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Inspection on 09/07/09 for Barnes Court Nursing Home

Also see our care home review for Barnes Court Nursing Home for more information

This inspection was carried out on 9th July 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 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

A good range of activities are offered to service users including outings in the home` mini bus and many comments were received from both service users and their families complimenting the male workers in the home. People living in the home have a choice of GP and when visits to hospital outpatients are necessary they are escorted by a member of staff. The home has pleasant garden areas with lots of seating areas where service users and their families can spend time. The home has good staffing levels and staff were observed to treat people with dignity and repect when carrying out personal tasks. Staff are well trained and the staff training matrix shows training completed and further training identified.

What has improved since the last inspection?

Of the care plans case tracked the assessment records were complete, with good information to be able to devise a personal care plan, identifying the needs of people to be carried out. Medication systems have improved and records were up to date, with full and accurate information. The home has now employed an activity co-ordinator and this has improved the day to day activities that are offered to service users. A number of improvements have been made, including replacing carpets in some areas, new furniture in the lounges and dining rooms and wall panels and flooring have been replaced in the ground floor shower room.

What the care home could do better:

Although staff have changed some of the content within the plans of care, they are not giving guidance for staff to follow and some information recorded is not being acted upon and therefore all of the care needs are not being met. Evaluation is repetative and is not highlighting if changes are to be made or if the care plan is working. Relatives made a lot of negative comments about the general care in the home and felt that their complaints were never addressed. Not all concerns or complaints are recorded and therefore it is difficult to know if complainants are happy with the outcomes of their concerns. The lunchtime meal was not pleasant for people. There were not enough staff in the dining room to offer help and support and no choices were made available to service users at lunchtime. Service users and their relatives were not very complimentary about the meals and felt they had no choice at mealtimes. The corridor and dining room on the first floor have strong unpleasant smells, which is unpleasant for people living in the home. Two of the homes three carpet cleaners have been out of order for eighteen months and have not been replaced. The acting manager has covered this post for over two years and since December 2008 was made up to Manager, however, she needs to be registered with the Care Quality Commission. Although one to one supervision sessions are in place for the staff team, the manager does not receive formal supervision from her line manager. In the absence of the home manager, the rota should identify who is in charge of the service to deal with any emergency situations, day to day events or concerns from service users or relatives.

Key inspection report Care homes for older people Name: Address: Barnes Court Nursing Home Wycliffe Road High Barnes Sunderland SR4 7QG     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: Eileen Hulse     Date: 0 9 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: Barnes Court Nursing Home Wycliffe Road High Barnes Sunderland SR4 7QG 01915202000 01915202622 barnes.court@ashbourne-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ashbourne Homes Ltd care home 89 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 physical disability Additional conditions: The DE category of registration refers to 3 current service users only The service may from time-to-time admit persons under the age of 65 within the OP category Date of last inspection Brief description of the care home Barnes Court Nursing Home is a 89 place facility, which consists of three floors. The top floor provides nursing care for older people. The middle floor provides nursing care for people with mental health needs. The ground floor has a 15 place nursing unit for people with a physical disability. Barnes Court opened in 1991 however the function of the home has changed over time resulting in a different client group being cared for in some of the units than when the home first opened. The owners are aware that work Care Homes for Older People Page 4 of 31 Over 65 20 20 41 1 3 0 0 15 1 7 0 3 2 0 0 9 Brief description of the care home still need to be completed to make some areas fully accessible to those people who have a physical disability. The home is near Barnes park and five minutes from Sunderland Royal Hospital. The home has been built in a residential area and is opposite to a local school. 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: 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: The last key inspection for this service was completed on 8 August 2008. This is an overview of what the inspector found during this inspection The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. How the inspection was carried out:Before the visit we looked at information we have received since the last visit on 8 August 2008; How the service dealt with any complaints and concerns since the last visit; Care Homes for Older People Page 6 of 31 Any changes to how the home is run; The providers view of how well they care for people; The views of people who use the service their relatives and staff. During the visit we observed staff practice and talked with people who use the service and looked at 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. We looked around the building to make sure it was safe clean and comfortable and checked if any improvements had been made. 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: Although staff have changed some of the content within the plans of care, they are not giving guidance for staff to follow and some information recorded is not being acted upon and therefore all of the care needs are not being met. Evaluation is repetative and is not highlighting if changes are to be made or if the care plan is working. Relatives made a lot of negative comments about the general care in the home and felt that their complaints were never addressed. Not all concerns or complaints are recorded and therefore it is difficult to know if complainants are happy with the outcomes of their concerns. The lunchtime meal was not pleasant for people. There were not enough staff in the dining room to offer help and support and no choices were made available to service users at lunchtime. Service users and their relatives were not very complimentary about the meals and felt they had no choice at mealtimes. The corridor and dining room on the first floor have strong unpleasant smells, which is unpleasant for people living in the home. Two of the homes three carpet cleaners have been out of order for eighteen months and have not been replaced. Care Homes for Older People Page 8 of 31 The acting manager has covered this post for over two years and since December 2008 was made up to Manager, however, she needs to be registered with the Care Quality Commission. Although one to one supervision sessions are in place for the staff team, the manager does not receive formal supervision from her line manager. In the absence of the home manager, the rota should identify who is in charge of the service to deal with any emergency situations, day to day events or concerns from service users or relatives. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good assessments are included within the plans of care for all service users that help to form the basis of the individual care plan. This ensures that before admission takes place the home is able to know if the care needs can be met by them. Evidence: All service users currently living in the home have had pre admission needs assessments carried out by a care manager and a registered nurse employed by the service prior to their admission. When a vacancy occurs, a care manager makes a referral to the home and the prospective service user spends some time in the home meeting other service users and having a meal with the people who live there. In some instances an overnight stay maybe offered. This gives the person the time to decide if they would like to move in and ensures the correct equipment and care plans are in place prior to their admission. The homes admission and assessment procedure ensures that people have Care Homes for Older People Page 11 of 31 Evidence: an informed choice about moving into the home. They are given information about the home such as the statement of purpose and the homes brochure and this tells people what they can expect from the service. Following admission, each service user has a care plan developed from information gathered during the assessment, so that when followed by staff, it helps the care needs to be met on a daily basis. The person lives in the home for six weeks to see if they want to live there permanently and to ensure the home can meet their needs. This period is followed with a review meeting held between the service user and their representatives, the home staff and the care manager. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users living in the home have individual plans of care, however, they do not explain in detail how the care needs are to be met by staff and therefore the home cannot be sure that care needs are being met on a day to day basis. Service users receive appropriate healthcare and with good medication administration procedures, these ensure that peoples health and wellbeing are maintained and promoted. Evidence: All service users have an individual care plan that is completed by staff and gives the staff guidance on how the care needs of people living in the home will be met. The care plans were organised with an index to find information easily and they included areas such as pre admission assesments, personal information and photograph, admissions sheet , that include healthcare needs, a life history and other healthcare information that should be kept. Care Homes for Older People Page 13 of 31 Evidence: However, the day to day care plans did not include sufficient information to guide staff to ensure that the care needs are met on a day to day basis. One care plan stated that (name) needs to be toileted every two hours, but there was no evidence to say this was being carried out. Another care plan gave instructions to staff to understand what tends to frustrate (name) and observe it, but did not inform staff what they had to look for and did not give guidance for staff on how to manage the situation when (name) became aggitated and aggressive. One recording in the daily notes detailed a condition one of the service users had developed that needed daily treatment but this was not recorded anywhere and therefore it was not known if the condition had healed or continued to need treatment. Another careplan recorded that staff had to liase with other staff in the home to give (name) choices, but when speaking with the service user they stated this does not happen and they are not given choices. One service user healthcare plan stated they had personality/behaviour difficulties but the care plan gave no information for staff on how to manage these difficult situations. In discussion with a service user they stated they would like to move out of the home and had spoken with the home manager about this. The care plan first highlighted this request in November 2007. There was no evidence of a review being held until June 2009 and the outcome of the review was that a meeting would be arranged with the deadline being one week. At the time of the visit this had not been followed up. The evaluations of the care plans were repetative and give no clear indication that the care is being met and the care plans are being followed. All service users have a choice of GP and there are regular visits from all local GPs and other healthcare professionals such as chiropodists, dental service and opticians. Service users needing to attend to hospital out patient appointments are escorted by a member of staff or if the person prefers a family member. The home uses a manrax monitored dosage medication system that is delivered to the home on a monthly basis by a pharmacy and only registered nurses administer medications to service users. Care Homes for Older People Page 14 of 31 Evidence: Medicine administration records were signed and up to date and a medication audit including controlled drugs held by the home confirmed medication was stored and recorded correctly and followed the guidelines of the homes medication procedures. In talking with service users and relatives about the general care, comments they made included, Many times my relative is left sitting wet The male carers are absolutely marvellous I feel the care is going down in this home Most of the staff are nice but they never seem to know if my (relative) has been to the toilet The care varies a good deal between good and bad The carer lads are really wonderful and caring I am never informed if my relative is poorly The staff are usually good I dont like anything about the home Some of the staff are kind to me but some say awful things to me 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of social activities are made available and service users are encouraged and supported to join in activities of their choosing and ability and this helps to contibute to varied and fulfilling days. Service users are offered and receive a varied, wholesome and nutritious diet and this helps to promote their health and well being. Evidence: A new activity co-ordinator has been employed since March of this year and works forty hours per week to plan, organise and provide social activities. These are held Monday to Friday and in discussion with the activity worker she explained that the new activities programme is almost complete and will be made available to all service users regardless of their individual abilities. The records kept are well maintained and up to date and each individual sheet per service user details the activity for the day, if the service user had participated, if it was a group activity or one to one activity but it does not state if the service user has been asked and refused to take part. Future events are placed on the homes notice boards so that service users and their families are kept informed as to what is going on in the home and visiting entertainers Care Homes for Older People Page 16 of 31 Evidence: events that are taking place. The activity co-ordinator has also introduced a monthly news letter named Barnes Court Times that records events that have taken place in the previous month. Activities include one to one days and sometimes group activities such as outings. The home has full use of the mini bus everyday. Some of the activities currently made available include visiting the local parks, a ladies club, arts and crafts, coffee mornings held in the home and visits to the local pub. Service users talked about the activities and comments they made included:(name) who does the activities is great we are always going out somewhere Its nice having something going on better than sitting looking at one another Its nice here and nice to get out and about and see the outside world Sometimes its the same people who go out all of the time and I dont like that During the visit, a lunchtime meal was taken with service users and this was not pleasant for people. Before the meal arrived, a scuffle broke out in the dining room and resulted in a service user throwing a knife , while another service user swept everything off the table. Although there were adequate staff around, there were no staff in the dining room when the incident took place. Tables were well set with tablecloths, serviettes and condiments and a choice of cold drinks were offered prior to the meal being served. It was also observed that one member of staff was helpful to people requiring assistance during the meal but there were no other staff in the dining room throughout the whole mealtime therefore some people had to wait for assisstance or just did not bother to eat their meal. The chicken casserole dinner was well presented especially dinners requiring a soft diet but there was no second choice of meal offered and discussions about mealtimes and activities with service users and visitors resulted in the following comments, You get a good breakfast here Meat was very tough its often like that where you cannot get a knife through it I dont like the food at all All the meals are poor one day service users only had custard for sweet Care Homes for Older People Page 17 of 31 Evidence: Between meals people are never asked if they want a drink My (relative) never gets the chance to go out, never asked Although clothes are named my (relative) wears other peoples clothes I get upset when things are always going missing I like being here and like all the male carers they are very kind to me The activity women is very very good we went to the coast it was lovely Care Homes for Older People Page 18 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. Service users and their families have the information they need should they have a concern or complaint about the service and good safeguarding policies and procedures are available which help to protect service users should an abuse situation arise or be suspected. However, not all concerns or complaints are recorded and therefore the home is unaware if these have been acted on appropriately and effectively. Evidence: The home has a complaints procedure that is given to service users and their representatives following admission into the home. It tells them how to make a complaint, the length of time it will take before a response is received and how the service will deal with the complaint. Staff were able to state how they act on any concerns or complaints received. Some complaints are well recorded on formal documents but minor complaints or concerns are not recorded and therefore no information is available to know if complainants were happy with the outcomes of their concerns. Some relatives spoken with during the visit made the following comments, Complaints are very rarely dealt with Clothes are always going missing so staff dont even bother to look for them now My (relative) always has clothes in wardrobe not are not theirs but staff dont even bother to read the names Its an absolutely waste Care Homes for Older People Page 19 of 31 Evidence: of time complaining as nobody listens Whats the point in complaining nobody takes any notice of you I discussed this last comment with the manager who stated that the specific circumstances it relates to had been dealt with through the safeguarding adults framework with the local authority. Staff have received complaints training and protection of adults training and in discussions with some staff it was clear they would know what to do should an abusive situation arise or a complaint be received whilst they were on duty. Safeguarding procedures are made available to staff and although service users and relatives were aware of how to make a complaint they all stated they were not confident their complaints or concerns would be listened to or addressed. Care Homes for Older People Page 20 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 is clean and generally well maintained and although a number of improvements have been made to the furnishings since the last inspection, further issues need to be addressed to provide service users with a comfortable and safe place to live. Evidence: The home is a purpose built property offering accommodation over three floors and there are a variety of communal sitting areas for service users to choose from. The ground floor and first floor corridor carpets have been replaced and the shower room on the first floor has new wall panelling applied and new flooring. A new industrial washing machine has been installed and furniture has been re-newed in both the dining rooms and lounges on the first floor, the homes maintenance person continues to complete the decoration programme. However, the dining room and corridor on the first floor have strong unpleasant smells which need to be eliminated. The home have three carpet cleaning machines but for the last eighteen months two of the machines have not been in working order and this has made it difficult to keep some areas of the home free from unpleasant smells. Care Homes for Older People Page 21 of 31 Evidence: The gardens surrounding the home are pleasant and well maintained and have lots of seating areas service users and their relatives can enjoy in the summer months. There is also good access for service users as there are ramps leading into the garden from patio doors in the lounge area. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Well trained and competent staff are in post and there are good recruitment procedures used and this helps to ensure that suitable staff are employed and that service users are kept safe and receive a good quality of care. Evidence: The duty rota reflected the numbers of staff on duty on the day of the visit and the staffing levels were adequate to meet the current needs of service users. The staff on duty over three floors included three registered general nurses, twelve care assistants, four domestic staff, one laundry assisstant and two kitchen staff. Other staff on duty included an administration clerk, a maintenance handyman, activities co-ordinator and the home manager. The home has a policy and procedure on staff recruitment that is used when the home have staff vacancies. Over fifty percent of the care staff currently employed in the home have achieved an NVQ qualification in care and all members of staff complete mandatory training. The training matrix identifies the training needs and shows training that has taken place, also confirming that all the necessary mandatory training had been completed and was up to date. Care Homes for Older People Page 23 of 31 Evidence: Inspection of the personal staff files for two members of staff, one of whom was recently recruited was carried out. Both personal files were organised and kept up to date and the information included all of the necessary documentation that the home is required to keep such as job application, interview notes, references, photocopies of cpmpleted training, personal identity and criminal record bureau checks. In discussions with staff on duty, they were positive about the service and made the following comments:The care in the home is quite good I get the best support more than I expected I have had loads of training but no specific complaints training Feel we are friends of service users not workers We dont write in the care plans but we complete monitoring sheets I enjoy working here and we work great as a team Care good in this home and supported by management. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home currently has an acting manager who is appropriately qualified to manage the service. However, health and safety and staff accountability is not always maintained within the service and therefore practice does not always ensure service users are kept safe. Evidence: The acting manager has been in this role for over two years and is currently completing an application to be the registered manager of the service. She has worked in the home for thirteen years in various positions, including a registered general nurse, unit manager, and four years ago was promoted to deputy manager. She is a registered general nurse with experience of being in the position of deputy manager in another home and her qualifications include Care of the Elderly with dementia diploma, palliative care training and is currently a Yesterday,Today and Tomorrow trainer for the Alzheimers Society. Care Homes for Older People Page 25 of 31 Evidence: The home employs a financial administrator who deals with all financial matters. Staff one to one supervisions are now in place. Staff meetings and service user meetings take place regularly and a relatives surgery is held weekly. However, although the manager has regular verbal contact with her line manager, there is no formal supervision held. Internal quality assurance systems are developed and allow the views of service users, relatives and others to be sought and to monitor the quality of the service provided. Observation showed that not all staff follow safe working practices at all times, for example, located in a service users toilet on the Younger Physical Disabled unit was an unattended domestic trolley that contained many bottles of various cleaning agents and a double soiled laundry trolley. On arrival at the service, in the absence of the acting manager, staff were unsure who was the responsible person on duty should an emergency situation arise and were also not aware of how many service users were currently in the building and this information had to be obtained from the administrator. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Individual care plans must 31/05/2009 include more detail as to how people are being supported by staff. This will ensure that staff are following consistent practices. 2 7 15 Individual care plans must 31/05/2009 include more detail as to how people are being supported by staff. This will ensure that staff are following consistent practices. 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 15 Care plans must include all details about the care needs required This gives guidance for staff and ensures the care needs are met 01/09/2009 2 15 12 There must be sufficient numbers of staff at mealtimes This ensures all service users are given support and help they need and that they are kept safe 01/09/2009 3 15 12 Service users should be given choice around meals offered This ensures that a preferred choice of food is made avilable 01/09/2009 4 16 17 All complaints or concerns must be recorded and acted upon 01/09/2009 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 This gives people the confidence that their complaints will be adressed effectively 5 19 13 Unpleasant odours must be eliminated in some parts of the building This ensures this is a comfortable place for service users to live 6 19 23 Equipment necessary for the 01/09/2009 cleanliness of the building must be obtained To make sure the home is clean and pleasant to live in 7 31 7 The acting manager must apply to the Care Quality Commission to become registered to manage the service This gives service users and their families confidence in the day to day running of the service 8 31 12 The acting manager must receive regular formal recorded one to one sessions with the line manager 01/09/2009 01/09/2009 01/09/2009 Care Homes for Older People Page 29 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 This ensures that the management are supported and that any issues are addressed confidently 9 31 7 In the absence of the manager a person must be named to take responsibility for the service This ensures accountability of the staff team and gives service users the knowledge of who is in charge at a particular time 10 38 13 The manager must instruct staff on the safe storage of hazardous substances following guidelines of COSHH Service users will be kept safe 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 01/09/2009 01/09/2009 1 12 The activities records should include if a person has been asked to participate in activities and record when they have refuesd to take part The service should communicate with relatives and address any concerns they may have 2 16 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. 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. 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