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Inspection on 02/07/09 for Astley House

Also see our care home review for Astley House for more information

This inspection was carried out on 2nd July 2009.

CQC found this care home to be providing an Poor 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides prospective residents with whatever length of time they need to decide if they wish to live at the home. Detailed information is collected about a new resident to help ensure staff can provide the necessary levels of care and support to the person. People living at the home receive a very good standard of care but it does not respect their rights. There are good arrangements for people to maintain contact with their family and friends. People have the opportunity to follow their religion if they wish to. There is a very good standard of record keeping.

What has improved since the last inspection?

The freezer has been replaced. The level of staff training continues to improve with 99% of staff having achieved National Vocational qualifications at level 2.

What the care home could do better:

The service user guide should be made available in a format for people with memory loss. The environment should be made suitable for people with memory loss in order to maintain their independence as far as possible. The personal histories and preferences of people living at the home should be used to help create a meaningful activities programme for the individual if they wish to become involved. The rights of people living at the home must be respected. People living at the home receive a good standard of care but it does not respect their rights. Advice must be obtained from the community pharmacist about methods of administration of medication when the person is unable to swallow. Special diets should be catered for in an appropriate way with food for the person not all being blended together. Advice should be taken or more training about food preparation and specialized diets should be obtained. Food portions should be reviewed especially for meat to at least 4ozs per serving and advice taken about nutritional value and content of food. The home should continue to explore ways of communicating and engaging with people with memory loss by keeping up to date with latest dementia care research and best practice. More opportunities should be provided for people living in the home to go into the community. More effective odour control should be provided in the sitting room. The chairs in the sitting room should be cleaned in the interests of health and safety. The bath panel in the upstairs bathroom should be replaced in the interests of health and safety. Staffing levels must be kept under review to ensure that the liberty and choice of people living at the home are not restricted. A staff training and development programme must be maintained to ensure that staff training is kept up to date and to ensure all the needs of people living at the home are understood by staff.

Key inspection report Care homes for older people Name: Address: Astley House 1/2 Hartley Gardens Seaton Delaval Whitley Bay Tyne & Wear NE25 0AB     The quality rating for this care home is:   zero star poor 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: Karena Reed     Date: 0 2 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 31 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 31 Information about the care home Name of care home: Address: Astley House 1/2 Hartley Gardens Seaton Delaval Whitley Bay Tyne & Wear NE25 0AB 0191-2377209 F/P01912377209 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs M Powers,Mr R Powers care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 15 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 5 Dementia, Code DE, maximum number of places 10 Date of last inspection Brief description of the care home Astley House is a large, detached house that used to be the village police station. The home is situated in a residential area in the village of Seaton Delaval, it is close to local shops, doctors and public houses. It is also very close to the Northumbrian coast and the nearby countryside. It is registered to provide personal care to fifteen residents, the categories of registration are for five older people and ten older people with memory loss. Bedrooms are all for single occupancy, some are situated on the ground Care Homes for Older People Page 4 of 31 Over 65 0 5 10 0 Brief description of the care home floor. There is a large lounge and a separate dining room that is also used as a quiet area when meals are not being served. Both living rooms overlook a well- maintained garden to the front of the building. There are two bathrooms both containing equipment that can be used to assist with getting in and out of the bath. A Statement of Purpose and service user guide are available for prospective residents and their relatives to give them information about the services provided by the home and the relevant charges. Fees payable for living at the home at the time of inspection in July 2009 are 441 pounds per week. Additional charges are payable for hairdressing, private chiropody and personal newspapers. Care Homes for Older People Page 5 of 31 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: zero star poor 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: The quality rating for this service is 0 stars. This means that the people who use the service experience poor quality outcomes. 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. How the inspection was carried out. Before the visit: We looked at information we have received since the last inspection in July 2007, how Care Homes for Older People Page 6 of 31 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 and the views of people who use the service and their relatives, staff and other professionals. The Visit: An unannounced visit was made on July 2nd 2009. During the visit we talked with people who use the service and staff. We looked at information about the people who use the service and how well their needs are met.We looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for,looked around the building to make sure it was clean, safe and comfortable and checked what improvements had been made since the last visit. We told the proprietor and manager what we found. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The service user guide should be made available in a format for people with memory loss. The environment should be made suitable for people with memory loss in order to maintain their independence as far as possible. The personal histories and preferences of people living at the home should be used to help create a meaningful activities programme for the individual if they wish to become involved. The rights of people living at the home must be respected. People living at the home receive a good standard of care but it does not respect their rights. Advice must be obtained from the community pharmacist about methods of administration of medication when the person is unable to swallow. Special diets should be catered for in an appropriate way with food for the person not all being blended together. Advice should be taken or more training about food preparation and specialized diets should be obtained. Food portions should be reviewed especially for meat to at least 4ozs per serving and advice taken about nutritional value and content of food. The home should continue to explore ways of communicating and engaging with people Care Homes for Older People Page 8 of 31 with memory loss by keeping up to date with latest dementia care research and best practice. More opportunities should be provided for people living in the home to go into the community. More effective odour control should be provided in the sitting room. The chairs in the sitting room should be cleaned in the interests of health and safety. The bath panel in the upstairs bathroom should be replaced in the interests of health and safety. Staffing levels must be kept under review to ensure that the liberty and choice of people living at the home are not restricted. A staff training and development programme must be maintained to ensure that staff training is kept up to date and to ensure all the needs of people living at the home are understood by staff. 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 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate procedures in place to ensure that prospective residents are making an informed choice about living at the home. Good arrangements are in place for assessing the needs of people before they are admitted into the home. Evidence: The Statement of Purpose and service user guide were examined. They contained the necessary information as required by the Care Homes Regulations 2001. They were not written in a way that might support people with dementia care needs. In surveys received people who live at the home and their relatives felt that they got enough information from the home and other agencies to make a decision about whether to use this home. One person living at the home commented;My family gathered information from the internet before we came to look around. Records for four people who live at the home showed that when they were admitted to the home an assessment of their care needs had been carried out before their Care Homes for Older People Page 11 of 31 Evidence: admission. A copy of the social services assessment and care plan for each person had been obtained before they moved into the home. The manager or senior staff carry out a pre-admission assessment to ensure that it can meet each individuals needs. The person living at the home and relevant people are involved in the assessment.These initial assessments are used to create care plans. The home currently does not encourage the independence of the person who is suffering from memory loss. There were no meaningful photographs or pictures to aid reality orientation. The decoration around the building does not aid reality orientation. The home is not associated with national dementia care groups to keep up to date with current best practice People have the opportunity to visit the home as often as they need in order to decide if they want to live there. A prospective resident may come for meals, have overnight stays and be introduced to other people who live at the home at a pace suitable to the individual. Care Homes for Older People Page 12 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are good arrangements in place to ensure the health and personal care needs of people living at the home are met by staff,this is not always carried out respecting the rights of the individual or promoting their dignity. Evidence: After a person has moved into the home a care plan is designed around their assessed needs so that staff know how to provide the right amount of support. Care plans detail the night time needs of people living at the home. Care plans cover areas such as continence, personal hygiene, mental health and social care needs. The sample of care plans examined were written in a respectful way but they did not promote the dignity of all people living at the home. The sample showed that all care plans had been evaluated regularly. One of the care plans examined provided evidence that a person living at the home was confined to their bedroom in the evenings when staff were busy and unable to provide supervision in communal areas such as the lounge. The persons care records showed that they had agreed to this, but this restriction on their liberty and Care Homes for Older People Page 13 of 31 Evidence: movements around the home is not acceptable. A further safe guarding meeting will need to take place to discuss these actions. Records were in place to show how the medical and nutritional needs of people living at the home were being met. Care plans recorded information about their social and leisure needs. Health care records were available to show they are supported to have access to health care services such as G.Ps,dentists,district nurses and continence advisors. A staff member commented;In my experience outside assistance when needed, isnt always available as promised from care management or the mental health team. A safe guarding investigation had taken place the previous September due to an allegation about the poor care of a physically frail person living at the home. The allegation proved to be unfounded. As a result of the investigation the home did obtain some further advice from the community nursing service about other more specialist equipment to help with the moving and assisting needs of the person confined to bed. Some people living at the home,due to higher levels of dependency,were assisted to complete surveys by staff. In order to maintain independence if people at the home are unable to complete surveys without a lot of support,assistance should be supplied by their relatives where possible.Comments include: The home makes me feel safe and lets me do things I enjoy, and staff give me help when required. All of the girls-staff are very good. They are helpful-as I depend on them to get around. The home makes sure I am safe and well cared for. I know someone is always there to help me when needed. Everyone helps me, nothing is ever a bother. Staff provided the following comments, however the care practices described did not support these comments. Comments include: All residents needs are met and their safety is assured. Staff support residents well. Care Homes for Older People Page 14 of 31 Evidence: The needs of the residents always come first. Astley House treats everybody as individuals and helps each resident with their own personal needs as well as making them safe and welcome. The home has a medication policy that is available for staff to read. All medication is stored in an appropriate locked cabinet to which only senior staff have access. All staff administering medication have received accredited training. A staff member commented:I have just finished another course,(because we are always doing them), Safe handling of medicines. Medication and records for 2 people living at the home were checked and all were in good order. One record showed that a person who was unable to swallow was prescribed medication in tablet form. The G.P had given permission that the medication should be dissolved in the persons breakfast as they were unable to swallow the tablets or capsules should be opened by staff and mixed with jam. This is not good practice and the home must seek advice from the community pharmacist about medication being dispensed in other more appropriate forms for a person that is unable to swallow. Care Homes for Older People Page 15 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have limited opportunities to make choices about activities, daily routines and menus so that they may lead a lifestyle that matches their social care needs. Evidence: Residents files contained personal histories and entries about their likes and dislikes and preferences regarding daily life. Comments include:I have just celebrated my 80th birthday,it was a lovely day, one of the best days of my life. There is a limited programme of activities available to people living at the home and these include;memory games,old time music,chair aerobics,sing a long,hairdressing and pamper sessions, a minister also visits. A person living at the home commented:I enjoy Father Phils visits,he comes once a month. There is a large well tended garden that people can sit in if they choose to.There was little evidence of outings and people visiting the local community. One person said ;there should be more outings from the home. There was also little evidence to show that residents personal life histories were used Care Homes for Older People Page 16 of 31 Evidence: to ensure activities were more individual and person centred. They could help staff to ensure that social and cultural needs of people living at the home are given as much attention as their health and personal care needs. This would also make reminiscence more personal and help staff engage and retain the involvement of people living at the home. At the time of inspection people a number of people were sitting asleep. Staff ask each person about their wishes, interests and choices.Comments include:I am lucky as I also get a lot of visitors and they are made to feel very welcome. I still have my glass of sherry every day, just as I did at home. No one makes me do anything I dont want to do. Staff have had training about memory loss. This training should help to ensure that people living at the home are given more choice in order to keep some control in their lives. A four weekly menu is used in the home. The home does provide for special diets and dietary requirements. Discussion highlighted that a person who was unable to swallow had their food pureed, but it was all pureed together, rather than each item of food being blended separately and portioned appetizingly on the plate. Examination of the freezer showed that 2 pound joints of meat such as beef were being used to feed 11 residents on Sundays, this is not in line with dietary advice that each person should have at least 4ozs of meat per serving. The menu did not advertise the substantial alternative available that day. There was very little evidence of fresh vegetables, a turnip was available and potatoes. There was basic margarine,long life milks and frozen vegetables available rather than fresh vegetables, fruit and milk. It was noticed that quantities of food prepared such as scones did not allow for a second portion per person. Comments included that the food was alright. On the day of inspection lunch served was; savoury chicken, potatoes and peas followed by rhubarb and custard. Tea was to be chopped pork sandwiches, pate on toast, scones and biscuits. Care Homes for Older People Page 17 of 31 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. The home has a complaints and protection system, which helps to protect people who live at the home. Evidence: The homes complaints procedure is given to new people as they move into the home. The procedure assists and supports them and their relatives to bring any matters to the attention of staff outside of the home in case they felt uncomfortable bringing any complaints or concerns to the attention of staff within the home. There is a complaints procedure on display within the home for the use of residents and their relatives. The home keeps a record of complaints. There have been no complaints received about the home since the last inspection. There have been two safe guarding incidents using the council safeguarding strategy. One has been investigated and the allegation was not upheld. Another safeguarding is still ongoing. Surveys returned stated people living at the home or their relatives knew how to complain if they needed to. Comments from people living at the home include: I feel that the home always does the best for both staff and residents and therefore I dont feel that there is anything that could be bettered. Care Homes for Older People Page 18 of 31 Evidence: The home has a copy of the Local Authorities Vunerable Adults procedure. This provides staff with clear guidance on how to deal with adult protection concerns. Staff training about Protection of Vulnerable Adults, the local authority multi-agency training,is planned to be up dated. Staff have received training about behaviour that may be difficult to work with, this should help them understand the different support needs of individuals. Staff have received training about dementia care to give staff more insight into the needs of people with memory loss. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and safe environment for those living there, but the standard of hygiene could be improved. Evidence: The home is accessible to the local community and situated in a residential area in the centre of the local village. It is very near to the sea front and coast. A maintenance person is available part time at the home. There is an on going programme of decoration and refurbishment around the home. People living at the home all enjoy their own bedrooms apart from a married couple who share a bedroom, they also have a separate sitting room which they can use if they wish to. Peoples rooms were comfortable and personalized with some of their own belongings. Comments from people living at the home include: I like the way my bedroom is decorated. I can use my own duvet covers from home. I am happy with my room. Overall the home is a clean, pleasant and friendly home to work in. The home has an appropriate amount of sitting, recreational and dining space. Care Homes for Older People Page 20 of 31 Evidence: Furnishings and fittings were domestic in design. Some chairs were soiled and required cleaning. More effective odour control was required in the sitting room. The bath panel was cracked in the upstairs bathroom. There was emergency lighting around the home. The washing machine has the specified programme to meet disinfection standards. Care Homes for Older People Page 21 of 31 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. There are not sufficient staff to meet the dependency levels of people living at the home,they are appropriately recruited.Despite staff training, person centred care respecting the rights of the individual was not always provided to people living at the home. Evidence: Examination of staff rosters and discussion with the proprietor,manager and members of the staff team showed that staff numbers are as follows: 3 staff members 8.00am-4.30pm 2 staff members 4.30pm-10.00pm 2 staff members 10.00pm-8.00am These numbers include the manager. The proprietor is also available at the home two days of the week. There is a senior staff member on each shift when the manager is not on duty. Other members of staff are employed for duties such as cleaning, food preparation and maintenance work. Care Homes for Older People Page 22 of 31 Evidence: Due to the high dependency levels of some people living at the home staffing levels did not appear adequate in the evening to ensure the safety of all the people living at the home and to make sure all their needs were being met. As described previously there was evidence that a person living at the home was confined to their bedroom in the evenings when staff were busy and unable to provide supervision in communal areas such as the lounge. The persons care records showed that they had agreed to this, but this restriction on their liberty and movements around the home is not acceptable. A sample of staff files were examined and it was evident all the necessary checks are being carried out prior to workers being appointed or starting work at the home. Two written references were available on staff files examined. An application form had been completed for each staff member. Employment histories were available. CRB checks are carried out before a person is appointed. Staff photographs were available on staff files examined. 99 of carers have achieved a National Vocational qualification at level 2. Six carers have achieved or are studying for an NVQ at level 3. Staff training is planned to up date some statutory training. Safe handling of medicines and manual handling have been up dated for staff. Developmental training such as literacy, low vision, health and nutrition, deprivation of liberty courses have taken place this year. There was no evidence of a continuous developmental training programme for staff to ensure that staff can continue to meet the specialist needs of people living at the home. Some developmental training is provided to give staff knowledge about the specialist support needs of some people. The care and support provided in some instances does not demonstrate true person centred care recognising the individuality and rights of each person. A relative commented:The staff are all very experienced and professional in the care home. Care Homes for Older People Page 23 of 31 Evidence: We always get up to date training on everything that helps us to do our jobs well. Some of the care practice although keeping people safe from harm did not recognise the rights of the person or provide evidence of truly person centred care. Care Homes for Older People Page 24 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home live in a home that is quite well run but it is not always run respecting their interests or promoting their rights. Evidence: The manager has the relevant qualifications for managing the home. The home is adequately run but it is not always run in the interests of the people who live there. Good personal care is provided to people who live at the home but it does not give enough attention to their rights. The home provides care to a number of people with memory loss and advice should be taken to ensure the home is providing individualized care to this user group, and is helping to maintain the independence of people for as long as possible. Discussion has taken place with the manager at previous inspections about ensuring the environment is suitable for people with memory loss. Signage should be available around the home to help maintain the independence of people living there, one Care Homes for Older People Page 25 of 31 Evidence: example is there is no identification on bedroom doors to help people identify their own bedrooms. Management should keep up to date with the latest developments and research available in order to ensure the most up to care practice is provided by staff. Staff and resident meetings take place, the last staff meeting was in March 2009.People living in the home are asked individually about their daily living requirements, this could be further extended to include people with memory loss so they still have some control in decision making in their lives. Lockable facilities are available for people to keep their own money if they wish. A suitable accounting system is in place to record the personal finances of people living at the home, if the home was to hold any monies for people living there. Staff training relating to health and safety was up to date,first aid training is planned There was a good standard of record keeping and documents detailing fire safety and other statutory records were all up to date. The homes self assessment document, AQAA, was returned but it did not provide evidence of how the home was continuously trying to improve the service by identifying itself any improvements that may be required e.g. the proprietor stated in some sections;we have not been asked to make improvements therefore we havent made any. Improvements would be made if they were requested. Care Homes for Older People Page 26 of 31 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 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 18 Restrictions must not be 30/07/2009 placed on service userss liberty and freedom of movement around the home because of staffing levels. To ensure the freedom and liberty and health and safety of the service user. 2 15 16 Wholesome,nutritious foods must be provided in sufficient quantity for the benefit of residents. This is to ensure the nutritional needs of residents are met. 03/08/2009 3 27 18 Staff must be employed in 27/08/2010 sufficient numbers to ensure the safety and protection of all people living at the home and to offer them choice in areas of daily living. To ensure the health and safety and protection of all people living at the home. Care Homes for Older People Page 28 of 31 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 4 30 18 A training and development programme must be introduced to ensure staff training is kept up to date including developmental training. This is to ensure that staff continue to meet the needs of people living at the home as individually as possible. 27/08/2009 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 1 The homes Statement of Purpose and service user guide should be made available in a suitable format for people with memory loss to more easily understand. The home should seek advice about the best environmental design,decoration and signage for people with dementia care needs in order to maintain their independence and orientation. Advice should be taken from the community pharmacist about alternative methods for the administration of medication to people who are unable to swallow. The rights of the person living at the home should be taken into account and their dignity maintained when providing care and support to them. The personal histories of people living at the home should be used to ensure that activities are of interest and are meaningful to the person. People living at the home should have more opportunity to go out into the local community. The home should continue to explore ways of communicating and engaging with people with memory Page 29 of 31 2 4 3 9 4 10 5 12 6 7 13 14 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 loss. 8 9 10 19 25 32 The bath panel should be replaced in the upstairs bathroom in the interests of residents health and safety. More effective odour control should be provided and the identified chairs should be cleaned. Management and staff should continue to keep up to date with latest dementia care developments, to receive up to date information, to ensure that specialized care is given to people with memory loss. Care Homes for Older People Page 30 of 31 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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