Inspection on 06/04/09 for Ambleside Residential Home

This inspection was carried out on 6th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ambleside Residential Home 20/10/09

Ambleside Residential Home 23/06/09

Ambleside Residential Home 19/05/09

Ambleside Residential Home 07/03/09

Ambleside Residential Home 28/04/08

Ambleside Residential Home 21/11/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ambleside Residential Home 69 Hatherley Road Cheltenham Glos GL51 6EG     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Adam Parker     Date: 2 1 0 4 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 35 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 35 Information about the care home Name of care home: Address: Ambleside Residential Home 69 Hatherley Road Cheltenham Glos GL51 6EG 01242522937 01242522937 pepwalsh@yahoo.co.uk 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) : James Christopher Walsh,Perpetual Walsh care home 18 Number of places (if applicable): Under 65 Over 65 18 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 18. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Ambleside is a large, detached, Victorian house that has been extended and adapted to provide accommodation for older people. It is situated in a residential area of Cheltenham close to a few shops and the bus route into town, which is approximately a mile away. The railway station is within easy reach, together with a number of churches. The accommodation is located on three floors that are all served by a shaft lift and stairs. All the bedrooms have en-suite facilities, approximately five have a bath or shower. There are three bathrooms two of which have hoists. Ground floor communal facilities include a dining room and two lounges one of which has a piano. The lounge at the rear of the property is an extension of the main building and gives Care Homes for Older People Page 4 of 35 Brief description of the care home an all round view of the large landscaped garden. A patio area provides a pleasant place for service users to sit in warmer weather. The provider supplies information about the home, including the most recent CQC report to current and prospective residents on request. The fees range from 480 to 598 pounds per week for local authority funded residents and 610 pounds per week for privately funded residents. Hairdressing, chiropody and any personal items are charged extra. The costs of these services are available as required. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place with one inspector on two days in April 2009. The registered provider of the home and the manager of the home were present for the three days of the inspection visit, which consisted of a tour of the premises and examination of residents care files. In addition documents relating to the management and safe running of the home were looked at. A sample of residents were selected for inspection against a number of outcome areas as a case tracking exercise. During the inspection visits six residents were spoken with to gain their views of the service. Prior to the inspection visit the home supplied us with their Annual Quality Assurance Assessment (AQAA). This had been completed by the manager in March 2009. Information about how the home would meet the National Minimum Standards for Care Homes for Older People was brief and vague in places. Care Homes for Older People Page 6 of 35 Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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 8 of 35 Care Homes for Older People Page 9 of 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information from funding authorities has in some cases been inadequate and has not been obtained in a timely fashion for the home to make a full assessment of the needs of some prospective residents. Some work still needs to be done around fees invoices for privately funded residents. Evidence: Information supplied to relatives of residents about fees was looked at following requirements at a previous inspection. The fees invoices had not improved in that they still did not show what services the fees were being charged for. A requirement relating to information about fees has been repeated in this report. The admission and assessment information for the three most recent residents admitted to the home was looked at. All three had funding from the local authority and although the home had completed their own assessments, with two of the residents Care Homes for Older People Page 11 of 35 Evidence: information from the local authority in the form of their care plan had not been received before the resident was admitted to the home. One of the care plans from the local authority was poor in relation to describing the mental health needs of the resident. Other information received by the home at a later date indicated that the resident had dementia. The lack of information supplied by the local authority would not have allowed the home to adequately plan for this residents care. In addition the home is not registered to provide care for people with dementia. The homes AQAA document gave us no information about how prospective residents would be assessed for their suitability for admission to the home. The home does not provide intermediate care and so standard 6 does not apply. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments must be further developed for all residents to guide staff in meeting their personal and health care needs. In particular medication administration practices need improvement to ensure that residents receive their medication when needed and that an accurate record of administration is made to ensure residents are not placed at unnecessary risk. Evidence: The care plans and related documentation for a number of residents were looked at as part of case tracking. Each resident had a care plan book to record care/action plans and reassessments of needs. However in most of the care plan books looked at there had only been brief comments recorded about the aims as opposed to the actions that staff would need to take to meet residents needs. One care plan stated To help remain independently at Ambleside and had been reviewed to read Staff to continue to promote (the residents) independence and promote choice in her daily life. although there was no indication of how this might be achieved. Another resident had a need where a skin condition needed monitoring. This had been detailed in the care Care Homes for Older People Page 13 of 35 Evidence: plan supplied to the home by the local authority. However there had been no care plan prepared by the home in relation to this need. One resident had sensory impairment, apart from statements in the care plan about guiding the resident in walking and sitting down there were no other actions recorded for staff to follow. The care plan did not make note of support that the resident had received in the past from a sensory impairment support organisation. The homes AQAA document stated that The home ensures that comprehensive care plans are in place and reviewed each month. Clearly this was not the case and such care plans had not been developed as a record of how residents needs would be met by staff. The home is currently using two care plan folders for each resident which is an improvement on the three in use at the previous inspection. However it is still recommended that this be reviewed in the interests of providing simpler documentation that may be easier to use. The care plan books contained a number of risk assessments and these had been completed. With one resident a Waterlow pressure area risk assessment had been completed by the manager although a lack of understanding of how to use this assessment had led to an inaccurate result. A district nurse was visiting one resident on the first day of the inspection visit and there was evidence that residents were receiving visits from other health care professionals. One resident had been having some falls and this had been refereed to the General Practitioner who had referred the resident to a physiotherapist. Following concerns that we received, medication storage and administration systems were looked at a previous random inspection in March 2009. Major shortcomings in the storage, administration and recording of residents medication were found and these are described in the random inspection report. A statutory enforcement notice has also been served on the registered providers in respect of failures in medication systems. Residents spoken to during the inspection visits confirmed that staff knocked on doors before entering rooms and were polite to them. Care Homes for Older People Page 14 of 35 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. Although the home has consulted resident about their preferences for activities, it has little awareness of how any diverse needs may be met in relation to religious observance and special diets. Evidence: Since the previous inspection a meeting had been held where residents were asked about their choice of preferred activities. Activities in the home generally consist of visits from musical entertainers, quizzes and bingo and these were in line with the preferences expressed by residents. Holy Communion is provided in the home fortnightly for residents who follow an Anglican Faith. However it was noted that one resident was following the Roman Catholic faith. When asked about this, the manager had little knowledge of the difference between faiths and of religion in general. The resident was spoken to and she confirmed her faith and that she wished to see a Roman Catholic priest. Management and staff in the home must have more knowledge and resources such as contact details for faith representatives to assist with the religious and spiritual needs of any resident. The Homes AQAA document indicated that twelve residents in the home followed no religion at all and a with a further three their religion was indicated as unknown. No other information was given. The AQAA Care Homes for Older People Page 15 of 35 Evidence: document was clearly not an accurate reflection of the religions or faiths followed by residents in the home. In addition there was a statement in the AQAA document in the section What we do well. that read The home endeavours to ensure the service users lifestyle religious and cultural needs matches their expectations. which was clearly not the case in relation to one resident . The home has information about advocacy services available if this should be needed by residents. Individual rooms showed various degrees of personalisation where residents had brought in their own personal possessions. The home has a menu that runs on a four weekly basis. A cooked lunch is provided and in the evening supper consists of sandwiches. A resident spoken to during the inspection visit stated that she always enjoyed the meals provided in the home. One resident had some dietary restrictions relating to a health issue and the cook described how the residents meals were provided for using a number of substitutes. As well as the menu displayed on the notice board, menus had been prepared for vegetarian and vegan meals. However there was no information available about the nutritional content or even the ingredients of some dishes and other meals lacked any protein element and therefore did not represent balanced meals. Fortunately there were no such meals being provided to resident in the home at the time of the inspection visit and the menus were taken down on the instruction of the registered provider. Despite issues being raised at a previous inspection about unbalanced vegetarian meals being provided to a resident, these menus had still been produced and demonstrated a lack of understanding in providing a nutritional diet. Care Homes for Older People Page 16 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite staff training and a clearly displayed policy on how to deal with the abuse of residents, allegations of serious abuse to residents have been made and so residents may not be safe in this care home. Evidence: The home had a folder for keeping details of complaints. When examined this folder was not in a good state of order and contained a number of unrelated documents. The information about complaints, how they were dealt with and any findings should be kept together in one folder in a good state of order. The homes complaints procedure was clearly displayed in the entrance hall although the name and contact details for the Commission were out of date and needed amending. One resident spoken to confirmed that they knew who to approach in the home if they were unhappy with anything. In the homes care documentation there was an area for recording issues around mental capacity. This area was not seen to have been completed for any resident and there was little awareness in the home about the implications of the Mental Capacity Act 2005. No training had been undertaken by staff or management in this important piece of legislation. The policy and procedure for protecting residents from abuse was looked at. This was Care Homes for Older People Page 17 of 35 Evidence: displayed near the entrance of the home and made reference to contacting other agencies if the need should arise. However the specific contact details for contacting the local authority adult protection unit should be added to this. Despite staff receiving training in protecting residents from abuse, at the time of the inspection visit the home was being investigated by a number of agencies following serious allegations of abuse towards a number of residents. Care Homes for Older People Page 18 of 35 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. Residents have the benefit of living in a generally well-maintained and clean, environment with personalised individual rooms. Evidence: A tour of the premises revealed that the home was generally clean, well decorated and well maintained. Communal areas consist of a lounge at the front of the home, a dining room adjacent to the kitchen and a rear lounge that was particularly light and overlooked the extensive rear garden. Outside there were two patio areas accessible to residents. CCTV equipment was noted to be installed in a number of communal areas of the home although the cameras were no longer functioning and the monitoring equipment was disconnected. A communal toilet on the ground floor was noticed to be very hot during the first day of the inspection visit with a radiator on full in a small space. This had been remedied by the second day of the inspection visit. However it was noted that the toilet did not have any signage identifying its use and apart from the lack of a door number, looked the same as the doors to individual residents room. Signage should be provided to identify the room and so promote the independence of any residents making use of the toilet. Care Homes for Older People Page 19 of 35 Evidence: Individual rooms showed various degrees of personalisation and were clean. It was noted that ventilation in one room on the top floor had been improved since the previous inspection with the roof windows now easier to open. However the blinds covering these windows were damaged and in need of replacement. All the residents spoken to during the inspection visits were happy with their individual rooms. In some bedrooms small tables were in use, it was reported that the bases of some of these had been painted since the previous inspection although a number of them had damage to the table surfaces and should be replaced. Rooms had locks fitted on the doors suitable for residents use and lockable drawers were available. A risk assessment exercise had been carried out in the past on each room in the home to check on the condition of the room and if any issues arose from this. One resident spoken to confirmed that their room was kept clean. Radiators in residents bedrooms were covered as well as two radiators in communal areas that had been covered to protect residents from accidental burns. The laundry was tidy, well organised and had received some re painting in one area where the paint had been peeling away in one corner. Hand washing facilities were available in the laundry and in a number of other locations in the home. Care Homes for Older People Page 20 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The general improvement in staff training should ensure that residents needs are met although recruitment practices are still not robust enough to protect residents. Evidence: Staffing, NVQ training and staff recruitment were looked at in the previous random inspection in March 2009 where shortfalls were found with recruitment procedures. Induction training was checked at this inspection and the manager reported that the induction training received by staff lead on to NVQ training although was still awaiting confirmation that this was in line with the nationally recognised Common Induction Standards. Care Homes for Older People Page 21 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home has been inadequate and despite the introduction of quality assurance audits, the home has failed to improve the service provided to residents in a number of areas. Evidence: The manager has previous experience in working in care settings and has the Registered Managers Award and NVQ 4 in care. He had been working as manager at the home since April 2008. He reported that he had made an application for registration with the Commission, however this had not been received and it was unclear what had happened to this. By the final day of the inspection visit the manager was able to confirm postage of another application for registration. The home had used surveys as part of its quality assurance system and these had been sent to residents and their relatives, health care professionals and staff. All those returned had favourable responses. One issue had been raised on behalf of a resident Care Homes for Older People Page 22 of 35 Evidence: by a relative about the suppers provided in the home. It was reported that this had been passed on to the cook and improvements had been made. Various audits had been taking place such as risk assessments of residents rooms and audits on recruitment as well as an annual health and safety audit. The home had been making use of its quality assurance folder which had not been in use at the previous inspection. However quality monitoring systems have not been robust and this has led to increased risk of harm for residents. The AQAA had been completed by the manager in March 2009. Information about how the home would meet the National Minimum Standards for Care Homes for Older People was brief, inadequate and vague in places. The arrangements for looking after residents money in secure storage was looked at and were satisfactory with records kept. A check on the money held for one resident showed this to be accurate in relation to their records. Staff had received training in fire safety, first aid, manual handling, food hygiene, infection control and health and safety. Window restrictors are fitted to windows on the first and second floor of the home. Bed rails had been fitted to one residents bed and it was reported that these had been fitted by the manufacturer and a risk assessment had been completed. Instructions were also available for staff to follow. However there is no system in place to check if these are functioning. It was noted during a tour of the premises that the restrictor in room 18 was broken enabling the window to fully open. This room was unoccupied at the time of the inspection visit. Window restrictors should be checked in the interests of residents safety. The central heating system had been serviced in May 2008. Portable electrical appliances had been checked in March 2009 and hoists in December 2008. Work had been carried out in respect of any potential risk to residents from Legionella. The latest test on the water had been carried out in August 2008. The home has kept a regular check on hot water temperatures both in individual rooms and communal bathrooms. The home had a fire risk assessment completed by a health and safety consultant although it was reported that a fire officer had not seen this with their last visit being in April 2008. It was noted that individual fire risk assessments had been completed for residents. The home had received a recent visit from the environmental health department of the local authority although no documentation relating to this was looked at during the inspection visit. Care Homes for Older People Page 23 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 2 5A (2) (a) The Fees Invoice must show information about what services the fee relates to in terms of accommodation, including the provision of food and personal care. The registered person must ensure that all care plans contain clear instructions as to how the care needs of each resident are to be met. This is to ensure that care staff have the correct information to follow. 31/07/2008 2 7 15 (1) 31/07/2008 3 9 13 Always keep complete and 17/04/2009 accurate records of all medicines received, administered and leaving the home or disposed of so that all medicines can always be accounted for. This is to make sure that there is no mishandling or abuse of medicines and that people living in the home receive the right amount of their medicines. 4 9 13 When people are admitted to 17/04/2009 the home make sure there are always robust arrangements to fully check with the doctor or other Page 24 of 35 Care Homes for Older People appropriate health professional that the correct medicines are administered. This is to make sure that people receive the correct medication. 5 9 13 (2) Medication administration or 30/06/2008 omission must be signed for as an accurate record that residents are receiving the medication that they require to meet their health needs. When medicines are 30/04/2009 prescribed to be administered when required make sure that there are clear written guidelines to staff on how to reach decisions about the administration of all these in accordance with the provisions of the Mental Capacity Act 2005. Where people may lack capacity in respect of taking medicines staff must include consideration of how they have reached the decision to administer these medicines, in accordance with the provisions of the Mental Capacity Act 2005. This will help to make sure people receive the correct amounts of medication in a consistent way. 7 9 13 The registered person must 11/04/2009 make sure that the controlled drugs records and the medication administration record provide confirmation that controlled drugs have been given on the prescribed day. 6 9 13 Care Homes for Older People Page 25 of 35 This will make sure that people receive the correct medication. 8 9 13 When medication is 17/04/2009 administered to people who live in the home it must always be administered in accordance with the doctors directions and clearly and accurately recorded. This will help to make sure people receive the correct amounts of medication. 9 29 19 The registered person must ensure that before a person starts work in the home, all the information and documents specified in Schedule 2 of the Care Homes Regulations are obtained. This is to safeguard people from possible harm. 10 29 19 The registered person must 17/04/2009 complete a risk assessment relating to any information disclosed by Criminal Records Bureau checks in the interests of protecting residents. This is to protect people from possible harm. 11 29 19 (1) (b) Schedule 2 Before a person starts work 30/06/2008 in the home, all the information and documents specified in Schedule 2 of the Care Homes Regulations must be obtained to ensure that residents are protected through robust recruitment procedures. This requirement has been repeated from the previous inspection. 17/04/2009 Care Homes for Older People Page 26 of 35 12 33 26 The registered person must 17/04/2009 complete unannounced visits to the home and produce reports in accordance with regulation 26 keeping copies in the home. This is so that the registered provider can demonstrate that they are checking that the home is being managed in the interests of the residents. Care Homes for Older People Page 27 of 35 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 2 5A The Fees Invoice must show information about what services the fee relates to in terms of accommodation, including the provision of food and personal care. This is so that any resident or their representative paying fees are clear about the services being charged for. 30/06/2009 2 3 14 Where a prospective resident is funded by a local authority, the home must receive a copy of the care plan before the resident is admitted to the home. This is so that the home has enough information to determine if it can meet the needs of any prospective resident. 30/06/2009 Care Homes for Older People Page 28 of 35 3 7 15 The registered person must 30/06/2009 ensure that all care plans contain clear instructions as to how the care needs of each resident are to be met. This is to ensure that care staff have the correct information to follow. 4 8 12 Care staff that complete risk 30/06/2009 assessments for residents especially those which relate to pressure area care must be competent to do so in the interests of the residents health and wellbeing. This is so that an accurate assessment can be made. 5 9 13 Investigate the anomalies in the quantities of medicines remaining in stock identified at the inspection and let the Commission know of the outcome. Put in place regular audit systems that will promptly identify inaccuracies with medication. This is to help make sure people receive the correct levels of medication and that all medicines can always be accounted for. 17/04/2009 6 9 13 When people are admitted to the home make sure there are always robust arrangements to fully check with the doctor or other appropriate health 17/04/2009 Care Homes for Older People Page 29 of 35 professional that the correct medicines are administered. This is to make sure that people receive the correct medication. 7 9 13 Always keep complete and accurate records of all medicines received, administered and leaving the home or disposed of so that all medicines can always be accounted for. This is to make sure that there is no mishandling or abuse of medicines and that people living in the home receive the right amount of their medicines. 8 9 13 Make arrangements to review and improve the storage arrangements for medicines so as to reflect current legislation and best practice guidance. This is to make sure the shortfalls identified at this inspection are corrected so that all medicines are always stored safely and do not present a risk to anyone in the home. 9 9 13 When medicines are prescribed to be administered when required make sure that there are clear written 30/04/2009 31/05/2009 17/04/2009 Care Homes for Older People Page 30 of 35 guidelines to staff on how to reach decisions about the administration of all these in accordance with the provisions of the Mental Capacity Act 2005. Where people may lack capacity in respect of taking medicines staff must include consideration of how they have reached the decision to administer these medicines, in accordance with the provisions of the Mental Capacity Act 2005. This will help to make sure people receive the correct amounts of medication in a consistent way. 10 9 13 The registered person must make sure that entries by staff onto medication administration records are clear and provide information supplied by the pharmacist. This is to make sure people are receiving the correct medication. 11 9 13 Make sure that the pain relief patches identified at the inspection for a particular person are changed every 72 hours in accordance with the doctors directions and make arrangments to determine with the doctor what is the correct dose of the 5mg tablets 11/04/2009 11/04/2009 Care Homes for Older People Page 31 of 35 identified at the inspection for a particular person or if this should be discontinued. This will make sure that people receive the correct medication. 12 9 13 When medication is 17/04/2009 administered to people who live in the home it must always be administered in accordance with the doctors directions and clearly and accurately recorded. This will help to make sure people receive the correct amounts of medication. 13 12 16 The home must ensure that 30/06/2009 management and staff have the knowledge and access to information on how residents religious and spiritual needs can be met. This is to ensure that residents religious and spiritual needs can be met. 14 33 26 The registered person must 17/04/2009 complete unannounced visits to the home and produce reports in accordance with regulation 26 keeping copies in the home. This is so that the registered provider can demonstrate that they are checking that the home is being managed in the interests of the residents. Care Homes for Older People Page 32 of 35 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 Review the use of different care plan files for residents to provide clearer and more accurate information for care staff to follow in meeting residents needs. Where residents are identified as needing pressure relieving equipment such as a mattress this must be identified in the appropriate risk assessment or care plan. Review and update the medicine policy and local procedures (including homely remedies) so as to provide all staff with precise direction about the way medicines are safely managed and handled in this home. Handwritten entries on medication records should be checked and countersigned by a second member of staff. Write the date on all containers of medicines when they are first opened to use to help with good stock rotation in accordance with the manufacturers or good practice directions and to help with audit checks that the right amount of medicines are in stock. Staff competency in the administration of medication should be assessed regularly and systems should be in place to deal with staff poor practice in the administration of medication. Handwritten medication administration records for people staying for respite or longer stays must be prepared in advance so that there is continuity of recording. Medication should be administered to people directly from the medication trolley. Any menus compiled for any special diets should be checked in relation to their nutritional content in the interests of providing residents with healthy and balanced meals. Update the complaints procedure on display in the home to include the new contact details for the Commission. Documents relating to complaints and their investigation and findings should be kept in good order. Management and staff should undertake training in the Mental Capacity Act 2005. 2 8 3 9 4 5 9 9 6 9 7 9 8 9 9 15 10 11 12 16 16 17 Care Homes for Older People Page 33 of 35 13 18 The homes policy on protecting residents from abuse should have the contact details for the local authority adult protection unit added to it. Suitable signage should be provided to identify all communal toilets. The two damaged roof window blinds in room 19 should be replaced. Tables in individual rooms that show signs of wear should be replaced. Review the quality assurance system in operation in the home to ensure that it is robust enough to check that the home is operating in the interests of residents well being. Correction fluid should not be used on care documentation. 14 15 16 17 22 24 24 33 18 37 Care Homes for Older People Page 34 of 35 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. 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