home has not yet received the results of these. The registered manager was asked what the home does Care Homes for Older People Page 25 of 31 Evidence: with the results of the questionnaires and the inspector was told that the home used to complete a summary but this hasnt been completed for a while. The registered manager said she would like to commence this again. The inspector asked if the home held residents meetings and the registered manager said they do but minutes are kept of these. This is recommended. Regular monthly visits are undertaken and the inspector saw evidence that these were carried out on 19/01/09 and 20/02/09. There was no report for March and the registered manager said this had been completed but the home had not received a copy of the report yet. Service users are encouraged to look after their own financial affairs where at all possible. If this is not practicable then families will undertake this role. There are secure facilities available for the safe-keeping of money and valuables and record and receipts are kept of possessions left for safe keeping. Records were seen for fire safety. The fire risk assessment is dated 26/02/2008 and this has just past its expiry date and needs to be reviewed. The registered manager must address this and is strongly recommended. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. Evidence of mandatory health and safety training demonstrates that staff are up to date with this training. Service reports are in place for PAT testing dated 10/04/2008,electrical installation 24/04/2007. The home has just recently had a new gas boiler installed and the documents for this were in place. The inspector looked at Infection Control guidelines that are available for all staff and training records show staff have completed Infection Control training. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person is required to ensure the identified care needs of people using the service are detailed in the care plan. To ensure the needs of people using the service can be fuly met. 30/07/2009 2 7 13 The registered person is required to ensure that the home to implement a system to be put in place that ensures service users plans include guidelines for the administration of all when reuired/when needed medicines. These guidelines must include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. 30/06/2009 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure people receive their medicines as prescribed by the doctor. 3 12 12 The registered person is 30/07/2009 required to ensure that daily routines are flexible and recorded in detail in the care plans. To ensure service users find the lifestyle experienced matches their preferences and meets their individual needs. 4 18 13 The registered person is required to ensure that the home updates its own safeguarding policy and obtains a copy of the local Safeguarding Vulnerable Adults policy. To ensure staff have access to current information to ensure service users are kept safe from abuse and harm 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 30/05/2009 1 7 It is strongly recommended as good practice that when it is necessary to handwrite on a medication administration record chart in the home, the member of staff writing the Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations chart signs and dates the chart and a second carer checks the entry for accuracy and then initials the chart. In addition the entry should include a reference to where this information was sourced, such as the prescribers name. 2 7 It is recommended that care plans contain more detailed and specific guidance for staff to follow, to ensure they can fully meet the needs of the people using the service. It is recommended that the daily notes are completed in more detail and are written legibly. It is strongly recommneded that when it is necessary to handwrite on a medication administration record chart in the home, the member of staff writing the chart signs and dates the chart and a second carer checks the entry for accuracy and then initials the chart. In addition the entry should include a reference to where this information was sourced, such as the prescribers name. It is recommended that activities reflect the service users preferences and meets their social care needs. It is recommended that people using the service are offered a choice of meal and drink. It is recommended that all CRB checks dated 2003 and 2004 are renewed. It is strongly recommended that the fire risk assessment is reviewed and updated. 3 4 7 9 5 6 7 8 12 15 29 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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