Inspection on 09/09/09 for Anglesey Court

This inspection was carried out on 9th September 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Anglesey Court 13/09/07

Anglesey Court 17/11/06

Anglesey Court 06/02/06

Anglesey Court 14/09/05

Anglesey Court 24/01/05

Anglesey Court 01/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Anglesey Court 26 Crescent Road Alverstoke Gosport Hampshire PO12 2DJ     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 Kinch     Date: 0 9 0 9 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 28 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 28 Information about the care home Name of care home: Address: Anglesey Court 26 Crescent Road Alverstoke Gosport Hampshire PO12 2DJ 02392582322 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: angleseycourt@btconnect.com Anglesey Court Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admisison ot the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Anglesey Court is a large detached house, situated in the village of Alverstoke, Gosport. The home has a garden at the front of the property and a car park to the rear. There is a public park opposite the house and the beach is a short distance away. Angelsey Court is registered to provide care and accommodation for up to twenty older persons. There are five double and ten single bedrooms. Residents also have access to the communal lounge and dining room. The manager informed the Commission that the current fees are from £335.25 to £376.60 per week. Care Homes for Older People Page 4 of 28 Over 65 20 0 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 was the first inspection since 13/9/07 although the home was reviewed in an Annual Service Review in 2008. For this inspection we reviewed the information held about the home and information we had received about the home since our last visit. We sent out surveys to people living in the home staff and professionals. We received 14 completed forms from people living in the home and some were helped by staff or relatives. We received 6 surveys from staff and 5 from health and care professionals. Comments have been taken into account. We visited the home for 7 hours, met the staff on duty and had conversations with several people living in the home. We also looked at some of the documentation including a sample of staff records and care plans and we had a look at some of the physical environment. Care Homes for Older People Page 5 of 28 What the care home does well: What has improved since the last inspection? What they could do better: As a result of this inspection a number of requirements have been made and relate to the home not having an effective quality assurance system in place to ensure that standards are followed routinely.We have made a requirement about this. We have made a requirement about care plans and the need for thorough risk assessments. These must be more individualised and person centred and include more details about emotional and social needs in general and more about moving and handling and dietary needs. We have made requirements about accuracy in following medication procedures, about staff being assessed as competent and this kept under review. We identified aspects of medication needing to be better in the last report. We have made a requirement about health and safety and this embraces issues about infection control and risk assessments. Both we also referred to in the last inspection report.We have also made a requirement about keeping the use of the second floor bathroom under review. Other matters have been raised in the body of the report for the manager to address such as issues regarding privacy and dignity, developing the service user guide and pre admission assessment process and making sure that staff are fully supervised to ensure the service is consistently provided and training put fully into practice. Care Homes for Older People Page 6 of 28 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 7 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is shared by the home before people are admitted but not enough is available for people to be clear about the service to be provided. Assessment information is obtained before people come into the home but this is not always in enough detail to ensure all needs are met. Evidence: In the AQAA the manager told us that the home continues to assess people before and after admission to the home. She said they had admitted six people since the last inspection including some people for short stays. In the information we received from people or relatives most said that they were provided with enough information about the home before admissions were made. One person said I have been very happy here since the day I walked in. Verbal and written feedback from staff told us that they are given information about people coming for a stay or to live in the home. One staff member says this enables Care Homes for Older People Page 9 of 28 Evidence: them to provide support needed. Three health professionals said that the services assessment arrangements ensure that accurate information is gathered and that the right service is planned for people. We sampled two sets of records in relation to admissions to the home and found that the home had completed their own assessment for one person and had not obtained a care management assessment. A care management review had taken place since then. A care management assessment had been obtained for the other person in our sample but there was no home assessment. Care plans had been developed but these were not in sufficiently informed by the assessment to provide staff with enough information about care that people want. The statement of purpose and brochure for the home was viewed and discussed with the manager. The guide, help sufficient information and was held in a file a available for those visiting the home. The brochure was available for people to take away and did not contain enough of the information,such as details about admissions and care reviews, required in the service user guide so that people could consider how the home runs in their own time leaving them at risk of not having all the information they should have about how the home runs. The manager agreed to address this. Care Homes for Older People Page 10 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments including risk assessments and care plans are not in sufficient detail to ensure that staff are given clear guidance about how people wish to have some aspects of their care provided and exactly what they need help with, putting people at risk of some needs not being met consistently. The home does enlist the support of health professionals to assist in meeting health needs but errors in medication, one identified at the last inspection, indicate a deterioration in medication management.These issues and a lack of checks that staff training is effective and that staff are competent leave people at risk of not having the full treatment that they should. Privacy and dignity is not always taken into account when providing care to people living in the home leaving them at risk of their needs not being met as they wish. Evidence: At the last inspection one recommendation was made about medication. This was about ensuring that records reflect the dose given. When we completed an Annual Care Homes for Older People Page 11 of 28 Evidence: Service Review in 2008 the manager confirmed with us by telephone that this had been completed. In the information received in surveys from people staff and health professionals for this inspection no issues were raised about medication. While we were in the home we looked at aspects of the medication system and discussed it with a member of staff. We found that the person had a good working knowledge of it. A monitored dosage system was in use and the staff member described the process of administration in line with national guidance. However there were some problems with the system. We sampled records and the medication for four people living in the home and found errors for all of them meaning that people are at risk of not having their prescribed medication correctly administered. Examples follow: for one person four as required medications were written on the administration sheet but one medication was not available;a medication care plan detailing as required medication was not in place for this person;for another as required medication was on the medication sheet four times daily but only given once a day; the staff member said that it was offered but we noted that refused had not been recorded;another person was having a medication three times daily although the sheet indicated that it should be provided four times daily and the box the medication was provided in was not labelled; unprescribed creams were found in a room for another person. The problems with medication were brought to the managers attention who agreed to address it. Although staff are reported to be trained before carrying out medication in the home there was no paper evidence to show that they had recently been re-assessed as competent in medication. One person said that they had received training several years ago. Another had completed a distance learning pack and had recent training from a chemist. Not all training provided is recorded and the manager agreed to address this. Other aspects of support with medical, health and personal care were considered. People mostly said that they had the support and care needed in the home and staff said that they had the information they needed to provide it. One said that the home had a good rapport with the chemist, district nurses and doctors. We had positive responses from five health and care professionals in our surveys and they did not raise concerns. One said that the staff are quick to ask for extra help and try to maintain a high standard of care and that people were treated as individuals. However, we found that the two care plans viewed were not in sufficient detail to describe peoples preferred routines and preferences. It had been recognised in the review of one person living in the home, that some of their needs could not be met Care Homes for Older People Page 12 of 28 Evidence: including independent shaving and alternatives arrangements were not in the care plan. In another care plan the dietary needs of that person discussed with staff were not documented. In the sample viewed risk assessments did not cover enough detail such as moving and handling in different areas of the home. The risk of using hot water in bedrooms and aspects of personal care (such as support with mental stimulation and medication) were not documented in enough detail to ensure that consistency would be provided in the home. Although in the surveys and during our visit people said that privacy and dignity is promoted in the home we found evidence that this is not fully embedded in practice. In the afternoon two male residents were shaved by staff in succession in a double room which was not theirs. Both were noted to be shaved just inside the doorway with the door wide open so that anyone visiting the home or moving in the area could see. Although one person had requested assistance that persons preferences were not in the care plan. This was brought to the managers attention and she agreed to address it. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with some regular mental stimulation and are encouraged to follow their own routines. However, this is not always followed through due to care planning not addressing individual wishes and preferences in enough detail. Evidence: In the AQAA the manager said the home is good at providing social events for people living there involving their friends,relatives and staff. She said she has received positive feedback about these events and more trips to the beach in wheelchairs and other trips are planned. They plan to make more use of the community garden across the road from the home and link with the local school. We noted that an activity list is on the wall of the lounge and people told us of some of the activities in the home such as quizzes and singing. During our visit to the home we were told that staff had time to talk with people living in the home and noted that at lunchtime the staff and the manager also joined people for lunch. We talked with people about mental stimulation and observed what was happening in the home. We noted that people were able to move about the home as Care Homes for Older People Page 14 of 28 Evidence: they wished and make choices about being in their rooms or in shared areas. One person said that they were free to do as they wished and chose to spend time in their room. Music was being enjoyed by some people in the lounge in the morning and the new fish in the fish tank was causing a lot of interest among a few people. Staff planned a quiz for the afternoon.We noted that some people were reading newspapers and large print books were available. We have received mixed views about the levels of stimulation in the home with a couple of people telling us they were a bit bored and some staff commenting that although some activities are provided including, one to one support on Mondays, more could be done. When viewing care plans we noted that there is little recorded about what peoples preferred routines are, meaning that they may not get support when they want it. An example of this is in the section on individual needs and wishes. We also noted that little is recorded about social and mental stimulation including peoples choice and preferences and support they need with this leaving some people at risk of under stimulation. Visiting people said they are made welcome. A staff member said that family and friends are welcome at all times. Comments we received about the food in surveys were positive and the home has a cook for this purpose on six days of the week. At lunchtime food was served in the dining room and from a hot cabinet brought into the area and so people could decide what to have. Most meals were eaten and the food looked good and attractive and cooked well. People were given choices. All comments about food at that meal time were good. Staff said that changes are made to the menu but they know what people living in the home like and changes took this into account. In the AQAA the manager had told us that there are three staff including herself trained in nutritional care and assistance with eating and that this is enough to meet needs. Staff told us that one person in the home did not generally eat the meat served and of arrangements to provide preferred protein in the evening meals at the persons choice. This was not documented in sufficient detail in the care plan and was referred to in the section on individual needs and wishes.This was brought to the managers attention who agreed to address it. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place in the home to assure people living there that matters raised will be addressed. Safeguarding procedures are available for staff to use but people will be offered greater protection when all staff are clear about when the home should report suspicions to social services. Evidence: We considered how the home responds to complaints. Information from people, in the home for the ASR in 2008 and for this inspection tells us that staff listen and act on what is said and are mostly available when needed. Most people or their relatives know how to make a formal complaint and the procedure is available in the front hall of the home. Staff told us that the home always or usually responds appropriately if someone raises a concern about the home. No major complaints were made about the home during our visit. One person had raised concerns about their care but this was being addressed. In the AQAA the manager said that the home had not had any complaints since the last inspection and there were none in the complaints log. We had forwarded a complaint to the home since our last visit and asked the home to address it under the homes complaints procedure and the home investigated it and had responded to us about action taken. The manager agreed to record this in the complaints book. Care Homes for Older People Page 16 of 28 Evidence: Information from staff in the home indicates that staff are supported to think of the types of abuse that can occur in the home and action to be taken. One said that this is discussed in supervision and thought that staff would take action if concerned and report to the manager. We noted that there are leaflets about the risk of abuse available in the home and staff had been asked to sign, in August 2009, that they had seen the policy. Staff told us they have had some training in adult protection but not all staff were clear about the manager or themselves reporting all suspicions through the local safeguarding procedures and involving social services should an allegation be made. The manager and a staff member spoke of further guidance to staff being planned in some distance learning that would be taking place and this would include reporting procedures. Since the last inspection we made one referral under safeguarding procedures in relation to this home and in this instance it was not substantiated. The manager was reminded of this and include such referrals in future AQAAs. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A homely environment is provided for people living in the home with regular improvements but more attention is needed to ensure that people are not at risk of infection and to keep the home adequately maintained. Evidence: In the AQAA the manager said that there is ongoing improvement to the environment and that people living in the home had won a grant for an improvement to the front garden which has now been completed and is accessible to all. Three comments received about the home included statements about improvements to the upholstery and carpets being needed and another that the home would benefit from upgrading. We looked at the shared areas of the home, a sample of bedrooms and the bathroom facilities. The latter is commented on below. We noted that some rooms had a better quality of furnishing than others and the manager said that there is a rolling programme of improvement. Rooms contained peoples personal possessions. Generally rooms were clean and adequately decorated. But one room was not fresh and the ground floor carpets in the corridor and carpet in another room were stained. Blinds have not been provided in all bathrooms and toilets. People living on the second floor have access to a toilet but the adapted baths are on the lower floors of the home meaning that they do not have a fully functioning Care Homes for Older People Page 18 of 28 Evidence: bathroom near them and have to go to the first or ground floor for assisted baths.The second floor bathroom is not used for bathing and is used for sluicing commodes which are provided in all bedrooms.This must be kept under review by the home to ensure that the impact is not detrimental to people using the service.We have made a requirement about this. There was a tripping hazard brought to the managers attention on the first floor where the lino of the bathroom meeting the carpet was not secured to the floor meaning that people were at risk of falling. She agree to address this. Staff say that they have infection control training. The disposable equipment needed for various roles in the home is available and various pieces of guidance are posted on the laundry wall such as about hand washing and general infection control. Prior to our visit in the surveys received from people living in the home, their relatives and staff, we were told that most people thought that the home is clean and fresh although a comment was received about hygiene facilities in need of improvement. Through observations of various areas of the home during our visit we noted that there was some evidence to support this view. In some of the toilets and bathrooms we noted the provision of towels and liquid soap. However, some toilet rolls were stored on stands on the floor next to the toilet with paper trailing on the floor. All of these were at risk of being splashed. In one bathroom a toilet roll was sitting on a stained fabric covered seat next to the toilet. This tupe of risk was brought to the managers attention in the last inspection report. In addition some of the wooden holders were not adequately varnished to prevent the risk of infection. In the first floor bathroom some of the paint on the base of the hoist had come off and exposing areas of rust difficult to disinfect. These were all brought to the managers attention. Issues were also raised at the last inspection about the potential risks of general bars of soap being used yet these were found in the first floor bathroom and in the laundry. In addition the latter was sitting on fully exposed wood behind the hand washing sink in the laundry providing another risk. A requirement has been made about health and safety and ensuring that action to minimise risks are monitored. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures in the home are good but more recording is needed to show that adequate checks are always followed through for people providing care in the home. Staff are provided with training in the home to meet peoples needs but checks are needed to ensure that the training is put into practice in order to consistently meet peoples needs. Evidence: The manager said in the AQAA that pre employment checks are in place for people working in the home and the staff responding to in the surveys confirmed this. We sampled the records and found that the home obtains Criminal Record Bureau checks(CRB) or POVA first checks before employment and in the sample viewed the latter was followed up by a full CRB check. In one file we noted that the previous employers reference had not been obtained and there was insufficient evidence noted about reasons for previous care employment being left,the manager was advised to ensure that this is fully documented to show that adequate checks are made of staff working with people in the home. In the AQAA the manager said the home does not have a large turnover of staff, that they are keen to train and the number of staff trained to National Vocational Qualification (NVQ)level 2 has improved.In the AQAA she said she plans to have more Care Homes for Older People Page 20 of 28 Evidence: in house training but was not specific about what was required. At this visit we noted that the homes objective is to have 75 of staff reaching NVQ level 2 by the end of 2009. The manager said that there were two staff who needed to complete an NVQ assessment for this percentage to be achieved. The manager agreed that she needs to check that all training such as medication ,infection control and safeguarding is recorded. She told us of plans for staff training in safeguarding and medication. She also spoke about having been trained as a trainer in medication and in safeguarding and that she has introduced a distance learning package of training, covering a range of care issues, to the staff team. We received verbal and written information from staff about the provision of training in the home.In the surveys they said that they are having training relevant to their role,to understand how to meet peoples needs, to be kept up to date and to get enough knowledge about health care and medication. Staff told us about the training that they are having including some of the areas relevant to health and safety and other such as the Mental Capacity Act and medication.They were also aware of the new distance learning packs to be used and told us they were in use and that they also had training such as fire and moving and handling from external professionals. Staff told us that they have supervision and some of the senior staff are involved in providing it. Records are held.From the evidence found in other sections of this report such as regarding infection control, privacy and dignity, medication and health and safety there is not enough evidence that the training and supervision is effective in ensuring that the standard of service to people living in the home is consistent meaning that at times their needs may not be met. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The interests of the people using the service are taken into account by the management but further action is needed to increase this, improve the quality of the service and promote health and safety in the home. Evidence: The manager of the home has many years experience.She undertakes regular training and we saw records of this. It has included training in fire, food, deprivation of liberty and risk assessments.Comments about the manager from the people living in the home and the staff were positive including that she is a good leader and listens. We sampled the system of money management for people living in the home who need support. Money and valuables are held securely,are recorded for individuals and in the sample checked are accurate.Receipts are held for purchases. The AQAA did not contain much information about improvements and plans for the home.However, we were told about plans for the front garden which residents wanted Care Homes for Older People Page 22 of 28 Evidence: and after fund were obtained this has been carried out. We were also told of residents meetings and surveys that take place and the home has a small list of objectives for 2009. These focus on the environment and staff training. Improvements needed have been identified in other sections of this report such as in accuracy in medication, risk assessments for individuals and the home,care planning to be more detailed and more person centred and a review of infection control in the home. In the last inspection report some issues were raised about the storage and control of substances hazardous to health and when we completed the ASR in 2008,we were informed by the manager that this had been carried out. However,at this inspection we found similar substances were in an unlocked bathroom cupboard on the first floor and on an open shelf in the area where staff lockers are situated.These were all accessible to any person living in the home and as some people in the home a slightly confused they posed a potential risk to them. The manager locked the items away during our visit. Other issues in respect of infection control were raised in the environment section. We observed the household risk assessment which was recorded as reviewed on 26/1/09 but was not comprehensive enough to ensure that people living in the home are adequately safeguarded. We noted that some of the radiators in the the home are covered and others are not but there was no record of checks in place to ensure that these are not too hot. However there was some evidence of water temperature checks completed in the home and last done on 8/9/09. The manager confirmed that the water temperatures in bedrooms are not regulated and we noted that risk assessments are not completed for each person to assess the level of risk to them and action needed to safeguard those assessed at risk. We have made a requirement for the manager to review systems in place in the home to ensure that health and safety is maintained consistently. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 There must be detailed reviews of care plans to ensure that they provide guidance for all aspects of care that people need or want in the home including,moving and handling, dietary needs, medication, emotional and social needs to minimise risks. This is to ensure that people are given individualised care and support to meet their needs. 09/11/2009 2 9 18 There must be full records 09/12/2009 that staff receive regular training in medication, that they are competent to carry out the procedures. and that this is kept under review. This is to ensure that people receiving medication are supported by trained and competent staff at all times. Care Homes for Older People Page 25 of 28 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 There must be a full review of medication procedures in the home and amendments made to ensure that medication is given as prescribed at all times. This is to ensure that medication is given in the corrent dose and at the corret time. 19/11/2009 4 21 23 The registered person must ensure that the use of the second floor bathroom is kept under review and ensure that current usage for cleaning purposes is not detrimental to meeting the needs of people with rooms on this floor. This is to ensure that peoples individual needs are met. 09/11/2009 5 33 24 The manager must review the quality assurance procedures in the home to ensure that shortfalls are identified and plans in place to rectify them. This is to ensure that the people living in the home are provided with a consistent service. 09/12/2009 6 38 13 The manager must ensure that health and safety is 09/12/2009 Care Homes for Older People Page 26 of 28 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 reviewed including general and individual risk assessments and infection control and put systems in place to minmise risks. This is to ensure that people in the home are not put at risk. 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 10 It is recommended that the staff are provided with training in person centered care including aspects of values in practice such as promoting choice ,dignity and respect. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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