Inspection on 30/06/09 for Appleby Care Home

This inspection was carried out on 30th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Appleby Care Home 29/09/08

Appleby Care Home 06/09/07

Appleby Care Home 02/10/06

Appleby Care Home 20/02/06

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: Appleby Care Home Military Road North Shields Tyne And Wear NE30 2AB     The quality rating for this care home is:   two star good 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: Suzanne McKean     Date: 0 1 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 29 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 29 Information about the care home Name of care home: Address: Appleby Care Home Military Road North Shields Tyne And Wear NE30 2AB 01912579444 01912708226 Appleby@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne Boss Limited care home 55 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) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 55. The registered person may provide the following category of service only: Care home with nursing - Code N 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: 55 Date of last inspection Brief description of the care home Appleby is a 55 bed care home with nursing. It provides care for older people with enduring mental health problems. The home is owned and managed by Southern Cross Healthcare Limited a large national provider of services for vulnerable client groups. Care in the home is provided by Registered Nurses supported by care staff. The home is situated in North Shields in North Tyneside close to local shops and good public transport links. The building is comprised of two floors with 55 single bedrooms all with en-suite facilities. Each floor has separate lounge, dining areas, bathrooms and additional toilet facilities. The home also has a kitchen and laundry room. There is a garden and patio area to the rear of the home. Information about the homes services, Care Homes for Older People Page 4 of 29 Over 65 0 55 Brief description of the care home philosophy of care, service brochures and Inspection reports are displayed in the homes entrance area. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: 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 Summary: This is an overview of what the inspector found during the inspection. How the inspection we carried out:- Before the visit we looked at, the information we have received since the last visit on 6th September 2007. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service and their relatives, staff and other professionals. Care Homes for Older People Page 6 of 29 The visit: An unannounced visit was made on 30th July 2009 and a further visit was carried out by the Pharmacy adviser the following day, the total time of the visits was fourteen hours. The visit was undertaken by the link inspector for the home. Additional information was provided by the home following the visit. During the visit we: Talked with people who use the service, relatives, staff, the manager and visitors. Looked at information about the people who use the service and how well their needs are met. Looked at the records which must be kept. Checked the staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building and parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the Manager what we found. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Two requirements were made as a result of this inspection. The lounges should be redecorated and then organised in a way that promotes their independence and gives them a comfortable place to spend time. It had already been identified by the Manager as work that needed to be carried out as part of the general programme of redecoration. The management of medication should be further improved to ensure that they are given in line with best practice guidelines. Two recommendation were made. These were to undertake the ongoing work to Care Homes for Older People Page 8 of 29 further improve the environment with signage and to offer a more specialist environment to meet the needs of the people living there and the second was to amend the service user guide to clearly identify the service the home offers. 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents needs are identified during a good pre admission assessment, and they are given the necessary information to help them make up their mind. Evidence: There is a service users guide which shows the potential new residents the service that is offered by the home. This is available in all of the residents rooms and before the person decides to move in. Although this contains good information it does not clearly identify the type of care the home provides (the registration category). The care plans contain good comprehensive pre-admission assessments, carried out by the Manager or the senior staff. These are undertaken before the resident is offered a place in the home. Relatives said they were given good information about the home services prior to the admission and had the opportunity to visit the home. Care Homes for Older People Page 11 of 29 Evidence: The are also care management assessments carried out by Social Workers/Care Managers where the funding is being provided by Social Services through their contract system. These are given to the home before the resident is admitted and from these documents an individual care plan is produced. All of the care plans looked at had these in place. Potential residents are encouraged to visit the home before admission. They are able to visit for part of a day and have a meal with other residents and join in any activity event in the home. However They are provided with good information on which they can base their decision to move into the home. All residents have a six-week trial period after which a multi disciplinary review is held with the resident and their representative. Following the review the decision to stay in the home is then made. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home have good care which is well planned and delivered by staff who are sensitive to their needs They receive their prescribed medication in a way that is adequately managed although some improvements are needed. Evidence: Each resident has a care plan which is created from information The care plans were looked at closely as part of the case tracking process and they were completed to a good standard. Relevant risk assessments are completed for, prevention of falls, wound care, moving and assisting, and continence promotion. There is an assessment to look at the residents food and fluid intake and if needed a plan is then drawn up to prevent any further weight loss. Care plans show that when necessary advice is sought from a dietitian and speech therapist. There is an agreement with the local General Practitioners who have the majority of the residents on their list to visit the home weekly for a clinic to see residents identified by the staff. This works well and gives the staff confidence that even small issues can be discussed and advice sought without calling them out. There is good information for the staff to make sure that they know how to meet the individuals needs. Care Homes for Older People Page 13 of 29 Evidence: The care plans are regularly looked at make sure they are still accurate. They are also brought up to date by checking them with the residents and or their relatives or representatives. The care plans showed that the home staff make sure that the residents use NHS services and facilities if they need to. There is a good range of pressure relieving mattresses to reduce the risk of resident getting pressure sores. Records of what the nurses are doing to treat wounds were good with evaluations being dated and signed. Staff get expert advice for wound care for individual residents. The home also gets specialist advice for residents with different conditions for example physiotherapist or occupational therapist. There is a weekly visit from the General Practitioner who is responsible for a number of the residents and this gives the staff the opportunity to have health issues or concerns addressed on a regular basis and review of medication and care can be more pro-actively managed. Medication storage facilities in the home are good and all medicines were securely stored. Some medicines for external use were stored alongside medicines for internal use rather than being stored separately in one of the unused medicine cupboards. Morning medicine administration on the ground floor commenced at approximately 9.15 am but was not completed until nearly 12 noon. The nurse administering medicines was regularly interrupted during the procedure to attend to visiting social workers, for example and lunchtime medication administration commenced at 1.50pm. This means that the interval between the administration of some doses medication may be considerably shorter than prescribed and frequent disruption of the nurse increases the risk of medication errors occurring. Medicine administration record (MAR) charts were looked at on both floors. There were no gaps in the records of medicines administered but the quantity of medication recorded on some MAR charts did not always reflect any medication carried over from the previous month. This makes it difficult to maintain a complete record of medication in the home and to check if medicines are being given as prescribed. In addition, a sample of medicines were counted and checked against the quantity received and the number of doses recorded on the MAR charts and six discrepancies were noted. Handwritten medication entries on MAR charts are witnessed by a second person to confirm their accuracy but some entries amending the dose of medication or Care Homes for Older People Page 14 of 29 Evidence: confirming discontinuation of medication were not always fully signed and dated. One service user was prescribed a course of antibiotics to be given over 5 days. Although only 15 doses were supplied 18 doses were recorded as administered. The MAR chart for one service user contained multiple handwritten entries for mirtazapine on the same page covering different timescales rather than being recorded on a new MAR sheet. This makes it difficult to check that all doses have been administered as prescribed and can lead to medication error. The date of opening of medicines with limited use once opened is not always recorded. This means that there is a risk that the medication may be used beyond the date recommended by the manufacturer and may not be safe to administer. The controlled drug cupboard appears to meet safe custody regulations. There were no discrepancies between controlled drugs in the home and the relevant entries in the controlled drug register and on the MAR charts. All entries in the register were fully completed and controlled drug stock checks are carried out daily. Although audit of the medication system is carried out this is currently not regular enough to help identify any medication problems promptly, nor includes reconciliation of medicines stocks against administration records. Care Homes for Older People Page 15 of 29 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. The residents are given the opportunity to take part in a range of social activities according to their choices and abilities. Residents have choice about their lifestyle in the way they live. Evidence: The home employs an activities co-ordinator who works with the residents to give them opportunities to live more interesting lives. There are a number of activities arranged for the residents, these are recorded separately for individual residents. Both the records and the residents confirmed that they had been offered things to do that they enjoyed. Daily newspapers are provided to keep residents up to date on current events and although not all of them can read them staff help and talk about the articles or show them the photographs. There is a Newspaper group and although this does not always involve many of the residents there is a small core of people who find it useful and so it continued. Some residents enjoy going to the local shops and Get taken in to Wilkinsons and have tea or coffee - go into local shops to buy their own things There is an indoor activities area, which is a heated, wooden building in the garden, and there were items in this area to show that a number of residents had been Care Homes for Older People Page 16 of 29 Evidence: involved in arts and crafts. Examples of residents craft and collage work are displayed on walls in the home. A local priest visits the home each month and provides mass for those residents who want to take part, and a Sister from the catholic church also visits. Records show that residents enjoy this experience. There is an afternoon knitting group and some residents participate in gardening. The new manager is looking at ways of developing the outside area further to give more of the people living in the home more to get involved in and enjoy. The home has an open visiting policy. A number of relatives were visiting during the time of the inspection and said that they could visit at any time and that staff made them feel welcome. The relatives are encouraged to use the dining area to meet with their relatives and can access the beverage making facilities for themselves and their relatives. Menus show a fair range and choice of food. Improvements have been made and when sandwiches are offered their ingredients are now specified. Suppertime meals are now included in the menus. Records of residents birthdays are kept and the cook bakes a cake to celebrate these events. The dining area on the ground floor is well set out to provide a relaxed atmosphere for residents, the dining room on the first floor still needs to be improved in the same way. The manager confirmed that he has plans to carry out the same improvements in this dining room. There are also social activities, which encourage the residents to enjoy food, including the cafe activity when staff set out the dining room as a cafe and dress as waitresses. Residents and visiting relatives enjoyed this and the staff worked hard to make sure it was a successful activity. The activities co-ordinator makes sure that those who do that do not wish to participate in the crafts. Care Homes for Older People Page 17 of 29 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. The home has good complaints and safeguarding procedures and the manager uses these to protect people. Evidence: The homes has a complaints policy which is made available on the residents admission through the service user guide and it on display in the home. The staff are aware of its contents and what to do if they are the person who receives a complaint. There have been three complaints received by the home since the manager has been in post. There are good records to show how these were managed. They had been investigated appropriately and they had been concluded to the complainants satisfaction. The Protection of Vulnerable Adults policy is available and there is a detailed whistle blowing policy. Staff were aware of the procedure to follow and recent improvements have been made in the understanding of the mechanism to follow when an incident occurs which might affect the welfare of he residents. The Manager has been involved in the safeguarding adults alerts made since the last inspection. This is where events occurred which effect the welfare of the residents, which are more appropriately looked at as part of a multi-disciplinary process. It involves appropriate professionals, such as Local Authority social workers who are the Care Homes for Older People Page 18 of 29 Evidence: lead agency for Safeguarding Adults processes, the home and others such as General Practitioners, community nurses, Commission for Social Care Inspection or the Police who meet to look at what needs to be done to protect the residents. The manager is looking at the issues as part of the quality assurance process to identify improvements that could be made around the issues. Safeguarding information files are in place in each of the nursing offices to give staff advice as to how to proceed in the event of an incident occurring. The policy has been signed by all staff to show that they have read it. Care Homes for Older People Page 19 of 29 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. There are good systems in place to make sure that the environment is safe, well maintained and clean for the residents to live in and the staff to work in. Evidence: Appleby care home is a purpose built home of traditional brick and tiled roof construction. It has a smaller foyer so that people have easy entry into the home and then a large foyer with restricted access into the main area of the home. This large area also has the stairs up to the first floor. There is a car park to the front and garden area to the rear. The home is generally clean and tidy, here were particular areas of the home that had an unpleasant odour of urine, these areas were checked again later in the day and the odour had gone. A visiting relative said that the home was always clean and odour free. There is an ongoing redecoration programme and there has been a number of areas that have been improved since the last inspection including improvements to the bathrooms and toilet areas. Resident bedrooms are nicely decorated and furnished with some being very personalised with lots of personal effects and others less so. This depends upon the Care Homes for Older People Page 20 of 29 Evidence: choice and taste of the residents and their relatives. Residents bedroom doors on the ground floor have been painted in different bright individual colors, with brass nameplates to each door. Work is soon to commence to improve the redecoration of the lounges and dining areas. The manager had undertaken an audit of the work that was needed in th home and had a list of work needed. He has taken the necessary steps to get the work approved by the company so that it can start. He was very aware of the way the environment contributes to the welfare of the people living in home and has identified the improvements he wanted to make. The lounges in particular are in need of redecoration and re-refurbishment to make them comfortable places for the residents to spend their time. There has been work to make the home more suitable for the particular client group and there are plans to further enrich the environment. The manager is planning to provide specialist features so that there are more clues for the residents to find their way around and find their surroundings more stimulating. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are well supported by sufficient numbers of trained staff and the the recruitment and selection procedures are in place to ensure the safety of residents. Evidence: There have been a number of recent changes to the staff team and this has included the appointment of a new manager, he has been in post for five months and has worked hard to re-establish the good standards. On the day of the visit the manager was on duty and was working supernumerary, there was also two qualified nurses and six care staff working in the home. The rota shows that there are normally eight care staff on duty. Sickness had resulted in there being two less on duty on the day. A carer who had been contacted on the discovery that there was two carers on sick leave was able to come into the home by 10:00am. The staff on duty at night are two qualified nurses and three care staff. Staff rotas showed that these levels of staff are being maintained except where short notice sickness occurred. Staff recruitment files contained all of the necessary information to make sure that the home can be confident about the identity, previous experience and skills of the staff they recruit. All of the records were completed well with all appropriate checks in place. Good records were in place for the interview process to ensure that they are Care Homes for Older People Page 22 of 29 Evidence: considering each candidate in line with equality and diversity principles. There are more than 63 of the care staff have either already achieved level two or three in the National Vocational Qualification (NVQ) or are currently nearing the completion of the course. This number will include three staff who will have achieved level 3 NVQ. The manager has organised a good programme of training for the staff. This includes the statutory training around moving and handling, fire training, health and safety, first aid and safeguarding. There has also been training provided for end of life, and Deprivation of Liberty. There is a strategy in place for the manager to make sure that all of the staff have the training they need to undertake their role safely. Care Homes for Older People Page 23 of 29 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 is good and focuses on the needs of the residents. The systems for the management of residents finances are good. Supervision of staff helps to monitor the care being given and ensure that staff are competent to do their work. The health, safety and welfare of service users and staff are protected. Evidence: The home now has a new manager in post. He has been in post since February 2009 and has good evidence of the improvements he has made in the way the home is organised. He is positive about the way he intends to improve the care practices to make them more individualised and person centered. Relatives spoken to during the visit were very positive about his leadership. One said that the home is much improved since he became the manager and another said that the manager is very good. He is currently applying to the Care Quality Commission to be the Registered Care Homes for Older People Page 24 of 29 Evidence: Manager. There are clear lines of accountability both in the home and within the company. The manager ensures safe working practices in relation to first aid, food hygiene and moving and handling and takes the necessary action to ensure the health and safety of the service users. Records support this. Formal supervision for care staff is up to date is carried out at appropriate intervals. Senior staff work with carers to carry out informal supervision when delivering care and the qualified nurses are knowledgeable about the skills of the care staff. Staff said that they felt that there had been some issues when things were not the same, but that a good new manager and things have greatly improved and continue to do so. The Manager has recently completed some internal auditing of the quality of the service provided. The company have a very detailed mechanism for central analysis of the home performance and there are a number of triggers used by the company to judge the quality of the service being provided. The Manager facilitates relative and resident meeting, which although they are not well attended, give the opportunity for the home to communicate formally with them. During the visits the relatives visiting were chatting in a very positive way with the staff and all of them were spoken to by the Manager. This gives them the opportunity to approach him informally if necessary. The personnel records kept in the home of residents who get help to manage their finances are detailed, logical and appropriate. Receipts are in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place. The personal allowance records are audited regularly. Utility records in the home were inspected and were satisfactory. The Fire Log book and the Accident book records were also satisfactory. Care Homes for Older People Page 25 of 29 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 29 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 Medicines must be given as prescribed and at the time schedule specified by the prescriber. To safeguard the health and welfare of people living in the home. 01/10/2009 2 19 23 The lounge areas should be redecorated and suitable furniture provided. The residents should have comfortable, well decorated, pleasant places to spend their time. 21/01/2010 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 It is recommended that the service user guide be amended to more clearly identify the type of service provided and the category of care the home is registered for. Staff should sign and date handwritten entries they make Page 27 of 29 2 9 Care Homes for Older People 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 on MAR charts. Each entry should be checked and countersigned by a second person to reduce the risk of error when copying information. A system should be in place to record all medication kept in the home including any medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. A current photograph of each person should be attached to their MAR chart. This helps reduce the risk of medication being given to the wrong person. Guidance on the disposal of unwanted medication should be added to the medicines policy. The maximum/minimum thermometer should be used to monitor the refrigerator temperature to confirm that medicines are stored within the appropriate temperature range and so are safe to use. Regular audit of the medication system should include reconciliation of medicine stock against administration records for a sample of service users to help confirm that people are getting their medication as prescribed. 3 19 It is recommended that the manager pursue the plans he has to improve the home to give a more specialist environment to meet the needs of the people living there. Care Homes for Older People Page 28 of 29 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. 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