Inspection on 03/06/09 for Ashleigh House

This inspection was carried out on 3rd June 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Key inspection report Care homes for older people Name: Address: Ashleigh House 460 North Road Darlington Co Durham DL1 3AF     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: Rachel Martin     Date: 0 3 0 6 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: Ashleigh House 460 North Road Darlington Co Durham DL1 3AF Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Minster Care Management Limited Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 1. The maximum number of service users who can be accommodated is: 41 2. The registered person may provide the following category of service only: Care Home only- Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category, Code OP, maximum number of places 41. Dementia, Code DE, maximum number of places 41. Mental Disorder, excluding Learning Disability or Dementia, Code MD, maximum number of places 1. Date of last inspection 41 1 0 Over 65 41 1 41 Care Homes for Older People Page 4 of 29 Brief description of the care home Ashleigh House is owned by Minster Care Managerment Limited, who became the registered provider for the home in January 2009. The home is registered to provide care and accomodation for up to 41 people, whose primary needs are those of older people with dementia. Ashleigh House is an ex-local authority building, located in the Harrowgate Hill area of Darlington. It is situated on a main road, with good transport links and a small car parking area at the front of the home. The home has two floors, although only the ground floor is currently in use. There is a small enslosed courtyard and garden areas to the back of the property. 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: 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 an unannounced inspection of Ashleigh House. The site visit took place on the 3rd June 2009 and was completed by one inspector. The inspection was scheduled approximately six months after the registration of the homes new owners. During our visit we spent time talking to the manager and other staff, including the activities coordinator, cook and a district nurse who visits the home. We also talked to some of the people who live at the home and spent time observing the care and support people received. For example, we spent time sat in the lounge and observed the lunch time meal in the dining room. The manager showed us around the building and we looked at some of the records that are kept by the home. Before we visited the home we sent the manager a self assessment to complete and return to us. This was returned later than we had originally asked for it, but the manager did contact us to ask for an extension. We also sent out some surveys for Care Homes for Older People Page 6 of 29 people living at the home, the homes staff and professionals who work with the home to complete. However, none of these were completed and returned to us. We have reviewed our practice when making requirements, to improve national consistency. In future, if we have to repeat a requirement at the next inspection, it is likely that enforcement action will be taken. 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: Despite policies, procedures and staff training being in place, safeguarding incidents havent always been recognised and reported to the appropriate organisations. This means that people may not always have been fully protected or have received the help they needed. Ashleigh House is an old local authority building and now needs total refurbishment in order to provide a pleasant and comfortable place for people to live. For example, the bathrooms and toilets have old fittings which look worn, flooring that has gaps and is lifting up from the floor and there are unpleasant smells that cleaning does not get rid of. The majority of the soft furnishings and fittings in the homes lounge and other communal areas look marked and worn and the decor in the corridors is mismatched and depressing. Staff dont all currently have the up to date training they need to do their jobs properly. We also found that staff often start work after a check of the protection of vulnerable adults list (a list of people who are considered unsuitable to work with vulnerable people) while they are still waiting for their full criminal records bureau Care Homes for Older People Page 8 of 29 (CRB) disclosure to come back. This is allowed, but only in exceptional circumstances and when appropriate supervision arrangements are in place. There was no evidence to show that the appropriate supervision arrangements were being put in place. The home has very low occupancy levels and has not had any new admissions or enquiries for a long time. It also needs a significant amount of financial investment to improve, which means that its future is still uncertain. 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. People are able to visit the home and have an assessment of their needs before moving in. This helps people decide if Ashleigh House can meet their needs and is a place they want to live. Evidence: Since the last inspection no new people have come to live at Ashleigh House. This was confirmed by the homes manager. At the key inspection completed in February 2008 we looked at the assessment records for the last three people who had moved into the home. These records showed us that people had their needs assessed by the manager before they moved into the home. Information about peoples needs had also been obtained from other professionals involved in peoples care (such as social workers) before admission. Discussions with the manager confirmed that she would gather information to make sure that Ashleigh House could meet peoples needs, before they came to live at the home. She also confirmed that people can come and look around the home whenever they want, to help them decide if they want to live there. Care Homes for Older People Page 11 of 29 Evidence: Ashleigh House does not provide specialist intermediate care. 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. Each persons needs are recorded in their care records and staff treat people well. Peoples health needs are met by health care professionals who visit the home regularly and safe medication procedures are in place. Evidence: Each person who lives at Ashleigh House has a file, which contains their assessments, risk assessments, care plans and care records. The care records of two people were inspected and we spent time observing the care people were given. The care records we looked at were completed reasonably well. The plans gave staff information about the care people needed, although more detail about peoples abilities and preferences could still be developed further. Each care plan and risk assessment was reviewed monthly to make sure the information was still relevant and reflected the persons needs. However, although the reviews were being completed regularly, sometimes changes in peoples needs hadnt been recorded in their care or intervention plans. For example, one person had been visited regularly by the district nurses to treat a sore heal. However, their records Care Homes for Older People Page 13 of 29 Evidence: didnt contain any information about what was being done to prevent further skin damage (such as the use of a special mattresses), didnt show that the sore had now healed and the persons pressure care risk assessment didnt recognise them as being at risk of pressure damage. The care records did show that people had regular access to medical and other social care professionals. The records showed that people had recently seen their doctor, chiropodist, district nurse and dietitian. The home has in place arrangements with a dentist and optician, so that people get regular dental and eye checks. We spoke to a district nurse who visits the home. They told us that they had no particular concerns about the care people receive at Ashleigh House. Observations made during the inspection showed us that staff interacted well with the people they were caring for, chatting with them and asking what they wanted. Residents seemed at ease with the staff and staff made sure that personal care was carried out in private. On the day of the inspection people looked clean and tidy. The lunchtime medication round was observed. A senior carer (who has been trained in the safe handling of medication) gave out the medication and signed the medication administration record (MAR) appropriately. We looked at the arrangements for the storage of medication. Medications appeared to be stored safely in the treatment room, with a fridge available for cool storage when needed. The manager does regular checks to make sure that medication is being stored and recorded properly. We looked at a selection of MARs and found that they were up to date and accurate. We also checked the controlled drugs register and a selection of controlled drugs that are kept in the home. We found that these records were correct too. A lot of people living at the home need help to manage their medication and some are unable to ask for pain relief if they need it. It would be good practice to have a care or intervention plan in place that provides staff with detailed information about the assistance people need with their medication and any special requirements that they need to be aware of. For example, if the person can ask for pain relief independently and how decisions about medication prescribed on an as required basis are made for people who are unable to request it for themselves. Care Homes for Older People Page 14 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. People are given opportunities and encouragement to take part in social activities and events. People are given some choices about daily life, such as what meals they want, what activities they take part in and simple routines such as getting up and going to bed. Evidence: The home employs a person who organises activities and social events four days a week. This person is well thought of by staff, the residents and their relatives. Activities include trips out for meals, events in the home, such as family meals, Chinese takeaways, reminiscence videos and quizzes, crafts and games. During the morning and afternoon of our visit we saw that people sat around a table in the lounge, where staff encouraged them to colour in pictures and make a scrapbook. Old time music was playing and another person was sat in the entrance hall reading the papers. The manager and staff confirmed that recent trips out have included the local pub, shopping and lunch out. A Roman Catholic priest visits the home for prayers each week and a Church of England service is held once a month. The manager and staff confirmed that visitors can still come to the home at anytime and there are no unnecessary restrictions on visiting. Where possible relatives are Care Homes for Older People Page 15 of 29 Evidence: encouraged to join in with activities, for example during a recent wine and cheese evening and a BBQ which were advertised in the homes newsletter. On 15th June the home is holding a childrens day with local school children visiting the home and a traditional Punch and Judy show. Observations made throughout the visit showed that staff tried to communicate with people and offer choices around meals and activities. However, communication with some people in the home is difficult, due to the level of dementia they have. Peoples care records and plans contain some information about their wishes and preferences to help staff give support in the way people want, but this could be developed further. We observed the lunchtime meal on the day of this inspection. The choice of food at lunch time was soup and a bread roll or a selection of sandwiches, pork pie and crisps, followed by pineapple upside down pudding and custard. According to the menu displayed in the dining room the evening meal was chicken curry and rice or egg and chips, followed by vienetta ice cream. We heard staff ask people what they wanted for lunch during the morning and the activities coordinator told us how they had recently changed the menus, with the help of the people who live at the home. For example, they found that people preferred and ate more if the bigger meal was served in the evening, with lighter options served at lunch time. Snacks and drinks are provided mid morning, mid afternoon and at supper time. We saw the morning tea and coffee being served, with a home made sponge cake served as a mid morning snack. The food looked appetising and the portion sizes varied according to different peoples appetites. One person had seconds of soup and a second bread bun, another was offered cream or ice cream as an alternative to custard with their pudding. Someone else was offered banana and custard or jelly as an alternative. People were given a cup of tea with their meal, but were not routinely offered a glass of juice or water. However, one person had a beer with his meal, while someone else had a glass of sherry and lemonade. Staff sat next to people who needed assistance and helped to feed people in a pleasant way. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite policies, procedures and staff training being in place, incidents havent always been reported to the appropriate organisations. This means that people have not always been fully protected. Evidence: Ashleigh House has in place a complaints procedure. The manager told us that there have been no complaints made to the home since the last inspection. There have been no concerns or complaints made directly to us since the last inspection. We have been informed of one safeguarding incident that has occurred in the home since the last inspection. The manager had referred this to the local authority and had notified us about it. Because the incident involved a staff member the home used its disciplinary procedures and informed the independent safeguarding authority (who maintain a list of people who are unsuitable to work with vulnerable adults). This incident was handled appropriately and records showed us that staff have received training on recognising and reporting abuse. However, we found records of some incidents that had occurred in the home that had not been reported or handled appropriately. These incidents should have been reported to the local authority as safeguarding events and we should also have been told about them, but this had not happened. Following discussions with the manager it appeared that the training staff had received on abuse did not cover what to do if one resident was abusive towards another. This meant that staff didnt fully understand Care Homes for Older People Page 17 of 29 Evidence: these issues and that important incidents werent always recognised as safeguarding issues and were not always being reported appropriately. Care Homes for Older People Page 18 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ashleigh House needs a total refurbishment in order to provide a pleasant and comfortable place for people to live. Evidence: We looked around the building with the manager. Ashleigh House is showing its age and is in need of complete refurbishment. The homes toilets, bathrooms and shower rooms are in particular need of attention. For example, they have old fittings which look worn, flooring that has gaps and is lifting up from the floor and there are unpleasant smells that cleaning does not get rid of. The bathrooms and toilets are not pleasant places for people to use and staff we spoke to commented that they would not like to use them themselves. We saw that peoples bedrooms had recently been redecorated and had peoples personal possessions in them. People had their pictures, ornaments and small pieces of furniture around them, which made the rooms personal and homely. However, some of the furniture provided by the home in peoples bedrooms was old and should be replaced. The majority of the soft furnishings in the homes lounge and other communal areas looks marked and worn. For example, the chairs and carpets in the lounge look marked and grubby, despite attempts to clean them. The cupboards and worktop in Care Homes for Older People Page 19 of 29 Evidence: the dining room are damaged. The homes kitchen is old and the environmental health officer has recommended that it be refurbished. The homes lift is currently in working order, but due to its age and the difficulty getting spare parts the lift engineer has recommended that it is replaced. The highly patterned carpets throughout the homes communal spaces are not very appropriate for people with dementia, who may experience increased disorientation or visual disturbances because of them. The homes exterior paintwork is also in need of attention. Any redecoration and refurbishment of the home should take account of the needs of people with dementia and the research that is available in this area. This is important, so that Ashleigh House provides a good standard of accommodation, which meets the needs of the people living there. We found that there were domestic staff on duty, who clean the building and do the homes laundry. The home was reasonably clean and tidy. However, because of the age of the building and standard of decoration parts of the home still looked grubby. Staff wore aprons and gloves while carrying out personal care tasks. The manager and staff confirmed that there are plenty of gloves, aprons and other essential equipment available. The majority of care staff have completed infection control training, although some domestic staff have not. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate numbers of staff are on duty and staff dont work in the home unless checks have been carried out. However, staff dont all currently have the up to date training they need to do their jobs properly. Evidence: The homes new owners have started to recruit new staff, which is making it easier to cover shifts and possible to use fewer agency staff. Staffing levels seemed appropriate during our visit. For example, the lounge always had a member of staff there to supervise people, people appeared to get the assistance they needed and the staff rotas showed that a sufficient number of staff were usually on duty. Rotas show plenty of staff to cover domestic duties. We looked at the recruitment records for two staff who have been recruited since the last inspection. These showed that two references and a PoVA First check (this is a check of the Protection of Vulnerable Adults list, which lists people who are considered unsuitable to do care work) had been obtained before the staff started work. However, no formal supervision arrangements were being put in place while these staff awaited the return of their full criminal records bureau (CRB) disclosure. We reminded the manager that staff should only start work after a PoVA First check in exceptional circumstances and that suitable supervision arrangement must be in place. It is much preferable for a full CRB disclosure to be completed before staff start Care Homes for Older People Page 21 of 29 Evidence: work. We looked at a selection of staff training records and spoke to the manager and staff about training. One recently recruited member of staff had completed a two day induction course with a training company. This had covered all of the basic training that they needed to do their job. Other recent training had included manual handling, medication and fire awareness. However, some staff are not up to date with their manual handling and food hygiene training. Seventeen of the homes twenty-one care staff have completed a national vocational qualification (NVQ) in care. The manager undertakes regular supervision sessions with care staff. We looked at the records of staff supervision and appraisal and found that staff meet regularly with the manager to discuss their work. The manager told us that she operates an open door policy so that any problems that arise between supervision sessions can be discussed. However, all staff supervision and training records are currently stored together in large communal files. This is not ideal for maintaining confidentiality. Ideally each person should have their own individual records that are stored securely. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager runs the home in a safe and satisfactory way on a day-to-day basis. However, the home has very low occupancy levels and needs significant financial investment to improve. This means that its future is still uncertain. Evidence: Since the last inspection the home has been purchased by a new owner. The new owner is Minster Care Management Limited and they are registered with us. The registered manager is the same person as before. The homes manager is registered with us and is suitably qualified and experienced. She is being supported by an area manager who visits the home regularly. At the time of this inspection the home only had ten residents and there have been no new admissions or enquiries for a long time. The home also requires significant financial investment to improve the building and facilities that are provided. This raises concerns about the homes financial viability and future. Care Homes for Older People Page 23 of 29 Evidence: The manager uses a quality assurance system that was put in place by the homes previous owners. She carries out regular checks on the homes paper work systems and the building to make sure things are being done and that Ashleigh House is a safe place to live and work. We saw records of these checks during our visit. The home used to hold regular resident and relatives meetings, but has given these up due to low attendance. Instead the manager has an open door and encourages people to raise anything with her whenever they want to. They also try to involve the residents in decisions about the home, such as decorating, changes to the menus and activities. Ashleigh House does not look after peoples bank accounts for them. This is done by peoples relatives, solicitors or the local authority. However, the home does help people manage the small amounts of personal money that they may need on a day to day basis. Money is stored in a locked safe. Records and receipts for financial transactions are kept. We checked the records for three people and found them to be accurate and up to date. The manager checks these records regularly. This helps to make sure that peoples money is being used safely and appropriately. We checked a number of maintenance records during our visit. These showed that the servicing and maintenance of the homes equipment is up to date. For example, inspections of the homes lifting and electrical equipment had recently been completed by the homes new owners. The maintenance person carries out regular checks to make sure that the homes fire alarm is working and that hot water is supplied at safe temperatures. Records confirmed this. However, we found that in one room the hot water was a couple of degrees above what is considered a safe temperature and that the last test had identified this in a number of rooms. Records showed us that other regular checks are also carried out. For example, the nurse call system, emergency lighting and automatic door closures. Care Homes for Older People Page 24 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 25 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 1 19 23 The home requires major 31/10/2009 refurbishment and investment to make sure that the people living and working in the home have a safe, pleasant and well maintained place to live and work. See the accompanying recommendations for further information. People do not currently have a pleasant place to live and work. 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 18 13 All incidents of abuse or potential abuse must be reported appropriately through local safeguarding procedures. If incidents are not reported the appropriate investigations and interventions will not take place. People will not be adequately protected. 31/07/2009 2 29 19 Appropriate supervision and monitoring arrangements must be put in place when 31/08/2009 Care Homes for Older People Page 26 of 29 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 staff start work on a PoVA First check, while awaiting the return of their full CRB. Staff should only start work on a PoVA First check in exceptional circumstances. Adequate safeguards must be put in place to protect people until an enhanced CRB has been obtained. 3 30 18 Staff must be adequately trained to do their jobs. Staff dont all have the up to date training they need to do their jobs safely. 4 38 13 All parts of the home to 31/07/2009 which residents have access should be kept free from hazards to their safety where hot water temperatures are found to be above 43 degrees Celsius action must be taken to ensure that hot water is maintained at safe temperatures. People with dementia may be at risk of scalding if hot water is not maintained at safe temperatures. 30/09/2009 Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 More detail about peoples individual abilities, wishes and preferences should be included in peoples care records, to help make them more personal and person centred. Where people need assistance and support to manage their medication, medication care / intervention plans should be put in place. This would provided staff with information about peoples individual needs and any specific issues they need to be aware of when administering that persons medication. It is recommended that people are offered and encouraged to have a glass of juice or water at meal times, as well as a cup of tea. This will help people to drink more and prevent dehydration. All staff should receive training on safeguarding and abuse that enables them to recognise and report any incidents or suspicions of abuse appropriately. It is recommended that the homes kitchen be refurbished as recommended in the environmental health officers report. It is recommended that the recommendation made in the lift service report is acted upon (i.e. that the current passenger lift be replaced with a new version). This is especially important if occupancy levels increase and residents start to live on the first floor again. It is recommended that a full programme of re-decoration is carried out. It is recommended that the homes furniture and soft furnishings are replaced. It is recommended that the broken worksurface and cupboard door in the dining room are replaced. It is recommended that the highly patterned carpets in the homes communal areas be replaced with a more appropriate choice for people with dementia. It is recommended that the homes bathrooms and shower rooms are refurbished and redecorated. The registered provider should inform us of their plans for ensuring the homes future financial viability. 2 10 3 15 4 18 5 19 6 19 7 8 9 10 19 19 19 19 11 12 19 34 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. 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