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Inspection on 06/11/08 for Balgowan Nursing Home

Also see our care home review for Balgowan Nursing Home for more information

This inspection was carried out on 6th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 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 gives prospective residents the information they need to assist them in making an informed choice about whether the home will be able to look after them in the way they would like. The home provides a friendly, homely atmosphere. The majority of people living there appear relaxed and content in their environment. Residents said the staff are very kind and patient. On the whole interactions between the staff and residents were seen to be caring and positive. Family and friends are welcome at the home and are encouraged to be involved in the care of their relatives. Any complaints or concerns are taken seriously and acted on promptly. People living at the home told us they feel safe. There is a stable staff team and staff receive the training they need to look after the residents. Each of the residents have their own room. If people want to they can bring in personalised effects, which make them feel more comfortable and at home. The home is clean and well looked after. It is maintained to a good standard. The directors told us that they have on-going plans to continue with improvements and developments.

What has improved since the last inspection?

The service has improved how it assesses people once they arrive at the home. They need to make sure that these assessments move to the next stage when planning the care for residents. The home is developing an audit systems to check themselves against the national minimum standards. This will make sure that people are being well supported and cared for in a safe environment

What the care home could do better:

The resident`s care plans and risk assessments need to be easy to follow and used as a daily working tool by all staff. They need to be further individualised and developed to make sure that all needs are identified and met. There needs to be clear guidance given to staff so needs can be supported and met consistently. This will promote independence and autonomy for residents while keeping them as safe as possible. All documentation in the plans needs to be completed to make sure things are done. The service needs to evidence how people are offered choices as part of their everyday life. They need to evidence what people are doing during the day and how theyspending their time. People who take part in the homes surveys need to be informed of the outcomes, so they can see if the home is improving the service that it offers.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Balgowan Nursing Home 46 Bartholomew Lane Hythe Kent CT21 4BX     The quality rating for this care home is:   two star good 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: Mary Cochrane     Date: 0 6 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 29 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Balgowan Nursing Home 46 Bartholomew Lane Hythe Kent CT21 4BX 01303266782 01303230329 balgowan@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Penelope Jane Selby Type of registration: Number of places registered: Premium Healthcare Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category/ies of service only: Care home with nursing - N 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 - OP Date of last inspection Brief description of the care home Balgowan Nursing Home is owned by Premium Healthcare Ltd, which also owns Hythe Nursing Home. It provides nursing care for 33 Older People. There are 25 single and 4 shared rooms. Four of the single rooms have en-suite facilities. The home is a large detached two-storey house with accommodation on two floors. It is situated in an elevated position in Hythe. There are car-parking facilities in front of the home as well as off street parking. The home and garden are well maintained. The registered manager is Mrs Penny Selby. Mr Tony Barnes is the responsible person in partnership Care Homes for Older People Page 4 of 29 Over 65 33 0 Brief description of the care home with Mr Phil Barker. The homes email address is: premiumhythe@btconnect.com. The inspection report is freely available. Current weekly fees are in the range of £464 .07 600 to £873.80 per week. Additional charges are made for hairdressing, chiropody, dentist, newspapers and toiletries. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on 7th November 2006. This visit to the service was an unannounced Key Inspection which took place over one day. The registered manager was available throughout the day and we also spent time with 2 of the companys directors. The people living at the home and the staff on duty were helpful and co-operative throughout the visit. The visit included talking with people living in the home and the care staff. General observations were made during the day of how people are supported. We had a look around the home and various records were inspected. Care Homes for Older People Page 6 of 29 We observed how staff supported residents during the day and when offering care. We looked at and discussed residents individual support plans and their risk assessments. We looked at medication procedures and records. We also looked at staff training records and the homes quality assurance. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We also took into account the things that have happened in the service, these are called notifications and are a legal requirement. There has been a recent safe guarding adults alert raised at the home. This means that a complaint made about the home is being looked at by the local social services safe guarding adults team. A meeting is due to take place with the service and the involved agencies. The home has been active in dealing with the alert. What the care home does well: What has improved since the last inspection? What they could do better: The residents care plans and risk assessments need to be easy to follow and used as a daily working tool by all staff. They need to be further individualised and developed to make sure that all needs are identified and met. There needs to be clear guidance given to staff so needs can be supported and met consistently. This will promote independence and autonomy for residents while keeping them as safe as possible. All documentation in the plans needs to be completed to make sure things are done. The service needs to evidence how people are offered choices as part of their everyday life. They need to evidence what people are doing during the day and how they Care Homes for Older People Page 8 of 29 spending their time. People who take part in the homes surveys need to be informed of the outcomes, so they can see if the home is improving the service that it offers. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides information about the service for prospective residents. Prospective residents can be confident that their needs will be assessed, and that they will not be admitted unless the home can meet these needs. Evidence: The statement of purpose and service users guide have been rewritten and updated in September 08. The service users guide is available for all residents and the company are in the process of making it more service user friendly. They plan to write it in a format that suits the client group of the home. They told us this would be completed next month. It will include comment from relatives and information about how they plan to improve the service. All prospective residents are assessed prior to coming to stay at the home and joint assessments are obtained from care managers if there is one. The manager visits Care Homes for Older People Page 11 of 29 Evidence: prospective residents in their own home, in hospital, or in their existing placement to carry out a pre admission assessment. A relative told us the manager came to the hospital to do the assessment. They said, The managere did everything she could to make it easy to move to Balgowan, she was very helpful. The assessment covers the prospective residents physical and mental health, personal care, and cultural and religious needs. The manager told us the assessment continues after the person arrives at the home so they can get a better picture of their needs The home will not accept any resident unless they are confident that they can meet their assessed needs. The home does not offer 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. Residents cannot be sure that all their needs will be identified and met and that all risks are minimised. The homes medication procedures fully protect the safety of residents. Evidence: Three care plans were looked at during the visit and some shortfalls were identified in different areas of the care planning system. Each person living at the home has a personal and health care plan. These are done in individual booklets. Each person has 2 booklets with written information about their needs. The plans are difficult to follow and do not flow. Information is difficult to find and it hard to trail what has happen residents to make sure that all their needs have been met. The plans did identify the needs of the residents but did not give the guidance and direction to the staff on how to meet needs in the way the person prefers and chooses. Care Homes for Older People Page 13 of 29 Evidence: For example some people have a diagnosis of epilepsy, this was recognised in their care plans. However there was no individual information on how the staff should care for this aspect of the persons health and what action to take if they did have an epileptic seizure. When asked staff did know what to do, but this does need to be documented. We also saw that some people have dietary needs. Nutrtional assessments were in place which identified the need but there was nothing to say how this need was being monitored and met. The service does need to record the dietary intake of the residents living at the home. This will make sure people are receiving an adequate diet and any issues or concerns can be quickly highlighted and dealt with. The plans did give good guidance and direction to staff about reassuring people and communicating. Some of the plans we saw were not up- dated to reflect the changing needs of the people living at the home. Daily records are kept but they do not give a clear picture about how residents spent their time and do not relate to the individual care plans. We saw that some parts of the documentation were not completed therefore the service could not evidence, for example if someone had a bath, or their fingernails cut regularly, or if they did an activity. There are some risk assessments in place. These need to be further developed and more individualised to make sure each person is receiving all the support and care they need in the safest possible way. This will make sure all risks have been identified and kept to a minimum. The home does need to develop a more person centred approach to care. Key working needs to be developed and promoted. At present care needs are met in a task orientated way. Plans focused on what residents could not do instead of promoting independence and self- esteem. The manager does make sure that all the health care needs of the residents are met. Each resident is registered with a local G.P. and any area of concern related to health is referred to the G.P. There was evidence of GP visits and also visits by the specialist services. However care plans had not been updated to reflect the outcomes of the treatments or interventions needed as a result of the visits. The residents have regular appointments with opticians, a chiropodist and dentists. Medication is stored safely at the home, only trained nurses administer medicines. A sample of prescription sheets were seen. All prescriptions sheets had been signed to Care Homes for Older People Page 14 of 29 Evidence: indicate that residents had received there medication on time. Robust policies and procedures are in place. The recording of receipt, administration and disposal of drugs is sufficient to allow an audit trail. Controlled drugs are disposed according to legal requirements. Some of the people living at the home are prescribed medication (this includes analgesia, topical creams, eye drops) on a when required basis. There is no written instructions and guidance for staff to ensure that the medication is administered consistently and can be monitored. The effects of pain relief medication need to be monitored. Through observation and from talking to the residents and staff there was evidence to show that privacy and dignity is up-held. Residents are well dressed in clothing appropriate for the season and appeared well kept. The majority of staff were observed assisting the residents in a caring and supportive manner and were seen treating them with respect and understanding. Some members of staff were observed demonstrating good body language and communication skills when interacting with the residents. Members of staff spoken to confirmed an understanding and commitment to caring for older people. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does provide the residents with some opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home. Family links are encouraged and maintained wherever possible. The home provides nutritious and varied meals for the residents. Evidence: At the time of the site visit the activities co-ordinator was not available but was expected back to work the following week. Staff said that they had been doing individual activities with people when they got the time. Residents told us that they there had been an out-side entertainer who sang. They said they enjoyed this. Some people said they would like to more communal activities others said they were happy being in their rooms watching T.V. or reading and listening to the radio. The service needs to record what activities people have done during the day. There was no clear system to show what activities had taken place. There was nothing to say if the person enjoyed an activity or not, whether they fully participated or whether they got fed up. The home does need to incorporate how people would like to spend Care Homes for Older People Page 16 of 29 Evidence: their time within their care plans. There is a specific sheet in everyones file to document activities that have happened but this was not completed and there was nothing written in daily records to say what people had done. The Aqaa did tell us that the home plans to continue to build the activities and social side of the home to improve the quality of life for the people who live there. Relatives said they are made to feel welcome at the home at all reasonable times and no restrictions are imposed. One person said, They are all very kind. You always get a cup of tea. Residents are able to receive their visitors in the privacy of their own rooms or in the communal areas. The people spoken to felt they are able to have some choice in regards to their day-today lives. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. Generally they felt happy with the limited choices they are offered. The home does need to evidence and demonstrate more how it offers more diverse choices to people so they are encouraging them to be as independent and in control of their lives. There is a full time cook working at the home. The daily menu is displayed on the notice board in the home. We were told that the home offers three cooked meals a day with drinks and snacks available at any time. People are offered a choice of meals and the residents told us the food is good and there is plenty to eat. Likes and dislikes are recorded in peoples care plans. We observed a lunch time meal. Staff were observed offering choices of drinks to people but not meals. We were told that people are asked if they want the main menu and if they do not an alternative is offered. The meals are nutritious varied and well presented. The dining area of the home is in the conservatory. People can chose were they want to eat their meals. Some people prefer to eat in their rooms and others in the lounge. We did see that staff were available to offer assistance to those people who needed it. As mentioned previously in the report the registered manager needs to make sure that the home can evidence how people have made choices and a record needs to be kept of meals eaten or not eaten by residents. The manager said she would address these issues. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that their complaints will be listened to and acted upon, and that they will be protected from abuse. Evidence: The home has a complaints procedure, which meets the national minimum standards. The complaints procedure is available within the home. Some of the residents we spoke were able to tell us what they would do if they wanted to make a complaint. They said that they felt the manager would listen to them and act on what they said. The manager told us there have been 4 complaints made to the home since the last inspection. 3 of these have dealt with according to the homes policies and procedures. We were able to see how the complaints were managed and the outcomes that were reached. Practices within the home had changed as a result of 2 of the complaints. This shows that people are being listened to and their complaints taken seriously The 4th complaint has led to a safe guarding vulnerable adults alert being raised. This means that the compliant is being looked at by the local social services safe guarding adults team. A meeting is due to take place with the service and the involved agencies. The service has been active in dealing with the alert. All staff have received training in safe guarding adults. The homes recruitment procedure includes undertaking formal checks to ensure that Care Homes for Older People Page 18 of 29 Evidence: potential employees are suitable to work with vulnerable adults. Residents are encouraged and supported to look after there own finances and there are systems in place to make sure that monies and other valuables are safely kept. The service does need to make sure that the residents can access their money whenever they want to. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a clean, comfortable, homely and well-maintained home with bedrooms and facilities that suit their needs Evidence: On the day of the site visit the home appeared clean, fresh and well maintained. People who visit the home on a regular basis told us the standard of cleanliness and maintenance within the home is always very good. The home has 25 single (4 of which have an en-suite) and 4 shared rooms. The communal areas are bright and cheerful. The home has a friendly and relaxed atmosphere. Bedrooms are personalised and reflect the interests and lifestyles of individuals. residents have the aids and equipment they need to maximise their independence and protect them from skin breakdown. Upstairs can be accessed by a lift. The service told us that they have a continuous programme of redecoration and refurbishment. They are aware of the areas that need to be improved and have plans to address these. They plan to improve some bathrooms, the kitchen and laundry and are looking at developing the service further in the future. The kitchen and laundry rooms are suitable for purpose with adequate equipment in Care Homes for Older People Page 20 of 29 Evidence: place. Residents said that the laundry service was good and they had no complaints. The service makes sure that soiled laundry is transported correctly and there is a sluice room on both floors of the home. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported and protected by a sufficient number of properly recruited and well-trained staff. Evidence: We looked at the duty rota and saw that there are usually 2 registered nurses and 4 carers on duty throughout the day and one registered nurse and 2 carers at night. There is a good compliment of ancillary staff. The registered manager told this is enough staff to meet the needs of the residents and when the activities co-ordinator returns they will have a full staff team. The home works closely with the companies other nursing home which is just a few minutes away. The staff told us there is a stable staff team who have worked together for a period of time. They said that everyone gets on well together and are supportive of each other. Staff are flexible and the Aqaa told us they will cover extra shifts when there is a shortage. The residents told us that the majority of staff are very kind and thoughtful; they said they answer when they use the call bell. At the time of the visit we did observe that call bells were not in easy reach for some of the residents. The registered manager rectified this and told us she would discuss it with the staff team. Residents did tell us they us they do not have to wait very long if they need help. Care Homes for Older People Page 22 of 29 Evidence: The home has an NVQ programme for care staff and the service told us that they have over 50 of care staff working towards NVQ level 2. The home has training matrix and the majority of staff are up to date with mandatory training. Gaps have been identified and training has been planned to make sure everyone is kept up to date. Training is on-going. Registered nurses do the training required by them to make sure they can re-apply for their registration. There is extra training in wound care, dementia, continence and medication. All new staff do have an induction programme in place this is done over a 3 month period. The service needs to make sure their induction is linked to Skills for Care. The registered manager said she would address this. We looked at 3 staff files including those of more recently employed staff. We saw that the home has thorough recruitment practices. Files contained all the necessary information and safety checks to ensure that the residents are protected. There was evidence of POVA and CRB checks, two written references and proof of identity. The service needs to make they obtain a full employment history from staff and that they have an update photograph of staff on their files. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from effective management, and a home that is run in their best interests. Their financial interests, and their health, safety and welfare are safeguarded. Evidence: The registered manager has worked at the home for 3 years and is suitably qualified and experienced to manage the home. Service users commented, The manager is good she looks after the home well. There is a clear managerial structure within the home. The manager operates an open door policy with the residents, relatives and staff. She is very visible within the home. The manager is supported on a regular basis by the directors of the company. They produce a formal monthly report about the home and identify any areas within the service that need attention. Staff told us that they feel supported and valued by the manager and the company. The manager told us that she keeps up to date with Care Homes for Older People Page 24 of 29 Evidence: training and is currently doing training on end of life planning. The Company has a quality assurance programme in place. The service told us that questionnaires have been returned from relatives, service users and other people who have contact with the home. Regular audits are done to ensure that standards are maintained and with the aim to identify shortfalls. The manager has just started to extend these so they are more in line with the national minimum standards. The results of these questionnaires and audits need to be collated so that the strengths and weaknesses of the service can be identified. The results of the survey then need to be published and made available to the people who are involved and use the service. The directors told us that they would make sure that people are made aware of the outcomes of their findings. Effective quality assurance and monitoring systems measure the success of the home in achieving its main aims and objectives. The finances of the residents are safeguarded by the companys policies and procedures. A handyman is employed and he ensures that all fire safety and health and safety checks are carried out in a timely manner. All fire assessments and checks are done at the required intervals. Water temperatures are taken at regular intervals. The service needs to make sure that it actually records the temperature of the water to make sure any fluctuation can be identified and dealt with. The manager does inform us any unusual events that adversly affect the residents. The home provides a safe environment for people to live in and staff to work in. Good working practices ensure the home is free of hazards. The home has informed us that safety and maintenance checks of equipment are up to date. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 There needs to be individual 31/01/2009 care plans in place, which includes all the health, social and personal care required, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations. The plan needs to be implemented and updated to reflect the changing needs of the residents. Risk assessments need to robust and promote independence. Daily records need to contain relevant information about the day of the residents and written in conjunction with the care plan. To make sure all residents needs have been identified and met. And staff have the guidance and direction they Care Homes for Older People Page 27 of 29 need to look after the people at Balgowan in a way that best suits them. 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 12 The home needs to evidence how people have spent their time throughout the day. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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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