Inspection on 14/01/09 for Alexandra Care Home

This inspection was carried out on 14th January 2009.

CSCI found this care home to be providing an Good 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

Alexandra Care Home 08/11/07

Alexandra Care Home 18/05/07

Alexandra Care Home 05/06/06

Alexandra Care Home 08/03/06

Alexandra Care Home 04/01/06

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alexandra Care Home Doncaster Road Thrybergh Rotherham South Yorkshire S65 4AD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ramchand Samachetty     Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Alexandra Care Home Doncaster Road Thrybergh Rotherham South Yorkshire S65 4AD 01709850844 01709854823 alexandranh@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashbourne (Eton) Limited Name of registered manager (if applicable) Jillian Kilgallen Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Category OP includes persons from 55 years of age One PD is to be used for respite purposes only Date of last inspection Brief description of the care home Alexandra Care Home provides Nursing and Residential care and accommodation for up to 47 people in the category of older adults from 55 years upward. The home is situated in Thrybergh, which is close to Rotherham town centre. It is within reach of a range of community facilities and is accessible by public transport. Accommodation is provided on three floors; the lower ground floor, ground and first floors. Access between the floors is by passenger lift and stairs. There are 41 single bedrooms one of which has en-suite facility, and three double bedrooms. Some Care Homes for Older People Page 4 of 28 0 1 Over 65 47 0 care home 47 Brief description of the care home bedrooms on the lower floor have access to the garden. There is a car parking area to the front of the home. The garden is fenced off and is provided with some garden furniture. The registered person makes information about the service available by the homes Statement of Purpose and the Service User Guide. A copy of the inspection report is made available at the home. Further information can be obtained from the home. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out on 14 January 2009, starting at 10.00 hours and finished at 18.30 hours. The manager, Mrs Jill Kilgallen was present throughout the inspection. The service is registered to provide accommodation, personal and nursing care to up to 47 older adults. There were 43 people living at the home at the time of this inspection, twenty of whom required nursing care. The manager confirmed that the fees charged at the home at the date of this inspection ranged from three hundred and fifty- three and four hundred pounds per person per week. Prior to this visit, the manager had submitted an Annual Quality Assurance Care Homes for Older People Page 6 of 28 Assessment (AQAA), which gave us information about how the service was addressing the relevant National Minimum Standards for older people in residential care, the progress made since the last inspection on 8 November 2007 and the work planned for the next twelve months. We used some of this information in our assessment of the service. All the key national minimum standards for Care homes for Older People were assessed. We also checked compliance with the requirements that were made at our last inspection. This inspection included a tour of the premises, examination of care documents and other records, including those pertaining to complaints, staff employment, staff rota, medicines management and maintenance of equipment and quality assurance methods. We spoke to five people who lived at the home, four relatives and four members of staff. We also considered the views and comments that were expressed, by people who used the service and those of their relatives, in a recent survey conducted by the home. We gave feedback about our initial findings to the manager and to the operations manager during the course of our inspection. We would like to thank all the people living at the home, relatives and staff who helped with this inspection. What the care home does well: What has improved since the last inspection? What they could do better: Although the care needs of people who used the service was appropriately planned and catered for, staff should improve the way they record the actual care that is provided. This would help in better evaluation and review of care. Staff should make sure that they sign and date any changes and amendments they make to medicines administration records in order to evidence relevant authorisation. The arrangements for people living at the home to partake their meals should be improved. The clearing of food remnants whilst people are having their meals should be carried out away from the dining areas. Staff should make sure that cleaning materials, including hazardous ones are kept securely under lock in order to avoid potential harm to people who live at the home. The service should review its provision of bedroom furniture to make sure that it is sufficient for the comfort and wellbeing of each person who live at the home. Although staff had received training on various topics, there is a need to ensure that gaps in training are appropriately identified, prioritised and catered for. The qualified nurse staffing level should be reviewed in line with the nursing care dependency of people who use the service, in order to ensure that their needs are appropriately catered at all times. There is a continuing need to improve the recruitment and selection procedures used at the home. This will help to make sure that the required pre-employment checks, including two written references are sought and obtained before staff start working. Care Homes for Older People Page 8 of 28 The service should review and improve its use of quality assurance tools and methods in order to monitor progress effectively and continue to improve its standard of care provision. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care and support needs of people were appropriately assessed before their admission to the home and this helped to ensure that identified needs could be met. Evidence: We checked the care files of two people who were recently admitted to the home. In both cases we found that assessments had been undertaken before their admission to the home. This ensured that identified needs of the people concerned could be met. We noted that the assessments had been carried out by both the placing social workers and by staff at the home. However, in one instance, the assessment from the social worker was not fully related to the admission of the person to residential care. Staff at the home had made sure to assess all the relevant needs by working closely with the relatives concerned. The home does not provide intermediate care services. Care Homes for Older People Page 11 of 28 Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home were provided with individual care plans, which ensured that their health and personal care needs and preferences were addressed. However, there were minor shortfalls in record keeping and these could affect the evaluation of care. Evidence: We checked, at random, the care plans of three people who used the service. The care plans were developed on the basis of identified needs, risks and preferences of the individuals concerned. They also outlined the actions that were required to meet the care needs of individuals. Care provided was regularly recorded. However, the records of care consisted of generalised statements and did not reflect the actual care that was being delivered. The care records lacked information and therefore could not fully contribute to care evaluations and to care reviews. The care plans that we checked, were reviewed on a regular basis. In some instances, changes had been made to individual care plans as a result of a review. People living at the home told us that care staff were friendly and courteous. They Care Homes for Older People Page 13 of 28 Evidence: said that care was always provided in a manner that respected their privacy and dignity. Personal care was provided in private in peoples own bedrooms or in bathrooms. We noted that staff interactions with people in their care were polite and respectful. People who used the service told us that they had good access to health care professionals. They said that staff were prompt in helping them with appointments to see their GPs , dentists and other health care professionals. The care plans included details of the visits of health professionals and outcomes of such visits as well. During our visit, we met a community psychiatric nurse who was involved in the care of a person living at the home. She said that she was satisfied with the collaboration she was receiving from the staff. She felt that all her advice had been followed and that had helped to improve the health and wellbeing of the person concerned. We noted that another person had been referred to a dietitian with regards to her nutritional status. We checked the management of medicines, in the presence of the manager. The medicines administration record (MAR) sheets that we checked, indicated that medicines received at the home were appropriately recorded. The records of medicines administered were appropriately signed for and dated. However, in a few instances, amendments and handwritten entries were not signed and dated. These were also not explained in the individuals care plans and therefore, there was no record of any authorisation for such changes to or of administration of prescribed medicines. We noted that only one person was administering his own medicines, which consisted of injection of insulin. An appropriate risk assessment had been carried out and this had also been included in his care plan. Staff indicated that they were able to supervise the receipt and storage of his medication in an appropriate way. We noted that the person concerned was able to keep his medicines securely in his own room. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home were able to benefit from the recreational and social activities that were offered to them. This helped in maintaining and improving their quality of life. Evidence: During our visit, we observed people who lived at the home, spending time in the lounges and in their own rooms, watching television and listening to music. Three people chose to sit in the entrance hall and enjoyed conversing with each other. We noted a notice board in the downstairs corridor and it had information about the recreational activities taking place at the home and other events within the local area. Staff explained that both indoor and outdoor activities were offered to people who used the service. Records of activities showed that some group activities, like singalongs, indoor board games were carried out. We looked at some care plans. They showed that information about peoples preferences about social activities were recorded and used in planning their daily activities. We noted that there were some staff interactions with people in between tasks that Care Homes for Older People Page 15 of 28 Evidence: they were undertaking. This allowed for some time to be given to people on a one to one basis. One person said that she enjoyed having a chat with the care staff as she did not have regular visitors. Relatives confirmed that they were always welcomed at the home. They felt that staff communicated well with them, about their loved ones. They also commented that they felt routines at the home were flexible. Their loved ones could, for example, be assisted to go to bed and get up at times that suited them. They could choose how to spend their daytime. Where people could not fully make decisions on their own, staff would assist them in making their choices known. People who lived at the home and their relatives stated that meals served at the home were good and nutritious. People were offered adequate choices for breakfast, lunch and dinner each day. We observed lunch being served on the day of our visit. People who lived at the home told us that they had been well served and that they were happy with the meal. We observed staff helping a few people who required assistance to eat their meals. They offered help in an unhurried and dignified manner. However, we noted that a trolley was left in one of the dining areas and was used to clear food remnants from plates whilst people were eating their meals. This practice was not pleasant and did not help in promoting the dignity of people using the service. Care plans that we checked included nutritional assessments and where necessary, there were actions to make sure that identified needs were catered for. This helped to promote the health and welfare of people who required such interventions. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures were in place to enable staff to deal with concerns, complaints and any allegation of adult abuse. This helped to protect and promote the safety and wellbeing of people who lived at the home. Evidence: There was a complaints procedure in place and copies of it had been made available to people who used the service and their relatives. The procedure was also included in the homes statement of purpose and service user guide. Relatives told us that they were aware of this procedure and would use it if they had to do so. They commented that if they had any concerns, they would make them known to senior staff, who they felt would address such matters appropriately. We checked the records of complaints received by the service. We noted that there had been three complaints since 14 August 2008, the date at which the service had submitted its Annual Quality Assurance Assessment to us. Two complaints had been investigated and upheld. The manager stated that the third complaint had been referred to the local social services adult safeguarding team and had been concluded. There was an adult safeguarding policy in place to guide staff on the prevention of abuse. It also included procedures to be observed in reporting allegations of abuse or harm within the home to the local safeguarding team. The manager confirmed that Care Homes for Older People Page 17 of 28 Evidence: there had not been any other safeguarding referral from the home. In discussion, we noted that a small number of care staff had not received training yet on adult safeguarding issues. The manager explained that there was an ongoing training programme on this subject and the staff concerned would be provided with the necessary training. Care Homes for Older People Page 18 of 28 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. People who lived at the home and their relatives were satisfied with the standard of accommodation and its facilities. However, there were shortfalls regarding the provision of furniture and the storage of some cleaning materials.These could affect the safety and welfare of people who live at the home. Evidence: We undertook a tour of the premises, in the company of senior staff. The building comprised of three floors and there was a passenger lift and stairs to facilitate access to and from them. The main entrance at the front was wheelchair accessible. The communal areas consisted of four lounges and two dining areas. Bathrooms and toilets were located on each floor. The main kitchen was situated on the ground floor and the laundry room was located in the basement. The laundry equipment allowed for linen to be washed at the required temperature. Staff explained that the handling of soiled linen was in line with the homes infection control procedures. The communal areas were well decorated, clean and tidy. However, we noted that cleaning materials including a hazardous item were stored in a cupboard in a kitchenette. This was pointed out to staff for urgent remedial action. We viewed a few bedrooms with the permission of people who occupied them. A few Care Homes for Older People Page 19 of 28 Evidence: people had brought in some memorabilia and this helped them to personalise their bedrooms. In one instance, we noted that one person did not have sufficient furniture in his room. He had to keep his music equipment on a chair and had difficulty operating it. In discussion, two people told us that their rooms were rather cold. The manager explained that the radiators in these rooms had been turned off. She referred the matter to the handyman and it was rectified. The manager stated that four of the larger bedrooms had been upgraded to provide en-suite facilities. She also confirmed that two dining tables had been ordered in order to improve the seating arrangements for wheelchair users at mealtimes. People who lived at the home said that they were happy with their accommodation and found it to be pleasant and comfortable. The surrounding grounds, including the lawns were well maintained for the time of the year. Care Homes for Older People Page 20 of 28 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. There was a good and committed staff team in place and people who used the service were satisfied with the care being provided. However, the homes recruitment and selection procedures must be further improved in order to effectively safeguard people who use the service. Evidence: At the time of this inspection, there were 43 people in residence at the home. Twenty had nursing needs and twenty-three were receiving personal care only. Besides the manager, there was one first level registered general nurse and five care workers on the morning shift; between 08.00 and 14.00 hours. There were four care workers and one first level general nurse between 14.00 and 20.00 hours. Three care workers and a first level general nurse were scheduled to work at night. Other support staff during the day included an administrator, a cook and a kitchen assistant and two domestics. We noted that there was no activities co-ordinator in post. We checked the duty rota for the deployment of nursing and care staff. We noted that only one first level general nurse was deployed throughout the day to meet the nursing needs of twenty people. The manager stated that the staffing level was based on the dependency of people who lived at the home. Care Homes for Older People Page 21 of 28 Evidence: We looked at the employment files of four members of staff who had been recruited since the last inspection. In one instance, there was only one reference for a member of staff and this was not from the persons last employer. In another instance, there was no record of an interview and therefore we could not find out, for example, whether the employment history of that person had been checked. They had all been checked against the Protection of Vulnerable Adults (POVA) before they were employed. No disclosures had been received for three of the staff members concerned before their start of employment. All the four members of staff had been appropriately provided with induction training. In discussion, the manager stated that since the last inspection, care and nursing staff had been provided with training on a number of topics. These topics included health and safety, moving and handling, fire safety, first-aid, food hygiene, adult safeguarding, mental health in old age and mental capacity. We spoke to few care workers about the training they had been offered. They confirmed that they had received some training as mentioned. We noted that a number of care staff still required training on adult safeguarding and first-aid. The manager stated that out of 24 care workers, 11 had already trained to the National Vocational Qualification (NVQ) level 2 in care. Eleven others had started the same training. Two first level registered nurses were also undertaking the Registered Managers Award. (RMA). The manager confirmed that there was an on-going staff training programme and the gaps in training would be addressed. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was appropriately organised and managed and staff promoted the health, safety and welfare of people who lived in it. There were, however, minor shortfalls in the use of quality assurance methods and these could hinder progress. Evidence: A new manager was in post at the time of this inspection. She is a qualified first level general nurse who had been a deputy manager at the home for a few months. She stated that she had applied for manager registration with CSCI. She also stated that she has undertaken training and achieved the Registered Managers Award. People who lived at the home, relatives and staff told us that they felt the home was being managed appropriately. The new manager stated that she was receiving support and guidance from her line manager, a regional operations manager of the Company. We noted that the registered provider was undertaking the monthly monitoring visits to the home and providing written reports of such visits. We looked at reports covering Care Homes for Older People Page 23 of 28 Evidence: a period of three months. Most of the information consisted generalised and repetitive comments and where issues were noted, there was no record of an action plan. These reports were therefore not effectively used as a monitoring tool for the service. However, the manager told us of an action plan that was put in place by senior managers. We noted that it was an improvement plan and it was being implemented. We looked at other quality monitoring methods that were in use at the home. The manager showed us the results of a satisfaction survey, dated January 2009, that was undertaken with relatives of people who lived at the home. There was little information about the number of respondents and about the date the questionnaires were sent out. We looked at the questions that were asked. They referred to telephone response, staff appearance, knowledge of the manager, cleanliness and presence of odour. There was no question about provision of care. Most people were satisfied with the issues asked in the survey. A small number were not satisfied with staff attitude and also thought malodour was a problem. The manager confirmed that these issues had been addressed. The manager explained that she carried out regular audits of medicines, personal monies that staff manage for people who live at the home and maintenance of equipment and utilities in use at the home. We advised that a more robust audit of care plans should be undertaken in light of our findings. We looked at records of maintenance checks regarding equipment used at the home. These included the regular monitoring of water temperatures, fire fighting equipment, bath hoists and the passenger lifts. Appropriate health and safety measures were in place. Staff indicated that fire drills were carried out and that the fire alarm was checked regularly. In discussion, staff confirmed that they were receiving regular supervision and guidance. We noted that the manager had planned supervision sessions for all her staff. Care Homes for Older People Page 24 of 28 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 25 of 28 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 19 23 Staff must make sure that all cleaning and other hazardous materials are kept secure at all times. This will ensure the safety and wellbeing of people who live at the home. 27/03/2009 2 29 18 All pre-employment checks, including two written references, must be sought and obtained before staff start working at the home. This will help to maintain and promote the safety and welfare of people who use the service. 27/03/2009 3 30 18 Care staff must be provided with appropriate training on adult safeguarding issues. This will help them to maintain and promote the safety and welfare of people in their care. 20/04/2009 Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Staff should ensure that they record more details of the care that is actually provided to people who use the service and so enable better evaluation of care. Areas where medicines are stored should be kept tidy and free from clutter in order to ensure good and safe storage at all times. Staff should sign and date all handwritten entries and amendments that they make on medicines administration record sheets. This will help to show authorisation received and will improve accountability. The clearing of food remnants should be carried out away from the dining areas, in order to observe and promote the dignity of people whilst they partake their meals. Sufficient and appropriate furniture should be provided to people who live at the home in order to ensure their comfort and wellbeing. The qualified nurse staffing level should be reviewed in line with nursing care needs dependency of the people using the service. The formulation of satisfaction surveys should be reviewed to include topics on quality of care being provided at the home. This would help in improving the overall service. The audit of care plans should be improved to allow for remedial actions to be identified and timely addressed in order to improve practice. The reports of the monthly visits by the provider should be improved to allow them to be more effectively used in action planning and in monitoring progress. 2 9 3 9 4 15 5 19 6 27 7 33 8 33 9 33 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!