Inspection on 28/04/09 for Barons Down Nursing Home

This inspection was carried out on 28th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barons Down Nursing Home 14/05/08

Barons Down Nursing Home 22/06/07

Barons Down Nursing Home 19/06/06

Barons Down Nursing Home 15/11/05

Barons Down Nursing Home 21/06/05

Barons Down Nursing Home 13/10/04

Barons Down Nursing Home 10/05/04

Similar services:

Springfield House

The Shelley

Thorndene

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Barons Down Nursing Home Brighton Road Lewes East Sussex BN7 1ED     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elizabeth Dudley     Date: 2 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Barons Down Nursing Home Brighton Road Lewes East Sussex BN7 1ED 01273-472357 01273479104 brooklandsnursinghome@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Hadi Rajabali,Mrs Shehnaz Rajabali care home 24 Number of places (if applicable): Under 65 Over 65 24 0 old age, not falling within any other category physical disability Additional conditions: 0 24 The maximum number of service users to be accommodated is 24. 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) Physical disability (PD). Date of last inspection Brief description of the care home Barons Down is registered to provide nursing care for twenty-four service users, who are over 65 years of age and may also have a physical disability.The home is purpose built and is located in a quiet residential area on the outskirts of Lewes. Local amenities can be found within walking distance of the home and there is nearby access to public bus routes. Free car parking is available at the home. Rooms are located over three floors, all of which are served by a passenger shaft lift. Eighteen rooms are for single occupancy of which all have en suite facilities. There are three double rooms that do not have en suite facilities. Care Homes for Older People Page 4 of 35 Brief description of the care home There are additional toilets and bathrooms located throughout the homeThe home has a number of specialist equipment in use such as mobility aids, adjustable nursing beds and hoists. There is a small patio area leading off from the lounge/dining area that is accessible to service users. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on the 28th April 2009 over a period of eight hours, as there was no current registered manager in post at this time it was facilitated by the general manager. During the inspection a tour of the home was undertaken and records, which included care plans, medicine charts, catering and health and safety records and personnel files were examined. Other records essential to the smooth running of the home were also examined. The inspector observed a medication round taking place and lunch being served to the residents. Whilst all residents were seen and spoken with on the day, individual discussions took place with six residents, four visitors and six members of staff. Comments received from residents and visitors included Very happy with the care Care Homes for Older People Page 6 of 35 given to me. Someone always comes when I ring my bell. I did have a concern once but it was dealt with to my satisfaction very quickly. The home is always clean and the food is very nice. Staff said there were always sufficient staff on duty and that they believed the standard of training equipped them for the work they have to do. Prior to the inspection the AQAA ( Annual Quality Assurance Assessment - a document required by regulation which sets out the current status of the home, past achievements and future plans) was received when we asked for it. Although the document was not very comprehensive and did not give sufficient information, the general manager was able to supply the inspector with additional information required. The last key inspection took place on the 20th May 2008. Current fees are available from the home and do not include hairdressing, chiropody, costs for these can be requested from the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 8 of 35 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 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 35 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. It is unclear whether the home provides sufficient information for prospective or existing residents. There was a disparity of information between the preadmission assessments and the care plans, which could lead to residents not receiving on going care and treatment relating to health care needs. Evidence: The home produces a Statement of Purpose which is available in the entrance hall. Whilst this document includes most of the required information about the home it does not include the number and size of the rooms, neither is all the information correct regarding the current services offered. Discussions were held with the General Manager who gave assurances that the amendments would be put in place. There was no Service Users Guide available and it was unclear whether the home produces this Care Homes for Older People Page 11 of 35 Evidence: as a separate document, or whether it is combined with the Statement of Purpose. Residents do not have a copy of either the Statement of Purpose or Service User Guide, and it was not clear how much information prospective residents have about the home to allow them to make a decision about whether they wish to live there, or how they receive information about the home and its routines once they are living there. The provider must ensure that these documents are made available to residents and that both documents present the correct facts about what services are offered. The general manager gave assurances that all residents in the home receive a terms and conditions (Contract) following admission. Due to these not being available in the home, blank copies of this document only were seen, it was noted that there was no available space for the number of the room to be occupied, but otherwise these met the regulations. Prospective residents are assessed by a senior member of staff either the general manager or the manager prior to admission to the home. Three preadmission assessments were examined which belonged to recently admitted residents. Whilst these initially appeared comprehensive, information in the care plans and on observing residents indicated that this was not so. Therapies indicated as required by the residents in the assessment had not been accessed for the resident at the home following the residents admission. Preadmission assessments should be used to inform both the staff and the care planning process, and management should ensure that any health requirements such as physiotherapy are carried forward into the care plan and acted upon, and that the information presented in the assessments is accurate. Residents or their representatives are able to visit the home prior to admission and can be admitted for either respite or permanent care. The home does not admit residents for intermediate care. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the standard of actual medication administration safeguards the residents, failure to accurately record this may put residents at risk. Failure to ensure that registered nurses attend updating and training specific to their health care practice could put residents at risk of not receiving care in line with current researched practice. Evidence: Whilst it was apparent that staff were very aware of individual residents health care needs, and were acting to address these, the standard of care planning and recording did not support the care that was being given. During the inspection three care plans were examined in depth. Daily records were more detailed than the care plans and whilst stating that care given as per care plan, continued in further detail to identify care not detailed in the plans. Care Homes for Older People Page 13 of 35 Evidence: Instances of this include where one resident was identified as having a urine infection, all the treatment for this was in the daily records, but there was no care plan to address the care required. Details of wound care treatment given, was in the daily records of another resident but not identified in the care plan. Following a residents hospital visit, some aspects of care had changed but this had not been included in the care plan, although was very detailed in the daily records. It is important that care plans identify the current and changing needs of each resident and of specific episodes in the residents health needs such as infections or hospital treatment which may cause reactions, as by this information being only available in daily records may lead to changes of need being missed and appropriate care not given. Care plans must also give detailed instructions for the care assistants on delivering the care. Generally the care planning was not comprehensive and although the care plans have been signed as reviewed monthly, this was not relevant as not all care plans had been updated to reflect change of need. One resident was detailed in the care plan as being mobile with two care staff but it was then seen that she was immobile, there was no documentation relating to gradual change of need or actions taken to address this, and no records of the physiotherapist being brought in although the preadmission assessment stated that the resident would need this therapy. Nutrition care plans were in place, but information in these was scant, and although staff have received training in, and have information on the MUST (Malnutrition Universal Screening Tool, a care tool to determine and maintain or improve an individuals nutritional status) there was no evidence of this being used to inform the nutrition care plans. This was particularly relevant insomuch that the MUST advocates the use of brachial measurements to assess the Basal metabolic indices (BMI) when individuals cannot be weighed ,and this had not been undertaken in the case of some of the individuals in the home, where it would have been appropriate. No staff have updated wound care training, and although in some instances residents have received care from the Tissue Viability Specialist Nurse, these specialists are not routinely asked to come in to residents with skin integrity or wound care needs. More information is required in continence care plans and night care plans, and staff Care Homes for Older People Page 14 of 35 Evidence: should ensure that residents or their representatives are routinely involved in the formation of care plans and their reviews. Risk assessments for bed rails were in place, but require to be more robust to ensure that residents are protected. Electric bed pressures had not been included in the individual care plans or recorded and monitored on a regular basis. Residents appeared well cared for and well groomed. All residents had access to a call bell with staff being around for those residents sitting in the lounge and some way from the call bells. There was evidence of fluid charts, which had been regularly recorded, but no evidence of turn charts in some rooms. Residents being nursed in bed appeared comfortable. Residents and relatives spoken with said : Very satisfied with the care given and with the staff. Food good and always plenty to eat. They always ask my opinion on things and always do as I ask and usually very quickly. They get the doctor promptly when I need to see him. Bells answered promptly at night and all other times. Very nice here indeed, they are very kind and the food is very good, I do get terribly bored though but its comfortable and everyone is very nice. It is my request that my wife comes to bed in the afternoon. I am very happy with the care they give here, its a wonderful place and the staff are amazingly helpful. They havent got a manager at the moment but the general manager is managing and they seem to be doing well here. Cant really fault it I just want to get out of bed and go home, not sure if my family visit but thepeople here say they do. The food is quite good I think, I know I like it and I think the people here are alright, they seem very nice here quite kind. Very nice here, am very comfortable and happy. A medication round was observed, this was seen to be carried out in a manner that safeguarded the residents. Residents have their medications administered from a drug trolley and the majority of these are pre dispensed by the supplying pharmacist into blister packs. There were some omissions in the signatures in the MAR ( medication administration records) charts, and these were identified as occurring on specific shifts. The general manager gave assurances that this would be addressed. Likewise, handwritten Care Homes for Older People Page 15 of 35 Evidence: medication details and prescriptions had not always been signed and in some cases records of receipt of medications were not signed. These also were specific to certain shifts and the manager is addressing this. It is recommended that regular drug audits are carried out. The recording and storage of controlled drugs complied with legislation but witnessing staff must include their full names. It was noted that there was only one bottle of Lactulose in the trolley although several people were on this medication. The registered nurse on duty gave assurances that residents received this medication from their own bottles and this Lactulose was not used communally. Any prescribed creams must be signed by the registered nurse on duty following confirmation with the care assistant that this has been applied as directed. There are no end of life wishes in place either for resuscitation or preferred place of death, and no member of staff has attended training in the Liverpool Care pathway or Gold standards framework. The manager said that this will be commenced. The home does have residents who are at the end of their lives. There was evidence that residents who were ill were comfortable and the appropriate care being given fluid and food charts, and in some cases turn charts, were in place and these interventions accurately recorded. Compliments on the care from relatives and friends of deceased residents were seen. Care Homes for Older People Page 16 of 35 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. There is scope to increase the range and frequency of the leisure activities provided to ensure that residents benefit from both mental and physical stimulation. There is a varied menu offering choices at each meal and residents enjoy the standard of meals provided. Evidence: The home does not currently have an activities person or a formal programme of activities, leisure activities are provided by care staff and are mainly on a one to one basis. Activities provided include manicures and nail care, discussions with residents, some crafts and some board games. No outings take place but at times entertainers, such as musicians, visit the home and the home also provides parties at Christmas Easter and for individual residents birthdays. One resident said that they were very bored. There is scope for the range and frequency of leisure activities to be increased. Residents can have visitors at any time; and visitors spoken with said that staff made them very welcome and the home communicated well with them if there were any Care Homes for Older People Page 17 of 35 Evidence: concerns about their resident. Whilst there are no formal religious services taking place, ministers of religion visit individual residents and can be accessed as required. The menus offer a varied and nutritious diet and showed a choice of two options at each meal. Staff find out from residents what the individual wishes to have and give this information to the catering staff. There is no other way of informing or reminding residents about what is available at meals and it is recommended that a menu board is put in place in a prominent position, to remind residents of the choices on offer that day. The serving of lunch was observed and meals, including soft diets, were well presented. Staff were assisting residents with meals in an empathetic manner which maintained their dignity, and were also using this time to converse with the individual resident. Meal portions were a good size and residents spoken with said: I really enjoy the food its lovely Always plenty to eat; and its good home cooked food. They even make the cakes; they made me a lovely birthday cake. Really like the food, but Ive put on weight since I came here. The cook will do us something different to what we said we wanted if we dont fancy it when it comes. Residents said that they could have hot beverages or snacks at any time: The girls at night will make me a cup of tea when I ring my bell. Resident questionnaires received as part of the homes quality monitoring process were positive about the catering. Times of breakfast were from 8am, although residents who choose can have their breakfast earlier. There was little evidence of fresh fruit in the home, but this is included in some desserts. The kitchen area was exceptionally clean and the cook was able to show that all records as required by the Environmental Health Authority were in place and in date. The home has recently had the Environmental Health Authority visit and a few minor recommendations were made. The cook and the kitchen assistant both have the food hygiene course. Care Homes for Older People Page 18 of 35 Care Homes for Older People Page 19 of 35 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. Complaints are addressed in an open and transparent manner and residents said that they were comfortable that any complaints they may have would be addressed in an open and transparent manner. The adult safeguarding policy does not give clear guidance for staff and could put residents at risk. Evidence: The home has had five complaints in the past year. These have been addressed by the management in line with the homes complaints policy. The CQC has received no complaints about the home. Satisfactory records were kept of how complaints were received and addressed, and whilst residents spoken with stated that if they had a complaint they would speak with a manager, all appeared comfortable with the idea of having to make a complaint about any issue which concerned them. There has been one adult safeguarding alert reported by the home this did not involve staff at the home. One of the complaints received by the home should have been notified to adult safeguarding although relatively minor and would have possibly been put back to the home to deal with. Subsequent to the inspection an adult safeguarding alert was made regarding administration of medication. This is still ongoing. Care Homes for Older People Page 20 of 35 Evidence: The homes policy on adult safeguarding does not give sufficient guidance for staff on reporting adult safeguarding and this must be reviewed in line with the Multi -agency guidelines. Senior staff spoken with were not clear on reporting protocols and it is recommended that they attend training with the local authority. All staff receive adult safeguarding training in house from a trainer. Care Homes for Older People Page 21 of 35 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. Barons Down provides a pleasant, clean and comfortable home for residents. Whilst the home is clean there were some areas which could create problems with infection control and put residents at risk. Evidence: Barons Down provides accommodation for residents over three floors, these are served by a shaft lift. Communal space consists of a lounge, dining room and a small garden, which is accessible to all residents through the lounge. The majority of residents accommodation consists of single rooms; although there are three rooms which are used for shared accommodation for a maximum of two people. Whilst all single rooms have ensuite facilities, these are not provided in the double rooms. Whilst the AQAA did not state whether there had been any physical improvements to the home in the past year, the general manager said that there had been some new carpets provided and new linen. The home would benefit from replacement of some of the lounge chairs, which although fit for purpose are looking very tired. The home is generally well maintained and redecoration of some areas were taking Care Homes for Older People Page 22 of 35 Evidence: place on the day of the inspection. All residents are provided with call bells and these were within their reach. Whilst all doors to residents rooms were furnished with a lock; no evidence was seen regarding whether any residents were given the opportunity to have keys to their doors and there were no risk assessments in place to support any reasons for them not having these. All rooms seen had a lockable cupboard, but again there was no evidence of whether residents were supplied with keys for these. Water temperatures to residents outlets have been monitored on a regular basis and generally were within recommended parameters; however where there were inconsistencies there was no record of the action that was needed. One room had a very low recorded temperatures between February and April 2009, which were too low to afford the resident comfort. The general manager was unsure about whether these had been addressed and there were no records to indicate this. It was noted that one residents room and the staff room (which is accessible to residents) did not have patent window restrictors. An immediate requirement to remedy this was made, and the provider must ensure that window restrictors are regularly monitored. Whilst the home has policies on infection control, no member of staff has undergone the training recommended by the Health Protection Agency, and the home does not currently have a member of staff as infection control champion. As with all the policies seen, the infection control policy requires reviewing and expanding to ensure that it details the results of current research and how these are applied to practice. The underside of the bath seats in all of the bathrooms required cleaning. This should be done after every use. The bath in the top floor bathroom had the bath seat cover tied on with a piece of bandage which would hold bacteria, and the bath had the enamel peeling off which would also hold bacteria. It was noted that residents did not have individual hoist slings or hoist toileting slings which could lead to cross infection. Hibiscrub, which should only be used in cases of infection as it can lead to an allergy in the user, was found in the top floor bathroom with the top off, this could lead to cross infection and also to an ingestion risk for residents, and should be removed. The home was clean and there were no unpleasant odours apparent. Care Homes for Older People Page 23 of 35 Evidence: The kitchen was very clean and a recent environmental health visit had taken place. A few recommendations regarding recording were made. A range of equipment is provided for residents; these included hoists, variable height beds and other moving and handling aids to enable residents to maximise their independence. Care Homes for Older People Page 24 of 35 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. There are sufficient staff with suitable training employed to meet the needs of the residents in the home. The home operates a robust recruitment policy which ensures that residents are safeguarded. Evidence: The duty rota and conversations with staff and residents showed that there are sufficient staff on duty to meet the needs of the residents currently living in the home. Over 50 of the staff have the National Vocational level 2 or three in care. All staff participate in the Skills for Care recognised induction course at commencement of their employment. The home is to be commended over its commitment to ensuring that staff undertake the National Vocational Qualification. Staff receive mandatory training at intervals and attend ongoing training relating to their role in the home. Catering staff have the Food Hygiene Certificate and also attend mandatory health and safety training. Discussion with registered nurses showed that they have not attended ongoing Care Homes for Older People Page 25 of 35 Evidence: updating courses, in particular infection control and tissue viability, and registered nurses must be aware that it is their responsibility to ensure that they keep themselves updated with current practice and the provider must consider this when arranging training. Personnel files belonging to four members of staff were examined and included all documentation as required by regulation. New members of staff receive copies of the General Social Care code of conduct on commencement of employment at the home. Six members of staff were spoken with during the inspection, they confirmed that they attended mandatory health and safety training and that they attended other training provided by the home. Care Homes for Older People Page 26 of 35 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. Managment systems in place and current staff knowledge around some issues do not always ensure the safety of residents or ensure that their expectations are met. Evidence: At the time of the inspection there was no registered or appointed manager employed by the home and had not been since the latter part of 2008.The home was being managed by the manager from the sister home who is referred to as the general manager. Subsequent to the inspection the commission was informed that a new manager had been employed and has commenced in post. The provider is expected to put in the application for registration of this manager with the commission in the near future. Discussions with residents, visitors and staff showed that residents and their visitors were pleased with the care given at the home: Marvellous place. Staff very good. Very attentive. Staff said that they believed they had sufficient training to perform in Care Homes for Older People Page 27 of 35 Evidence: their roles. The AQAA Annual Quality Assurance Assessment was received by the date it was asked for. This did not give full and comprehensive information about what the home had achieved in the past year and plans for the next twelve months but the general manager was able to supply this information during the inspection. The home does not hold any money for residents and does not act as appointee for any resident. Evidence of reg 26 visits were seen (monthly visits to the home by the provider required by regulation), these identified any issues needing attention in the home and showed results of interviews with staff and residents. The provider has delegated the undertaking of these to the general manager however whilst the general manager was responsible for managing the home he has undertaken these. Staff have not been receiving regular supervision and only one supervision record dated Feb 2009 was available at the inspection. Senior staff were not aware of the Deprivation of Liberty Safeguarding and had limited knowledge of the Mental Capacity Act although the general manager had a working knowledge of the latter. Certificates relating to the servicing of utilities and equipment were in place and there was evidence of staff having regular mandatory training. There were some instances of equipment such as portable electric fans, bedrails and hoists being used with either no risk assessments or inadequate risk assessments and residents were also put at risk by the laundry door not being locked when unattended. As previously discussed in the report, two window restrictors were not patent and an immediate requirement was made. Information was received by the commission that this was complied with by the compliance due date. Policies and procedures examined require reviewing in line with guidelines from other agencies such as the Multi agency guidelines for safeguarding and generally need to be updated to include the practice implications of current research and new acts such as the mental capacity act and the Deprivation of Liberty safeguarding. All policies need to include guidance for staff. Care Homes for Older People Page 28 of 35 Care Homes for Older People Page 29 of 35 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 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 38 13 That the patency of window restrictors in the identified rooms is addressed and that routine monitoring of restrictors throughout the home takes place To ensure service users safety 11/05/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The Statement of Purpose 01/07/2009 and Service User Guide should accurately reflect the current status of the home including accurate and up to date statements about services provided. This must be reviewed regularly to ensure accuracy. Service Users should be provided with a copy of the Service User Guide To ensure that both prospective and existing service users are fully informed about the home and the services it provides Care Homes for Older People Page 31 of 35 2 3 14 That the preadmission 10/06/2009 assessment fully reflects the physical and mental health needs and social needs of the service user. To ensure that the care planning will meet the service users needs and arrangements can be made for continuation of treatment or therapies required. 3 7 15 That care plans accurately 10/06/2009 reflect all aspects of care required by the service user, include all current and changed needs and include explicit instructions for the delivery of care. That care plans are reviewed and updated on a regular basis and are formed and reviewed with the service useror their representative and evidence of this is supplied where possible. To ensure that all members of staff are aware of the current care that is to be given and to ensure that the individual receives care appropriate to their holistic needs. Service users should be awareof and agree with the care that is to be given. 4 9 13 That all medications including external medication are signed for following administration. That receipt of medication and handwritten records are 10/06/2009 Care Homes for Older People Page 32 of 35 signed by the accountable member of staff. To ensure that service users are not put at risk. 5 12 16 That the range and frequency of activities is increased in line with social care plans and individual preferences and abilities. To ensure service users receive adequate mental and physical stimulation 6 25 23 That water is kept at a temperature that ensures the comfort of service users and is in line with the recommended parameters. That actions to address discrepancies are recorded. To ensure service users comfort and safety 7 26 13 That issues around risk of 10/06/2009 infection including cleanliness of bath seats and viability of surfaces of baths are addressed. To prevent cross infection 8 31 18 That all senior staff receive training on safeguarding, mental capacity act and deprivation of liberty safeguarding. To ensure service users needs and expectations are met 30/06/2009 10/06/2009 01/07/2009 Care Homes for Older People Page 33 of 35 9 36 18 That regular supervision of 10/06/2009 staff takes place at time scales directed by the National Minimum Standards To ensure that service users needs are met 10 38 13 That all aspects of safety and risk assessment as discussed in the main body of the report are addressed. To ensure service users safety. 10/06/2009 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 2 3 4 9 15 18 33 That the manager undertakes regular medication audits. That a method of reminding residents of the days menu is provided. That senior staff attend adult safeguarding training with the local authority That policies and procedures are reviewed as discussed in the main body of the report Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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