Inspection on 20/07/09 for Alexandra Lodge Care Centre

This inspection was carried out on 20th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexandra Lodge Care Centre 18/06/08

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alexandra Lodge Care Centre 355-357 Wilbraham Road Chorlton Manchester M16 8NP     The quality rating for this care home is:   one star adequate 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: Geraldine Blow     Date: 2 0 0 7 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 30 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 30 Information about the care home Name of care home: Address: Alexandra Lodge Care Centre 355-357 Wilbraham Road Chorlton Manchester M16 8NP 01618605400 01618629043 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dr Jawed Hamid care home 36 Number of places (if applicable): Under 65 Over 65 36 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category - Code OP. The maximum number of people who can be accommodated is: 36 Date of last inspection Brief description of the care home Alexandra Lodge Care Centre can provide accommodation for 36 older people. The home is owned by Dr Jawed Hamid. The home is located in the Chorlton area of Manchester close to main public transport routes, local shops, public houses and other social and recreational amenities. Parking facilities are available to the front of the property. The home is a three storey detached property set within its own grounds. Bedroom accommodation is provided on all 3 floors and consists of 34 single and 1 double bedroom. Twenty-one bedrooms offer en-suite facilities. The home is accessible by Care Homes for Older People Page 4 of 30 Brief description of the care home steps or a ramp to the main entrance. There is a well maintained, enclosed garden area to the back of the property. Fees for accommodation at the home range from £384.44 to £550.00 per week. Additional charges are also made for hairdressing, chiropody services and newspapers. Care Homes for Older People Page 5 of 30 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: This report is based on information gathered by the Care Quality Commission (CQC) since the last inspection visit on 18th and 19th June 2008 and supporting information received in the Annual Quality Assurance Assessment (AQAA) submitted prior to this visit. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Staff and some people living at the home were sent comment cards so that we could get their views on how the home is run. We received two completed comment cards from staff and six comment cards from those sent to people living at the home. Some of the comments are included in the body of the report. Care Homes for Older People Page 6 of 30 This visit was unannounced, which means that the manager and staff were not told that we would be visiting. The visit took place on Monday 20 July 2009. This report is an overview of what we found during the visit. References to we or us in this report represent the CQC. As part of the visit we spent time examining relevant documents and files. We also spent time talking with several people living at the home and some members of staff. We also walked round the home and looked at the communal areas and some bedrooms. Feedback was given to the manager and the provider during the course of the visit. Our last inspection report is available on request for people to read. What the care home does well: What has improved since the last inspection? What they could do better: To ensure that all peoples assessed needs can be met it is recommended that the pre admission assessment is reviewed and updated to include an assessment of any specific religious or cultural needs. It is recommended that an oral hygiene assessment is undertaken when people are admitted to the home to make sure that this care need is assessed and met. To ensure that people are not put at unnecessary risk the risk assessment for the use of bed rails must be reviewed and updated to assess the significant risk of entrapment. The procedures for medication administration need some improvements to make sure that people are getting their medication as intended by the GP. To ensure that people are fully protected all staff must receive appropriate safeguarding adults training. To ensure that the home is managed in the best interest Care Homes for Older People Page 8 of 30 of the people living there the manager must apply to CQC for registration as soon as possible. Some areas of the home are looking tired and worn in appearance. Wall paper is ripped and marked in places, door frames are chipped and marked and some furniture is old in appearance. To ensure the needs of the people living at the home can be fully met all staff must receive training appropriate to the work they are undertaking. 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 30 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 30 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. There are systems in place to make sure that peoples needs are assessed before admission to ensure their care needs can be met. Evidence: The completed AQAA identified and the manager confirmed that admissions to the home are only made after a pre admission assessment of the persons needs has been undertaken, to ensure that those needs can be met. In addition to the homes own assessment they also receive information from the care managers assessment of the placing authority. Evidence was seen of these assessments on the care files looked at during this visit. However it was noted that the homes own pre assessment document did not include an assessment of peoples specific religious or cultural needs. To ensure that all peoples assessed needs can be met it is recommended that the pre admission Care Homes for Older People Page 11 of 30 Evidence: assessment is reviewed and updated to include as assessment of any specific religious or cultural needs. The manager stated that people who are thinking about moving into the home and or their relatives are encouraged to visit, have a look round, meet staff and other people living at the home. This was supported by information received in the completed AQAA. The Statement of Purpose is available in the main reception for people to look at and there is a copy of the Service User Guide in Peoples bedrooms. The majority of returned comment cards indicated that people had received enough information about the home before moving in. Alexandra Lodge Care Centre does not provide an intermediate care service. Care Homes for Older People Page 12 of 30 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. Not all of the care plans were detailed enough to make sure that peoples needs would be met at all times. Evidence: The manager has been in post since May 2009. She acknowledged that there were shortfalls in the current care plans and that some peoples identified needs had not been incorporated into the plan of care. Because of this new care plan documentation has been developed and she and her deputy are in the process of reviewing and rewriting everybodys care plans on the new documentation. At the time of this visit one persons care plan had been reviewed and rewritten. The manager gave assurances that all care plans will be reviewed and rewritten in the next four weeks. Three care plans were looked at, including the newly written one. As expected the two care plans in the old format did have significant shortfalls. It was discussed with the Care Homes for Older People Page 13 of 30 Evidence: manager and the provider during the visit of the urgency for all care plans to be rewritten in the new format to ensure that all peoples needs are identified and included in the individual plan of care. The newly developed care plan was seen to contain details of peoples care needs, personal choices and preferences. For example the file looked at contained information about preferred getting up and retiring times, whether the person preferred baths or showers and preferred social activities. The plans of care clearly set out how the persons identified needs should be met by the staff delivering the care. Appropriate risk assessments had been undertaken to ensure that any identified risks are minimised. However it was noted that the risk assessment relating to the use of bed rails assessed the risk of falling out of bed but not the significant risk of entrapment. This could place people at significant risk. There was no formal assessment for oral hygiene needs. To ensure that peoples needs are appropriately met it is recommended that an oral assessment is undertaken on admission and then any care needs incorporated into the support plan. The manager confirmed that it was her intention to implement a system to regularly audit the care plans to ensure they meet the required standard. This would be considered good practice. People spoken to during the visit were complimentary about the staff and the care received. One person said the staff are good and always help you if you need help. Evidence was seen that people were registered with a local General Practitioner (GP) and of GP visits. There were arrangements in place to access to other health care professionals if needed. The manager confirmed that a copy of the GPs original prescription is not kept in the home. It is recommended that there is a copy of the GPs original prescription so that the medication received into the home can be checked against the medication prescribed. We examined the records and stocks of medication held for the thee people whose care plans we looked at and we did a random tablet count on 3 boxed medication. It was noted that in one instance a key was used to sign for prescribed cream. The key used was F and it was documented that this meant staff apply. For staff accountability it was discussed with the manager that the staff who apply the cream should sign for it. Care Homes for Older People Page 14 of 30 Evidence: Some medication was prescribed as use as directed with no specific instructions. To ensure that people receive medication as intended the GPs instructions should be clearly recorded. It was noted that some prescribed wound dressings had not been signed for on the medication administration record (MAR). To ensure there is a complete audit trail for all prescribed medication nurses should sign the MAR once the dressing has been applied or the MAR should clearly cross reference to where there is an accurate record of the dressings being applied. A tablet count was undertaken on boxed medication for three people. All three tablet counts were inaccurate. This was discussed with the manager at length during the inspection visit. This does have the potential to put people at risk if they are not receiving prescribed tablets as intended by their GP. During discussions with the manager she acknowledged the need for a thorough risk assessment to be undertaken prior to any person self medicating any prescribed medication. This includes drink thickeners and topical creams. Due to the shortfalls identified it is recommended that all medication should be accounted for at all times by means of an audit trail to ensure that people are receiving medication as prescribed by their GP. Staff and people living at the home confirmed that people are treated with respect and dignity. One comment received in a completed staff comment card was individual needs are met no matter of gender, race, sexual orientation and faith. Care Homes for Older People Page 15 of 30 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. Limited activities are provided and people are able to maintain contact with family and friends. Evidence: The manager stated that the home had recently employed the services of a part time activity coordinator, who unfortunately is now on sick leave. However an individual record has been kept by the coordinator of activities people have participated in. Some of the activities include board games, card making, knitting and trips out to the local shops. Several people spoken to said that there were not a lot of activities and one person said she would like to go out more. A comment received in the comment cards was they could do more activities. The AQAA identified that people are encouraged to practice their religion and join or continue to be part of local church groups. The manager confirmed that some people attend weekly sessions at an Afro Caribbean Centre and representatives from local churches regularly attend the home. There is a monthly news letter on display in main reception which includes a weekly Care Homes for Older People Page 16 of 30 Evidence: activity plan. The AQAA and the manager confirmed that outside entertainers are encouraged to visit the home to entertain the people living there. The new care plan documentation had as assessment titled How I spend my day and a section for work and play which identified peoples social interests and hobbies. A copy of the menus was seen. There was a choice of a light lunch or sandwiches but there was no choice for the main evening meal. The manager said that as well as the meal on the menu being provided other cultural meals such as Afro Caribbean or Asian meals were provided. There was no evidence to support this or that people are consulted on their choice of meals. People spoken to said that the food was nice but there was not a lot of choice. One person said you get what you get but I do usually like the food. People and staff spoken to all confirmed that visitors are made welcome to the home and within reason can visit whenever they like. There was information available regarding advocacy services and the manager said that they had good links with Age Concern and several people had Age concern advocates and advocates from the Afro Caribbean centre. From speaking to people living at the home and staff it appeared that people are encouraged to exercise choice and control over their lives. The new care plans documented peoples personal preferences around their day to day lives and people were free to access their rooms or any of the communal areas without restriction. The manager said it was her intention to access Deprivation of Liberty Safeguard (DoLS) training for staff, which came into force on 1 April 2009 and forms part of the Mental Capacity Act. This will help ensure that peoples capacity to make decisions is assessed and recorded as required under the Mental Capacity Act. Care Homes for Older People Page 17 of 30 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. Systems are in place to enable people to raise concerns and complaints. To ensure that people are protected from potential abuse, staff must receive appropriate training. Evidence: There is a complaints procedure, which is included in the Statement of Purpose and the Service User Guide. The Statement of Purpose is on display in the main reception and a copy of the Service User Guide is available in peoples bedrooms. Four of the returned comment cards from people living at the home indicated that people knew how to make a complaint and two indicated that they did not. Both of the comment cards from staff indicated that they knew what to do if somebody wanted to raise a concern or complaint. One person spoken to during the visit said they thought they knew how to make a complaint but had never wanted to. The manager took up post in May 2009 and has not received any complaints. However she was able to describe the action she would be required to take if a complaint was made. She said that she makes herself available and encourages people to raise any issues they may have as soon as possible so that they can be quickly dealt with. There was a copy of the Manchester No Secrets Guidance. It was discussed with the manager that this document has now been updated. Confirmation was received following this visit that the updated document had been obtained. The manager was Care Homes for Older People Page 18 of 30 Evidence: able to clearly describe the correct actions to be taken if an allegation was made. Staff training records demonstrate that less than half the staff employed have attended safeguarding adults training. The gaps in staff training has potential to put people at risk. Since the last inspection visit an appropriate referral has been made under safeguarding adults. Care Homes for Older People Page 19 of 30 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. Not all areas of the home are well maintained to provide a comfortable, attractive environment. Evidence: During the course of this visit a tour of the building was undertaken which included the communal areas and some peoples bedrooms. The general cleanliness of the home was acceptable and people spoken to confirmed that this was usually the case . However some of the furniture and decor was tired and worn in appearance. For example the wall paper on corridors was ripped and marked in places, door frames and bedroom doors were marked and chipped and much of the furniture in bedrooms was a mis match of furniture and old and worn in appearance. The garden was a safe enclosed area and was well maintained so that people could enjoy the nice weather. To reduce the risk of cross infection personal protective equipment (PPE) such as gloves and aprons are wall mounted and there are several wall mounted gels available. This is seen as good practice. The manager said it was her intention to have a small, personal amount of PPE in peoples room which again would reduce the risk of cross infection and be easily accessible to staff if needed. Care Homes for Older People Page 20 of 30 Evidence: It was noted that the hoist was dirty and appeared not to be regularly cleaned. To prevent the risk of cross infection it is recommended that the hoist is thoroughly cleaned and then wiped down in between individual use. Care Homes for Older People Page 21 of 30 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. Not all staff have had training appropriate to meet the needs of the people living at the home. Evidence: From talking to the manager and from observations on the day of this visit it appeared there were sufficient staff on duty to meet the needs of the people living there. The manager confirmed that 13 care staff were employed. Six people have successfully completed the National Vocational Qualification (NVQ) in care, Level 2 and three people have successfully completed NVQ Level 3. A further six members of care staff are currently applying to undertake Level 3 and 2 are applying for Level 4. A sample of staff files were looked at to see whether the required documentation was in place and the necessary safety checks had been made. Three files were looked at for staff that had been recruited since the last inspection visit. All the files seen contained the required documentation, with the exception of one. The file indicated that the nurses PIN number expired on 31/10/08 and there was no evidence that it had been renewed. The Nursing and Midwifery Council (NMC) website was checked during the visit and it had been renewed. To ensure that nurses have not been suspended or excluded from the register or that PINs have not expired it is Care Homes for Older People Page 22 of 30 Evidence: recommended that evidence be provided that the NMC website is regularly checked. The files contained some photocopied documents but in two of the files there was no evidence that the original documents had been seen. It is recommended that all photocopied documents are signed and dated to indicate that the original has been seen. In two of the files there was no evidence that a set interview format had been used or that notes were taken. To ensure a fair and consistent interview it is recommended that a set interview format is used and notes are taken during the interview process. There is a training matrix and an individual training record. The manager acknowledged that neither records were up to date and acknowledged that there may be shortfalls in staff training. She said it was her intention to update the records and then access any training needed. Dementia Care training has been arranged for all staff to attend and the manager and the deputy are to attend training on syringe drivers, Epilepsy, Swine Flue and Chronic Obstructive Pulmonary Disease (COPD). Then they will cascade the information to the staff during in-house training sessions. The AQAA identified that all new staff receive skills for care induction. There was no evidence to support this. There was an orientation checklist but no formal induction process. Care Homes for Older People Page 23 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements are needed to the management procedures to ensure the home is run in the best interest of the people living there. Evidence: The manager has been in post since 26 May 2009 and was aware of the need to apply to us for registration. During this visit she acknowledged some shortfalls in day to day running of the home, with particular reference to the care plans that are currently in place, the lack of accurate training records and some aspects of medication administration and recording. She was able to clearly describe how she was going to address the issues and appeared committed to make the necessary improvements. To review the quality of the service provided an independent quality assurance company audit the home on an annual basis and produce a report on their findings. The report from 2008 was seen and the 2009 audit is due in the near future. In addition to this formal audit the manager said that she makes herself available to Care Homes for Older People Page 24 of 30 Evidence: people living at the home and visitors for feedback on the service provided. The home received the Investors in People award in February 2009. Investors in people is an independent assessment aimed at improving business performance. The AQAA indicated that all policies and procedures are in place and are regularly reviewed and updated. The policy and procedure folder is in the office so that all staff can easily access the file. Systems are in place for peoples finances to be managed. The system was secure and records provided evidence of running totals for individual people and included receipts for any purchases made on peoples behalf. However the manager and the provider of the home confirmed that they did not have specific policies and procedures relating to finances. To ensure people are fully protected it is recommended that policies and procedures regarding peoples finances are developed and implemented to accurately reflect the procedures and processes used in the home and that agreements are made if staff purchases items on peoples behalf. The administrator was in the process of negotiating with social services that the client financial services take over responsibility for the people who the home are currently appointee for. The information provided in the AQAA demonstrated that the homes maintenance certificates and records were up to date. Evidence was seen that records are kept for some fire safety checks, for example weekly fire alarm testing and weekly emergency lighting. There were no records for testing means of escape or of regular fire drills or fire training. To ensure that people are not put at risk it is recommended that records are kept of all fire safety checks and that regular fire drills and fire awareness training in undertaken. The home is an old building and has a history of problems with the water temperature delivery, especially to the water being delivered too hot. During discussions with the maintenance man he made assurances that he would do regular water temperature testing, record the results and action any identified problems to ensure people are not put at risk. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 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 13 The risk assessment for the use of bed rails must be further developed to include the risk of entrapment. To ensure that people are not placed at unnecessary risk 17/08/2009 2 9 17 Clear and accurate records 27/07/2009 of medicines administered to people must be maintained. To ensure that medicines can be fully accounted for to show that they are being given correctly and to prevent mishandling. All staff must receive 31/08/2009 training appropriate to the work they are undertaking. To ensure the needs of the people living at the home can be fully met. 3 30 18 Care Homes for Older People Page 27 of 30 4 31 9 The manager must apply to 31/08/2009 the Care Quality Commission for registration. To ensure the home is run in the best interest of the people living there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 To ensure that all peoples assessed needs can be met it is recommended that the pre admission assessment is reviewed and updated to include as assessment of any specific religious or cultural needs. To ensure that peoples needs are appropriately met it is recommended that an oral assessment is undertaken on admission and then any care needs are incorporated into the care plan. To ensure that peopel receive medicatin as intended the GPs instructions should be clearly recorded. To ensure that people are receiving medication as prescribed by the GP medications should be acounted for at all times by means of an audit trail. It is recommended that there is a copy of the GPs original prescription so that the medication received into the home can be checked against medication prescribed. It is recommended that evidence be provided that any specific religious or cultural dietary needs of people are being met and that choice is offered with particular reference to the main evening meal. All staff should receive appropriate Safeguarding Adults training. To ensure that staff are appropriately inducted it is recommended that all newly recruited staff receive a formal induction based on Skills for Care. To ensure that nurses have not been suspended or excluded from the register or that PINs have not expired it is recommended that evidence be provided that the NMC website is regularly checked. 2 7 3 4 9 9 5 9 6 12 7 8 18 30 9 29 Care Homes for Older People Page 28 of 30 10 29 To ensure a fair and consistent interview it is recommended that a set interview format is used and notes are taken during the interview process. It is also recommended that all photocopied documents are signed and dated to indicate that the original has been seen. 11 19 It is recommended that some improvements are made to the decor and furnishing of the home in order to provide a well maintained environment for the people who live there. To reduce the risk of cross infecting it is recommended Thai the hoist if throughly cleaned and then wiped down in between each use. It is recommended that the policies and procedures relating to finances are reviewed and updated to clearly set out the systems to be followed. It is also recommended that written agreements be developed between people and the home setting out permission for the staff to purchase personal items for that person and the receipt be signed by the person purchasing items. To ensure that people are not put at risk it is recommended that records are kept of all fire safety checks and that regular fire drills and fire awareness training in undertaken. 12 26 13 35 14 38 Care Homes for Older People Page 29 of 30 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 30 of 30 - 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!