Inspection on 27/07/09 for Amphion View Limited

This inspection was carried out on 27th 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Amphion View Limited 16/09/08

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Amphion View Limited 17/19 Avenue Road Wheatley Doncaster DN2 4AQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sue. Turner     Date: 2 7 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Amphion View Limited 17/19 Avenue Road Wheatley Doncaster DN2 4AQ 01302595959 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: mue@amphion.co.uk Amphion View Limited care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Dementia - Code DE, maximum number of places 14 Date of last inspection Brief description of the care home Amphion View is a registered service that is able to provide care and support to a maximum of fourteen people who may have dementia care needs. The home is situated in a residential avenue in Doncaster and is close to local shops and amenities. Bus services to the city centre are a short walk away. The home has fourteen single bedrooms, all of which are ensuite and located over two floors accessed by a passenger lift. Communal rooms consist of one lounge and a large dining room with comfortable seating at one end overlooking the garden. The garden is accessed via patio doors and has a paved area with garden furniture and a large lawn. The home has two bathrooms, one of which has a hoist to assist people in and out of Care Homes for Older People Page 4 of 30 Over 65 0 14 1 6 0 9 2 0 0 8 Brief description of the care home the bath. The other has an unassisted bath and is for more ambulant people. The proprietors have plans to renovate this bathroom into a walk-in shower room. There is parking for a few cars in the driveway and in the avenue in front of the building. According to information received from the home the weekly fees are £435.93p. Additional charges are made for hairdressing, chiropody, clothing and toiletries. Information about the home and services can be located in the statement of purpose and welcome pack provided to prospective residents and available from the manager on request. The homes inspection report, will also be on display in the home. 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was an unannounced key inspection carried out by Sue Turner, regulation inspector. This site visit took place between the hours of 8.30 am and 3.30 pm. The registered manager is Muriel Broadhurst who was on annual leave during the site visit. The general manager Nigel Best and the assistant manager, Sam Dowman were present during the site visit and were given verbal feedback during and at the end of the visit. Prior to the visit the manager had submitted an Annual Quality Assurance Assessment Care Homes for Older People Page 6 of 30 (AQAA) which detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. Questionnaires, regarding the quality of the care and support provided, were sent to people living in the home, their relatives and any professionals involved in peoples care. We received five from people, some of which included comments from their relatives and eight from staff. Comments and feedback from these have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. Time was spent observing and interacting with staff and people living at the home. Six people and five staff were spoken to. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in September 2008. The progress made has been reported on under the relevant standard in this report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: To ensure that peoples health, safety and welfare is maintained:MAR (Medication Administration Records) sheets should not be signed retrospectively by staff when errors or omissions are identified. Arrangements should be in place to ensure that medication administration records are accurately maintained and that the person administering the medication completes the record at the time of administration. Medication training should be thorough and ensure that staff have accurate and up to Care Homes for Older People Page 8 of 30 date information about the management of medication. So that people are protected by the homes policies and procedures on the recruitment and selection of staff, application forms should give full details of peoples previous employment. Any gaps in employment history should be checked out and recorded on the persons application form. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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. Information was provided to inform people about their rights and choices. Peoples needs were assessed prior to their admission to make sure these could be met. Evidence: The service had a Statement of Purpose (SOP) which provided useful information about the home. When people were admitted to the home they were given a welcome pack. Considering that the home cares and supports people with dementia, both the SOP and welcome pack should be reviewed so that the information provided is easier to read and understand. The SOP needed to be more specific about the range of needs the home was able to meet, especially in the level or degree of dementia people may have. Five people surveyed, were asked, Did you receive enough information to help you decide if this home was the right place for you before you moved in? All five people said yes. The AQAA stated, We make sure people know about the home before they come in so that they know it is the best home for them. We offer our prospective clients a taster Care Homes for Older People Page 11 of 30 Evidence: by staying, for example, the weekend free of charge . Clients have a pre assessment prior to admission. The manager takes a member of staff on assessment so that the person has a familiar face when they come in and the staff member can have an input to discuss needs being met. We find out as much as possible about their likes and dislikes and inform the cook and care staff so that the client is eased into the home nicely. Before people stayed in the home they were also assessed by a social worker. Any information collated from the needs assessment would then form the basis for the care plan. People said, I came to stay for a short holiday before I made the decision to live here. I came to look around with my family. Id heard about the home from other local people who said it was very nice. 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. Each person had a care plan that reflected their individual care and support needs and personal preferences. Medication procedures did not fully protect peoples health and welfare. The health and personal care needs of people were met in a way that maintained their privacy and dignity. Evidence: Each person that lived in the home had an individualised plan of care. Three peoples care plans were checked. Care plans contained information about peoples health and personal needs. Staff had attempted to write care plans in a person centred way. There was information about what the person themself felt their needs were and how they would prefer these needs to be met. Care plans had been updated as necessary. When we checked the information in the care plans, against what people told us, it corresponded. This made it easy to establish peoples present care needs and requirements. Staff completed daily records at the end of each shift. Those seen related to the care plans. Staff worked closely with external professionals and specialists for advice and support. Access to dentists, chiropodists and opticians was available. Individual risk assessments were seen in peoples care plans. People seen Care Homes for Older People Page 13 of 30 Evidence: looked well cared for and were dressed appropriately. Staff approached people in a sensitive way, for people who were reluctant staff used skills of persuasion. This showed that staff used their skills to ensure that people who had problems with communication or who showed some reluctance still had their needs met. Five people surveyed, were asked , Do you receive the care and support you need? Four people said always and one said usually. People said, We get lots of care and attention. The staff make me laugh and are kind to me. The staff are kind and helpful. There was a medication policy and procedure that staff were familiar with. Managers and senior carers administered medications. Medicines were securely stored in a locked trolley. Staff said that they had undertaken a two day training course in medication administration. Whilst checking medication practices and administration we observed a number of issues that were of concern. We looked at peoples medication and Medication Administration Records (MAR) sheets. On most occasions staff had signed or written a code to confirm if people had taken their medication or not. However there were some gaps. The assistant manager said that when they monitored medications, if staff had not signed the MAR sheets this was brought to their attention and they where asked to sign the sheet on their return to work. We said this must stop as this was not a safe practice. We said that staff must sign for medications given at the time of administration. If errors or omissions occur then this must be recorded separately but MAR sheets must not be signed in retrospect. MAR sheets were hand written by the managers when a person came to stay at the home. We saw that one medication record for one person didnt state the strength that was to be given. The box of tablets being used were 25mcg and instructions said one each day. When we looked at the other boxes of the same medication that had been brought into the home they were 100mcg tablets, these also stated one to be taken each day. We asked the assistant manager to check this out. The information on the admission form said that the person took 150mcg of this medication daily. We instructed the assistant manager to contact the persons GP to inform them what the person had been given and to clarify what medication should have been given. The person had been at the home for seven days. Senior staff who had checked in the medication and staff who had administered medication to the person during this time had not picked up on this error. We checked the number of tablets that were recorded as received against what was recorded as given and this did not tally with the number of tablets in stock. The GP confirmed that the dosage given over the last seven days was incorrect. He said that the person would not suffer any serious ill effects from this error but he would send in the district nurse to carry out blood tests. The MAR sheet was rewritten correctly by the assistant manager. We asked the general manager to refer this incident to adult safeguarding so that full and safe procedures were followed. This was done immediately. The persons Next of Kin (NOK) was also informed of the Care Homes for Older People Page 14 of 30 Evidence: error. In the medication trolley there was a plastic container that contained a large number of tablets that staff had tried to administer to people but they had refused to take. When this happened the tablet was put into the container and left there until they were returned to the pharmacy. These tablets should have been moved out of the trolley and disposed of as soon as possible, so that they did not pose any risk. During the site visit we observed that people were cared for in a friendly and professional way. Staff were skillful in ensuring that people maintained their privacy and dignity when receiving personal care. Staff respected peoples preferences and were well aware of peoples intimate care needs. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples recreational interests and needs were met. People were receiving a healthy, balanced diet in pleasant surroundings. Evidence: We arrived at the home at 8:30 am. Some people were already up and moving around, others were still in bed. People said they were able to get up and go to bed when they chose. They said there was enough staff on duty to give them help and support when they needed it. We spoke to one person who chose to spend their time in their room. They said staff respected their wishes and didnt mind bringing their meals to their room if they chose. We saw that people coming into the home were made to feel very welcome. The home shared an activities coordinator with their sister home. The coordinator worked three days and divided her time between the two homes. There was information about what activities were available on each day. The coordinator wasnt at the home on the day of the site visit. Carers were expected to be involved in providing activities for people. We saw them playing games and sat talking to people. A variety of activities were arranged in the home and there was the opportunity for people to go outside on trips. People were encouraged to take part in activities. Choice was respected for those who did not want to take part. Even though some people did Care Homes for Older People Page 16 of 30 Evidence: not take part there was evidence of a positive mood and signs of well being as they watched, smiled and made comments about what was going on. Information about what peoples personal preferences were regarding activities was seen in care plans. Staff also recorded when someone had taken part in an activity and if they had enjoyed this. Five people surveyed were asked, Does the home arrange activities that you can take part in if you want? Three people said always, one said usually and one said sometimes. People said, I choose not to join in the activities. I enjoy reading my newspaper and watching television. I like it when we play skittles. We observed breakfast and lunch being served in the dining room. The dining room tables were set nicely with tablecloths, cutlery and matching crockery. The meal served at lunchtime looked healthy and appetizing. We saw that menus offered good choice and variety with alternative options always available. The days menu was displayed on a white board. We saw that the date displayed on the notice board was incorrect. It still showed a date that had passed over a week ago. As the home cares for people with dementia it is important that information displayed assists people to be orientated to time and place. Since the last inspection the catering arrangements had been improved. A cook had been employed which meant that all meals were cooked at the home rather than prepared at the sister home and reheated. We observed that people were given as much independence as possible at meal times. Some people drank from cups that assisted their disability. Where necessary staff assisted people, for example, cutting up their food, however people were encouraged to exercise choice and control. People werent rushed, making the ambiance in the dining room pleasant and relaxed. People said Theres a good choice. I am very happy with the meals. Theres always plenty to eat. I like the meals very much. 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. Complaints were dealt with effectively. The policies and practices for referring adult safeguarding concerns assisted in keeping people safe. Evidence: People and their families had been provided with a copy of the homes complaints procedure, which was also on display in the entrance hall. This detailed who to speak to at the home or, if preferred, external to the home to make a complaint, should they wish to do so. The complaints procedure was easy to understand. The home kept a record of complaints, this detailed any action that had been taken and the outcome of the complaint. Since the last inspection the home had not received any complaints. When five people surveyed were asked Do you know how to make a complaint, they all said, Yes. Relatives said, I would go to the manager. If I had any worries or concerns I could go to any of the staff and they would help me. Since the last inspection there had been 5 adult safeguarding referrals. These had been reported as per the agreed South Yorkshire adult safeguarding protocols. Referrals had been made by the home so that advice could be given. Prompt action was taken by the home manager to prevent any further risk to people. Adult safeguarding had not found it necessary to investigate any of these incidents. Staff said they had completed training in adult safeguarding. Staff spoken to were aware of their role and responsibilities in dealing with any alleged safeguarding incidents. Care Homes for Older People Page 18 of 30 Evidence: People spoken to said they felt safe living in the home. 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 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 maintained to a good standard, which helped to ensure that people were comfortable and safe in their surroundings. Procedures for the control of infection were in place which promoted peoples health and welfare. Evidence: The AQAA stated, We aim to have an inviting home. One that all of us would want to live in. So we try to look after our home as if it were our own. We try to keep everything clean, tidy, hygienic, fresh, cosy, welcoming, friendly and warm. From the comments we get, we think we are doing that quite well.. The home employed a maintenance person and a gardener. We saw that the home was maintained to a good standard. The outside grounds and gardens were pleasant sitting areas. Lounge and dining areas were clean, tidy and domestically furnished. Bedrooms were spacious and personalised. Since the last inspection some carpets and furniture had been replaced and bedrooms redecorated. There remained a number of carpets that needed to be replaced. Some furniture was also ready for replacement. The general manager acknowledged that some refurbishment of the home would be beneficial. The layout of the home meant that people and their friends and relatives could choose to sit in a number of communal areas. The environment promoted the privacy, dignity and autonomy of people. Bathrooms and toilets were fitted with appropriate aids and adaptations. The home smelt fresh and clean. Controls of infection procedures were in place. Staff were observed using protective aprons and Care Homes for Older People Page 20 of 30 Evidence: gloves. Staff said they had completed training in infection control. The homes laundry was sited away from food preparation areas. The home had been awarded a 4 Star Very Good Standard of Hygiene from the last Environmental Health visit. People said, I like my room its fine. I was able to bring in my own furniture so its just like home. I have everything I need in my room. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers were appropriate to meet the assessed needs of people. In the main recruitment information obtained protected the welfare of people. Staff were receiving training so that they were competent to do their jobs. Evidence: Staff interviewed said that they enjoyed working at the home and got a lot of job satisfaction. The diversity of the staff team matched the diversity of the people living in the home. On the day of the site visit staffing numbers were adequate. We saw one new staff member working supernumerary, familiarizing herself with the people that lived at the home and getting used to routines. She said that she was also booked in to complete the induction course prior to her commencing full employment. People said, The staff are very good and always there when I need them. If I need somebody, staff come to help me. Staff are always willing to help you. Staff were able to talk about the various training courses that they had attended which included fire training, moving and handling, food hygiene, health and safety and personal care. Training was provided to all staff on an on going basis. A number of care staff had completed the NVQ Level 2 in care and others had commenced the training. The number of staff trained fell below the required minimum of 50 per cent of the staff team trained to NVQ Level 2 in Care. Care Homes for Older People Page 22 of 30 Evidence: Eight staff surveyed, were asked, Did your induction cover everything you needed to know to do the job when you started? Four said very well and four said mostly. When asked what the home could do better, staff said, Communicate more at handovers. Better communication. Keep us up to date with all changes. We saw that issues about communication had been discussed at staff meetings. The manager had acknowledged that improvements were necessary in the way in which staff communicated with each other. Three records of employment were checked. These included the required references, certificates of training, health checks and evidence of Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check. One application form did not fully record the persons previous employment and the reasons for any gaps in their employment. Two peoples CRB checks had been returned and showed that they were not clear. We talked to the general manager and assistant manager about carrying out a risk assessment process to evidence the decision made to employ these people. This risk assessment should be written and kept on the persons personal file. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home was based on openness and respect. There were quality assurance systems in place. Peoples finances were safeguarded. In the main peoples health and safety was protected and promoted. Evidence: The AQAA stated, As the manager, I spend some time on the floor and I speak to all staff on duty everyday. I come to see the night staff and spend some time with them. The manager was trained and competent to run the home and meet its stated aims and objectives. She was clearly very committed to ensuring that people living in the home were consistently well cared for, safe and happy. Everyone spoken to and information from surveys confirmed that people, staff and relatives were all happy to approach the manager at any time for advice, guidance or to look at any issues. They all said that they were confident that she would respond to them appropriately and swiftly. Staff said that they found the manager easy to talk to and they could go to her at any time to discuss issues or concerns. Meetings took place and staff and residents were able to voice their opinions about the Care Homes for Older People Page 24 of 30 Evidence: way the home was managed. The company had a quality assurance system in place that consisted of audits and questionnaires. Audits covered areas such as catering, housekeeping, care and administration. There was also a spot-check system of audits to obtain the views of residents and visitors on staff kindness and whether staff were wearing identity badges plus checks of equipment in the home, care plans, other documentation and medication. Questionnaires had been formulated for people and visitors for a range of issues, for example, meals, laundry experience, activities, staffing and complaints management. It is recommended that the views of visiting professionals such as district nurses, community psychiatric nurses, GPs and care management teams are obtained at intervals to give a wider range of information about the services provided by the home. We also advised that an annual report on the services provided should be completed which should include the outcome of quality monitoring. This should then be made available for people to read. The area manager visited the home on a regular basis. Each month he completed a report which detailed what his observations of the home were, what improvements could be made and what peoples opinions of the home were. Any action that needed to be taken was then discussed with the manager. The home handled money on behalf of some people. Three peoples financial records were checked. Account sheets were kept and receipts were seen for all transactions. We were unable to check that peoples money balanced with what was recorded on the account sheet because the registered manager was on annual leave and hadnt left the safe key with anyone. She had left money available in the petty cash, which meant that people could access their money if they needed to. However we advised that the person left in charge in the absence of the manager should hold the safe key so that money was available for inspection. Staff spoken to said they had recently had formal supervision with their line manager. They said that supervisions were useful and beneficial. Fire records evidenced that fire alarm checks and fire drills took place. A fire risk assessment had been completed and updated. The fire risk assessment should have included specific precautions that needed to be in place for people that had dementia. We asked to see the electrical certificate for periodic inspection and the gas safety certificate, these had been completed. 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 9 13 Medication training must be thorough and ensure that staff have accurate and up to date information about the management of medication. So that peoples health and wefare is maintained and promoted. 17/08/2009 2 9 13 Arrangements must be put in place to ensure that medication administration records are accurately maintained and that the person administering the medication completes the record at the time of administration. This will help to make sure that peoples health and welfare is maintained by the safe and correct use of prescribed medicines. 17/08/2009 Care Homes for Older People Page 27 of 30 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 3 9 13 When errors or omissions 17/08/2009 from MAR sheets are identified staff must not sign the MAR sheets retrospectively. To ensure that peoples health, safety and welfare is maintained. 4 29 19 Application forms must give full details of peoples previous employment. Any gaps in employment history must be checked out and recorded on the application form. So that people are protected by the homes policies and procedures on the recruitment and selection of staff. 17/08/2009 5 38 13 The fire risk assessment 17/08/2009 must highlight any particular precautions that need to be in place for people that have dementia. So that people are kept safe Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The homes SOP should contain full information about the services provided especially in relation to dementia care. Care Homes for Older People Page 28 of 30 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 This will ensure that potential residents can make an informed choice about the home and be sure needs can be met. 2 9 A separate record should be kept of any errors or omissions made following the administration of medications. This should also detail what action the manager has taken to prevent errors reoccurring. Medication that is waiting to be disposed of should be returned to the pharmacy as soon as possible, so that it does not pose a risk to people. Information on display should be kept up to date and accurate so that people are orientated to time and place. The planned programme of refurbishment and redecoration should continue to ensure that people are comfortable and safe in their surroundings. 50 of the staff team should be qualified to NVQ Level 2 or above. This will help to ensure that staff are skilled and competent to do their jobs. When a CRB check shows that a person has committed offences, a risk assessment process should be carried out. This should show the decision made about employing the person and any safeguards that have been put in place. The care people receive would be enhanced if staff communication was better. Ways in which to improve staff communication should be discussed and then put into practise. The results of the quality monitoring information received should be collated into a report. Anyone with an interest in the home can then read the report and make their own decision about using the home. The views of professional visitors to the home such as GPs, district nurses, community psychiatric nurses and care management should be obtained as part of the quality monitoring system. Monies kept in safekeeping for people should be available for inspection. 3 9 4 5 12 19 6 28 7 29 8 30 9 33 10 33 11 35 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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