Inspection on 19/05/09 for Ar-lyn

This inspection was carried out on 19th May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ar-lyn 09/02/10

Ar-lyn 27/05/08

Ar-lyn 14/06/06

Ar-lyn 24/01/06

Ar-lyn 30/06/05

Ar-lyn 18/01/05

Ar-lyn 28/07/04

Ar-lyn 12/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ar-lyn Vicarage Lane Lelant St Ives Cornwall TR26 3JZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ian Wright     Date: 1 9 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Ar-lyn Vicarage Lane Lelant St Ives Cornwall TR26 3JZ 01736753330 01736759223 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) : Mr Peter Hubert Oxley care home 13 Number of places (if applicable): Under 65 Over 65 13 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Ar-lyn is a large detached property set in its own grounds in the village of Lelant near St Ives. The registered provider is Mr P H Oxley. The home provides personal care for up to 13 elderly people. There are nine single and two shared bedrooms situated on both the ground and first floors. There is a step at the main door; a ramped entrance is provided at a side door. A stair lift provides access to the first floor. The communal rooms are situated on the ground floor. Toilets and bathrooms are located on each floor. There are extensive secluded gardens around the home which house a range of aviaries and small caged animal enclosures. The garden provides seating areas for service users. A copy of the inspection report is available from the homes management or from the Care Quality Commission website. The range of fees at the time of the inspection is £314.25- £375 per week. There are additional charges e.g. for hairdressing, chiropody, Care Homes for Older People Page 4 of 32 Brief description of the care home and newspapers etc. Care Homes for Older People Page 5 of 32 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 key inspection took place by one inspector in eight hours in one day. All the key standards were inspected. The methodology used for this inspection was: (1)To case track three people using the service. This included, where possible, meeting and discussing with the people their experiences, and inspecting their records. (2) Discussion with staff about their experiences working in the home. (3) Discussion with other people using the service, and their representatives. (4) Observing care practices. (5) Discussing care practices with management. (6) Inspecting records and the care environment. Other evidence gathered since the previous inspection, such as notifications received Care Homes for Older People Page 6 of 32 from the home (e.g. regarding any incidents which occurred), was used to help form the judgments made in the report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 32 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 9 of 32 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 provided to people who use the service (e.g. regarding services offered) needs some improvement. For example people who use the service need to be issued with a contract if they are privately funded. This will give them suitable information regarding fees, and should assist in helping them to be more aware of their rights and responsibilities. Assessment processes are satisfactory. This helps to ensure the registered provider checks staff can meet the persons needs before admission is agreed. Evidence: The home has a statement of purpose and service user guide. A copy of the service user guide is issued to people using the service and/or their representatives before the person moves in. The registered provider has a pre admission assessment policy. The registered person Care Homes for Older People Page 10 of 32 Evidence: said senior staff will carry out an assessment for example at the persons home or a hospital, prior to admission being arranged. People are also encouraged to visit the home prior to admission. We inspected the pre admission assessments for the three people we case tracked, and information was satisfactory. People funded by the local authority receive a contract from this organisation. The registered provider said he was revising the homes contract and this was currently with his solicitor. As soon as this process is completed contracts need to be issued to people living in the home. Care Homes for Older People Page 11 of 32 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. Care planning is generally satisfactory although records of external medical intervention needs some improvement; so people can be more assured there is more effective monitoring of their health care needs. People said to us they were happy with the support given to meet their health and personal care needs. Medication is managed to a satisfactory standard, although improvement is required regarding staff training in this area. This will give more assurance to people using the service that their medication is administered by appropriately trained personnel. Evidence: We inspected the files of three people who use the service. A care plan was available in all files inspected. Care plans are accessible to staff. There is evidence care plans are reviewed. Care plans contained a manual handling assessment. People who use the service, who we spoke to, were positive about the care they received. We also spoke to some relatives of people using the service. They were also very complementary about the service provided. Care Homes for Older People Page 12 of 32 Evidence: People who use the service said they were satisfied with the health care support they receive. There is evidence on file that GPs and district nurses have visited, but it was difficult to determine when some people last saw other professionals such as a chiropodist, dentist or an optician. The registered provider said domiciliary visits are arranged for opticians and chiropodists. However, this information should be recorded in individual care files. The care planning system needs to be developed to ensure staff can ascertain when support from external professionals (such as a dentist, optician etc. was last received (e.g. at a glance). Subsequently it can then be easily determined when the person next needs to have support and treatment from these professionals. If the person does not wish to have these services this needs to be recorded. We inspected the medication system. Medication is transferred to dossetts on a daily basis. Technically this is deemed secondary dispensing of medication and should be avoided. However, the registered provider said the practice has been approved by the homes pharmacist. Recording of medication is generally to a satisfactory standard. However one member of staff did omit to sign two dosages of medication, and the registered person said he would discuss this with them. Some controlled drugs are kept in the home, and administration and recording of these are satisfactory. There was only a record that some staff have received training regarding medication. Any staff administering medication need to receive suitable training e.g. from a pharmacist. Guidance regarding this matter was issued by the Commission for Social Care Inspection and is available on the Care Quality Commission website. Care Homes for Older People Page 13 of 32 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. Routines,food and opportunities seem to meet the needs of the people living in the home Evidence: People using the service, who the inspector spoke to, said they could get up and go to bed when they wished, and they said routines in the home are relaxed. We observed a friendly, relaxed atmosphere in the home. People we spoke to said they were happy to organise their own time. For example people can have a daily newspaper and the local library visits the home. A religious minister visits the home so people can receive communion. The registered provider said parties and barbeques are arranged at religious holidays, New Year, and in the summer. The registered provider said a musician visits five times a year and an organist also visits. Informal sing songs are arranged. People get involved in craft work for the local village show. Some people receive regular visitors, and some people go out with relatives. People were very positive about the food provided. The main meal is served at lunch time. There is a wide choice of hot and cold options each tea time. Regular drinks were served to people throughout the days of the inspection. Suitable records are Care Homes for Older People Page 14 of 32 Evidence: maintained regarding food provided. Care Homes for Older People Page 15 of 32 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 and adult safeguarding policies are satisfactory. This should give more assurance that if people living in the home have a concern, the registered persons will deal with the matter appropriately. Evidence: The registered provider has a satisfactory complaints procedure. A summary of this is contained in the homes statement of purpose and service user guide. The registered provider has not received any complaints regarding the home. The Commission for Social Care Inspection, and subsequently the Care Quality Commission have also not received any complaints about the home. Some amendment should occur to the policy, for example, details of the Care Quality Commission should be included within this documentation. This should include details of the commissions national call centre. Details of Cornwall Councils complaints department (or other authority if the person is funded by another body) should be included in the service user guide of the person using the service. If the person is funded by a public authority they have a right to use the statutory complaints procedure of the funding authority,and subsequently they should be made aware of their rights. The registered persons have a satisfactory Adult Safeguarding procedure. The Care Homes for Older People Page 16 of 32 Evidence: Commission for Social Care Inspection and subsequently the Care Quality Commission have not received any safeguarding referrals since the last key inspection. The registered persons also have not referred any safeguarding concerns to Cornwall County Council, and there have not been any safeguarding concerns regarding people living in the home. People who live in the home, and work in the home, who we spoke to said they did not have any concerns or complaints. They said there was no concerns regarding staff attitudes or how staff worked with people living in the home. The registered persons said they had not had to refer any ex staff for inclusion on the Protection of Vulnerable Adults register. (A list of people deemed unsuitable to work with vulnerable adults). Care Homes for Older People Page 17 of 32 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. Ar-Lyn provides a suitable facility for the people living there. Minor improvement is required to ensure there is a lock on bathroom /toilet doors, and hot water temperatures are controlled to prevent scalding. These measures will ensure improvement to bathing facilities. Evidence: The building was inspected. Ar-Lyn provides suitable space for the people accommodated. There are two lounges, one which also contains the dining area. The television is situated in the other lounge. The lounge and other communal areas are all decorated and furnished to a good standard. The home is very comfortable and homely. There is a suitable number of toilets and bathrooms. Both bathrooms do not have locks on the doors, although there is a sign on each one which can be turned over when the facility is engaged. Locks need to be fitted to bathroom and toilet facilities. The hot water from one handbasin was very hot. The registered provider said thermostatic valves are fitted, and would check to ensure why the valve was not working for this wash hand basin. There are suitable kitchen and laundry facilities. The home has a stair lift to assist Care Homes for Older People Page 18 of 32 Evidence: people with a physical disability move between floors within the home. Bedrooms were inspected. The home has 9 single bedrooms and 2 shared bedrooms. Most bedrooms have a lock and each person is also issued with a cashbox so they can lock away any valuables. Two bedrooms have en suite facilities. Decorations and furnishings are to a good standard. People can spend time in their bedroom during the day if they do not wish to sit in the lounge. There is a very pleasant garden which people using the service can use. The home was clean on during the inspection and there were no unpleasant odours in the home. Care Homes for Older People Page 19 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are viewed very positively by people living in the home, however we require the registered provider to review the current staffing levels at night in the home, as we are concerned that there is only a sleep in member of staff. Staff recruitment and training needs significant improvement so suitable checks are performed in regard to new staff, and staff receive appropriate training to do their jobs. Improvement in these areas will ensure suitable checks are performed in regard to new staff, in a timely manner, and staff subsequently receive the training required by law to carry out their duties. Evidence: On the day of the inspection there were two care staff on duty throughout the waking day period (i.e. 07:00 to 23:00.) The registered provider confirmed there is always a minimum of two staff on duty, and this was evident from records inspected. The registered provider and his wife live in the flat above the premises and provide additional support as required. A cook is employed. Care staff carry out any cleaning and laundry. Staff were viewed very positively e.g. as kind and professional, by the people we spoke to. Staff were observed by us to be working calmly and professionally throughout the inspection. Care Homes for Older People Page 20 of 32 Evidence: The registered provider does not provide a waking night member of staff. Support at night is provided by the registered provider and his wife (who is the senior carer) sleeping in. We raised concerns about night staffing arrangements. We are concerned about the support that is available to people using the service if they become unwell or have a fall in the middle of the night. The registered provider said the call bell system is connected to their flat, and they will attend to any calls if the person presses the alarm. The registered person also said if some one falls the owner can hear this from the flat. The registered provider said there had not been any significant incidents occurring, on record, during the sleep in period. There were no recorded incidents in the accident book which have occurred at night. However, we are concerned that people may not be able to obtain urgent medical attention if they are not able to use the call bell, and there are no waking staff on duty to hear them if they are in distress. Although there has not been any incidents of concern, we are worried about the heightened potential risk considering the increasing vulnerability of people now accommodated in care homes. The senior carer said she does carry out regular checks of people at night if she has any concerns, and will sit with them during the night if she has any concerns about a person. The registered provider last reviewed the night staffing arrangements in 2006. We require the registered provider to carry out a further review of the current night staffing arrangement. This should include consideration regarding (a) security (b) health and safety (c) peoples personal care needs such as mobility, continence, current mental state (d) any other issues which may present a risk. Personnel records were inspected for five care staff (i.e. staff on duty during the 24 hour period on the day of the inspection). Personnel records inspected needed improvement. Each file had an application form. We would advise that the form should state clear dates regarding when someone worked for previous employers so any gaps can be identified and checked. There should also be a full declaration regarding medical fitness, as required by the Care Homes Regulations 2001. Two references were not obtained for some of the staff. For example one person employed in April 2009 did not have any written references on file. A reference from the last employer should always be obtained, and if possible a reference from when the person last worked in a caring capacity. Care Homes for Older People Page 21 of 32 Evidence: There was evidence the registered persons had obtained a Protection of Vulnerable Adults First check (POVA First) and a Criminal Records Bureau check (CRB) for the staff concerned. These checks ensure people employed are not on a list which states they are deemed not fit to work with vulnerable people (POVA), or have a criminal record (CRB) which may deem them unsuitable to work in an environment with vulnerable people. However the POVA First and CRB checks for two of the staff were only received after these staff commenced working at the home. The registered provider said the staff were started due to staff shortages. However it is illegal to employ someone who could be on the POVA list, and therefore it is essential that this check is performed before they start work. Similarly staff cannot be left unsupervised unless they have CRB clearance. An immediate requirement was issued for the registered person to ensure suitable pre employment checks are completed for all people subsequently employed. We issued a requirement regarding employment checks previously at the inspection on 27th May 2008, and the evidence suggests this has not been complied with. Staff working in the home have suitable opportunity to obtain a National Vocational Qualification in care. We checked records of training staff have received. By law staff require the following training: (1) Regular fire training in accordance with the requirements of the fire authority. (2) There must always be at least one first aider on duty (at appointed person level). (3) All staff must have manual handling training and regular updates of this (e.g. annually). (4) All staff must have basic training in infection control. (5) Staff who handle food receive food hygiene training. (6) All staff must have an induction and there needs to be a record of this. We checked the records for the five people on duty during the 24 hour period on the day of the inspection. There are records of staff induction, and procedures appear satisfactory. For example new staff shadow more experienced staff when they commence employment. An induction checklist is completed to state staff have been made aware of the homes procedures. Records of other training required by law needs improvement. In regard to the five files inspected: (1) Two people have received manual handling training. (2) In regard to first aid training the registered provider has a current first aid certificate. Three other people have received first aid training but their certificates had expired. (3) In regard to infection control one person had received some training in this area. The registered provider said this issue was covered in the staff induction. (4) There is no record of any fire training being received by these staff. The registered provider said Care Homes for Older People Page 22 of 32 Evidence: this issue was covered in the staff induction. (5) Only one person had received training regarding medication, but this was in 2005. We therefore have renotified the requirement issued at the inspection on 27th May 2008. Care Homes for Older People Page 23 of 32 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 registered provider is deemed by the commission as a suitable person to carry on and manage the home. The monies of people who use the service are managed appropriately. Some improvement is required to quality assurance procedures, for example to ensure there is a policy and system to ensure continuous ongoing improvement of the service. Health and safety standards need some improvement. For example the registered persons need to improve health and safety training and risk assessment (and subsequent preventative measures) regarding legionnaires disease. Improvement in these areas will help ensure there are improved management of the service. Evidence: The registered provider is Mr P.H Oxley. Mr Oxley has owned the home for many years and has suitable knowledge, skills and experience to manage the home. People using the service spoke positively regarding Mr Oxleys management of the home, and said he was approachable and supportive in helping to meet their needs. Care Homes for Older People Page 24 of 32 Evidence: We did not see a quality assurance policy for the home. A policy therefore needs to be developed which accurately reflects the actions taken by the registered provider to review and improve service quality. A survey of stakeholder views e.g. people using the service and their relatives, has been completed in the last year. The results of the survey were positive about the service delivered to people living in the home. People we spoke to were also very positive about the service they received, and the support obtained from the registered provider and his staff. However we are concerned about issues outlined in the staffing section of the report, particularly in regard to recruitment and training where we have had to renotify previous requirements. It is therefore necessary to ensure there are suitable systems in place to monitor and improve these areas. We requested the registered provider send us their Annual Quality Assurance Assessment (AQAA) initially by the end of March. We have sent out a reminder for this but the return has not been received. The AQAA has to be sent to us within the timescale set in the report. We can take enforcement action if this information is not received by us. We assessed arrangements regarding the management of the finances of people who use the service. Records kept for the management of individual monies were satisfactory.The registered provider does not act as appointee for any monies or benefits of people using the service. We have not received any notifications, as required by law, from the registered provider. This includes any untoward events, deaths etc. as outlined in the regulations. We are aware there have been a few deaths of people since the last inspection. It is essential that any matters reportable under the regulations are notified to us in future. The registered provider has a health and safety policy. There is a fire risk assessment. Internal checks on the fire system such as in regard to emergency call points and emergency lighting are completed appropriately. Fire extinguishers and the fire system are serviced by external contractors. Portable electrical appliances, and the electrical hardwire circuit have been tested. There is a valid gas safety certificate. The stair lift has been serviced in the last year. Some testing is completed regarding the prevention of legionnaires disease. However, this matter needs to be covered via risk assessment. The Health and Safety Executive publishes a leaflet regarding this matter, and the Environmental Health Officer may be able to provide further advice. Other health and safety risk assessments are in place. Care Homes for Older People Page 25 of 32 Evidence: As stated in the staffing section, training regarding health and safety issues needs improvement. A current certificate of insurance was displayed in the home. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 18, 19 The registered provider must 01/06/2008 ensure that the home adheres to a robust employment procedure in all instances to protect residents. The registered provider must 01/01/2009 provide staff with suitable training to do their jobs and meet regulatory requirements. Suitable evidence of training must be maintained. Training must include food handling (if food is handled), infection control, first aid, manual handling. Staff must also have training in dementia awareness. 2 30 13, 18 Care Homes for Older People Page 27 of 32 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 1 29 19 All staff must have pre employment checks competed before commencement of employment (e.g. two written references, POVA First checks). A full CRB check must be completed before staff are unsupervised. Other personnel information required by regulation must be maintained. IMMEDIATE REQUIREMENT (Similar requirement issued 27/5/08. Timescale 01/06/08 not met) Action in this area will help ensure people using the service are protected from staff deemed unsuitable to work with the vulnerable. 09/06/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 5 Ensure all people using the 01/09/2009 service are issued with terms and conditions of residency or a contract when they are admitted to the service. Care Homes for Older People Page 28 of 32 This will help to ensure people using the service are issued with information outlining their fees, rights and responsibilities. 2 8 12 Record keeping regarding 01/09/2009 when people last saw a medical professional (e.g. dentist, chiropodist, optician) needs improvement. It should be possible to track when some one had an appointment with each professional. This should help to give people more assurance their medical needs are being monitored and they will receive frequent appointments from these services as required. 3 9 13 Staff administering medication must receive appropriate training to do so, for example from a pharmacist. This will give more assurance to people using the service that their medication is administered only by appropriately trained personnel. 4 21 13 Ensure hot water temperature is controlled. This will ensure there is improved protection from scalding when people are using these facilities 01/09/2009 01/09/2009 Care Homes for Older People Page 29 of 32 5 21 23 There must be a lock on each bathroom and toilet door. This will ensure there is more privacy for people using these facilities 01/09/2009 6 27 18 The registered provider must review staffing levels at night. This will ensure the registered provider checks there are satisfactory numbers of staff on duty during the night so peoples care needs are met 16/07/2009 7 30 18 Staff must receive training required by regulation, as outlined in the body of the report. (Timescale 01/01/09 not met, Second Notification) This will help ensure staff are equipped with the skills and knowledge to carry out their roles. 01/09/2009 8 33 24 The registered provider 01/09/2009 must complete and return the homes Annual Quality Assurance Assessment within the timescale set. It is a legal requirement that this is returned on an annual basis to the commission. Events notifiable by regulation (e.g. untoward incidents, deaths) must be reported to the Care Quality Commission. 09/06/2009 9 33 37 Care Homes for Older People Page 30 of 32 This will ensure the Commission is informed of all reportable incidents 10 33 24 The home must have a 01/09/2009 quality assurance policy, and improve systems to ensure ongoing improvement of the service. This will help ensure there is ongoing improvement (e.g. in regard to staff recruitment and training procedures) at the service. 11 38 13 The registered provider must have a policy and risk assessment regarding the prevention of Legionella. This will help to ensure suitable preventative measures are in place regarding legionnaires disease. 01/09/2009 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 16 Ensure information regarding social service department / health department complaint procedures are included in individualised service user guides. This will help to ensure people, funded by these authorities, are aware of their statutory rights to use these procedures if they have a concern or complaint. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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