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Inspection on 16/12/08 for Blackdown Nursing Home

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

This inspection was carried out on 16th December 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 2 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 is managed by an experienced manager who is considered professional and capable by people who know the home. Staff are recruited using practise that protects the vulnerable People at the home. They are properly trained and supported. A G.P. who knows the home said that staff have an excellent clinical knowledge of their patients and a very pro-active approach. The The and and home environment is very clean, mostly fresh, warm and appeared comfortable. layout provides people with the opportunity to share small and fairly homely sitting dining rooms. There is a good quantity of equipment. The standard of cleanliness approach to hygiene is very high.People like the food, which is well presented, very tasty, varied and at intervals which ensures needs should always be well met. People are treated with respect by an enthusiastic and professional staff. People are offered choice and encouraged to partake in daily life at the home, which includes some organised activities and entertainment. Care is planned in sufficient detail that staff have the information to tell them what care they must deliver.

What has improved since the last inspection?

There were no previous requirements for the home to meet. The recommendations of implementing staff supervision still needs some attention but the scope of quality assurance is satisfactory. Improvements in the home environment includes; thermostatic taps to prevent scalds, replacement of furniture, upgrading of beds and nursing equipment such as pressure relief mattresses, refurbishment of bathrooms and toilets. Each will provide a safer and more pleasant home in which to live.

What the care home could do better:

Risks of pressure sores, falls, moving people with mobility problems and dietary risks are not always assessed as they must be. This would protect both the person receiving the care and the staff who is to provide it. People must be informed in writing that their assessed needs can be met. This protects both the person receiving the service and the home itself. It is also a legal requirement that this is done. The management of complaints would benefit from a review so as to make them a more important aspect of providing a quality service. People with mobility problems would benefit from handrails in the long wide corridors at the home. People with reduced memory would benefit from adaptations which help them understand their environment, in line with current good practise in dementiacare.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Blackdown Nursing Home Blackdown Blackdown Nursing Home Mary Tavy Nr Tavistock Devon PL19 9QB     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: Anita Sutcliffe     Date: 2 2 1 2 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. 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 28 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 28 Information about the care home Name of care home: Address: Blackdown Nursing Home Blackdown Nursing Home Blackdown Mary Tavy Nr Tavistock Devon PL19 9QB 01822810249 01822810279 anne.ringer@carehomeproperties.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) : Blackdown Care Ltd care home 33 Number of places (if applicable): Under 65 Over 65 0 19 3 33 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 19 0 0 0 The maximum number of service users who can be accommdated is 33. The registered person may provide the following category of service only: Care home with nursing- Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP- maximum of 3 places Physical disability age 65 years and over on admission- Code PD(E)- maximum of 33 places Dementia- Code DEmaximum of 19 places Mental disorder, excluding learning disability or dementia, aged 65 years and over on admission- Code MD(E)- maximum of 19 places Date of last inspection Care Homes for Older People Page 4 of 28 Brief description of the care home Blackdown Nursing Home is a care home that is registered to provide nursing care to a maximum of 33 people of either sex, over the age of 65. A maximum of 26 beds may be provided to people who have been assessed as having general nursing needs, and a maximum of 19 people who have been assessed as having mental health nursing needs. It is also registered for up to 3 people who have personal care needs only. The Registered Manager is a level one trained nurse. She leads a team of other registered nurses, care and ancillary staff. Blackdown Nursing Home is arranged on two floors with access to the first floor via a shaft lift. There is also a stair lift available. The home has a lounge at the front of the building, and two lounge/dining areas. The unit, designed for the 19 older people with mental health needs (Sunflower), is secured for their protection. There are extensive views over mainly rural land to Dartmoor and large gardens surrounding the home. New building work is planned which currently affects the gardens. The home is situated in the village of Mary Tavy where there are a number of local amenities. The homes present fee structure is £520 to £580 and does not include extras such as papers, hairdressing and chiropody the cost of which are invoiced to the appropriate person. Fees are negotiated based on the level of care that is to be provided. Care Homes for Older People Page 5 of 28 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: Information about the home has been collected toward this key inspection since the previous key inspection in June 2007. We have reviewed the rating and status of the home twice since that inspection and there had been no change. This inspection included one unannounced visit and one announced visit to the home. We were accompanied by an Expert by Experience. They are people who, because of their shared experience of using services, and /or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. As part of the visit to the home we looked at all communal areas, and several Care Homes for Older People Page 6 of 28 bedrooms. We spoke with several people who use the service, some family and other people visiting. We watched staff going about their work. After the visit we spoke with a social care professional who had recently visited the home. We looked at the care and support that three people receive, meeting them and looking at records of their care. We also looked at the records of a person, who had been at the home, in connection with a complaint. We spoke with the registered manager, registered provider and some staff. We looked at other records including medication, staff recruitment and training. People who use the service may be described within this report as residents, clients or service users. What the care home does well: The home is managed by an experienced manager who is considered professional and capable by people who know the home. Staff are recruited using practise that protects the vulnerable People at the home. They are properly trained and supported. A G.P. who knows the home said that staff have an excellent clinical knowledge of their patients and a very pro-active approach. The The and and home environment is very clean, mostly fresh, warm and appeared comfortable. layout provides people with the opportunity to share small and fairly homely sitting dining rooms. There is a good quantity of equipment. The standard of cleanliness approach to hygiene is very high. People like the food, which is well presented, very tasty, varied and at intervals which ensures needs should always be well met. People are treated with respect by an enthusiastic and professional staff. People are offered choice and encouraged to partake in daily life at the home, which includes some organised activities and entertainment. Care is planned in sufficient detail that staff have the information to tell them what care they must deliver. What has improved since the last inspection? What they could do better: Risks of pressure sores, falls, moving people with mobility problems and dietary risks are not always assessed as they must be. This would protect both the person receiving the care and the staff who is to provide it. People must be informed in writing that their assessed needs can be met. This protects both the person receiving the service and the home itself. It is also a legal requirement that this is done. The management of complaints would benefit from a review so as to make them a more important aspect of providing a quality service. People with mobility problems would benefit from handrails in the long wide corridors at the home. People with reduced memory would benefit from adaptations which help them understand their environment, in line with current good practise in dementia Care Homes for Older People Page 8 of 28 care. 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 28 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 28 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. People would benefit from a more thorough assessment of risk at their admission. Evidence: The manager told us that all prospective residents receive information about the home and we saw detailed written information displayed near the entrance. This included photographs and clear information about what the service does, and does not, provide. We looked at how the last admission to the home was managed and discussed our findings with the manager. Assessment information had been provided by the hospital from which the person was discharged. There was no additional assessment by the home. Of concern was that risks, for example, the likelihood of pressure sores, had not been assessed using tools normally associated with nursing care. The matron said this was because the person was at the home for short term care only, but agreed they should have been completed. The plan of how care was to be delivered did include how Care Homes for Older People Page 11 of 28 Evidence: staff are to manage those risks and we saw that pressure relieving equipment was in place as needed. (See also Health and Personal Care). The manager was unaware that people must have written confirmation that their assessed needs can be met by the home. This protects both the home and the person to be admitted. Care Homes for Older People Page 12 of 28 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. People are treated with respect and dignity. They are protected by the health care provision at the home, but this could be further improved. Evidence: We looked at four care plans and saw that there was detailed information for staff on how they were to deliver care to people. Two included assessment of how to move the person safely, nutrition, and their history of falls. Two did not. Care staff told us that nursing staff inform them what care is needed, but they knew the plans were also available for their use. We saw that plans had been reviewed and updated as necessary. There was no information to suggest that people who use the service, or their representative, are involved in the planning of their care, but at a meeting in March family were invited to: look at the care plans because families know the resident best and may thing of things we have missed. Plans should always be drawn up with the involvement of the person using the service or a representative to ensure the persons Care Homes for Older People Page 13 of 28 Evidence: wishes are fully taken into account. A visiting G.P. said of the home: Visits are well coordinated and staff have an excellent clinical knowledge of their patients, with a very proactive approach. We saw that people looked well care for and were told: Staff know what theyre doing and theyre all very sociable and kind and Couldnt wish for better care. We looked specifically at how the home protects frail people from getting pressure sores. We found that the risk of this was not always assessed, but there was always a plan of how to prevent it and specialist pressure relieving equipment in use. However, it was confirmed by the manager that one person left the home with a pressure sore and neither the persons G.P. or the community nursing service was informed of this. Continuity of care had not been arranged and this put the person at risk. This led to a complaint against the home. We talked to two care staff about how they record the care that is provided. They said that fluid, diet and turn charts are not always used. The manager confirmed this. One persons plan of care instructed staff to changed their position in bed two hourly, toward preventing pressure sores. There was no record that this is done. We looked at how the home manages medicines. We were told that currently no person is able to manage their own. We found that the storage of medicines was safe and the home keeps very good records of medicines in the home, administered and removed from the home, as they should to ensure the system in place is safe. We saw that stock was rotated so medicines are in date. Several people have medicines which are to be used as necessary, or as required but we found no information telling staff when they would be necessary or required. This information must be part of care planning so the use of the medicine is consistent. The manager said this would now be arranged. We saw that staff were polite, friendly and respectful to people. The Expert by Experience saw that there was a comfortable relationship between residents and staff, with gentle care and due respect being shown. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead a fulfilled life within their capabilities and their dietary needs are well met. Evidence: Care plans provide some good detail about peoples cultural and spiritual needs and personal interests. Some people were aware of the various activities available to them quoting: exercise and movement (one adding although I do try to avoid it!), board games, card games, music and weekly bingo. Activities are mainly organised by staff. We saw that library books at the home are replaced regularly, a hairdresser visits and friends and family are welcomed. There was a recent Christmas party, with entertainment, and a buffet described by family as excellent. The television was on continuously in the lounge. During the latter part of the morning most of the people in the lounge were seen to be sleeping or resting. After lunch some people retired to their rooms to rest. We were told that the local vicar attends once a month for the Sacrament of Holy Communion, which is said to be well attended. The home shares a minibus with two other homes and the service provider said that trips out are arranged fairly frequently but often people change their minds at the last minute and do not go. Care Homes for Older People Page 15 of 28 Evidence: The meal menu is displayed for people. There is a four week rota, with two choices of meal, which is varied. The cook described how she is able to provide specialist meals and was aware of peoples likes and dislikes. There is always a vegetarian option on the menu. Most people seemed satisfied with the quality and quantity of the food saying: Food very good, and I get enough to eat. One person said, The food is a bit heavy and stodgy. No one could recall ever being asked what his or her favourite meal was. On the day of the visit the lunch comprised of soup followed by a plated meal of roast pork with apple sauce, roast potatoes, carrots and cabbage. The meal was well presented, tasty and hot. The dessert was to have been apple crumble but was changed to apple with custard to aid those having difficulty in swallowing due to illness. Tea or coffee followed. Some people chose to eat in their bedrooms, others remaining in their armchairs in the lounge with the remainder sitting at tables in the dining areas of the lounges. The meals and drinks are well spaced during the day and evening. They include coffee with hot milk. We tasted the home baking, which was excellent. We observed water jugs being replenished and where people needed assistance with their diet this was provided sensitively. Care Homes for Older People Page 16 of 28 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. The management approach to complaints could be improved but people are protected from abuse. Evidence: The homes complaints policy is clearly displayed at the entrance to the home. It contains CSCI contact details and is clear that, if people want, they can contact us at any stage of a complaint. We have received one complaint against the home since the last key inspection, this having first been taken to the home itself. The complainant told us they found the response from the home unsatisfactory. This complaint was also referred to the local authority safeguarding team. We spoke with a social worker who accompanied the complainant to a meeting at the home to discuss it. She reports that the home did not handle the meeting well. The providers tell us they are at a loss to know how to put the matter (the complaint) right. On our first visit to the home the Expert by Experience was asked to inform the provider that a person wished to make a complaint to them. At the second visit we asked to see the record of that complaint. It had not yet been recorded and there was Care Homes for Older People Page 17 of 28 Evidence: only the one, previously mentioned, complaint on record. We visited the complainant who said that, so far, she was happy with the way her complaint had been handled. We discussed with the manager the value of taking any complaint, however apparently small, and ensuring there is a record of how it was dealt with. Two staff told us that if people are not happy they always tell the person in charge. People told the Expert by Experience that they would complain to the manager or service provider should the need arise. There are several posters telling staff and visitors how to respond if there are concerns, which might be abuse. This is repeated in the staff room and all staff receive training in how to safeguard people from abuse. We asked staff what they should do if they had concerns that were not being dealt with properly by the home itself. Two care staff were unaware of outside safeguarding agencies or that they were protected in law if they wished to whistle blow. Two care staff were fully aware of outside safeguarding agencies. A registered nurse and the manager were aware of how they should respond. Throughout the inspection we saw a comfortable relationship between people and staff. We believe that staff would report any concerns promptly. Care Homes for Older People Page 18 of 28 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 warm, very clean, mostly fresh, well maintained and meets the needs of people who live there. Evidence: At both visits we found the home to be warm, clean, mostly very fresh, well maintained and comfortably furnished. We were informed of recent upgrading, such as the refurbishment of a downstairs bathroom and safety thermostatic taps to all hot water outlets, and given a list of future planned improvements. Shared facilities are pleasant and well thought out. Two lounge/dining areas have outlooks to the gardens and a homely feel to them. An additional third lounge provides space for private, perhaps family, meetings and is also used for religious services. It was warm and welcoming on a cold day when it was not in use. Staff told us they have the equipment they need and the manager said that any equipment necessary is provided. The upgrading of beds is on-going and pressure relieving mattresses are available. However, we noted that there are no adaptations to the decor to help people with memory problems find their way about, and no handrail on long wide corridors. These would help people to maintain their independence as they could be less reliant on staff. Care Homes for Older People Page 19 of 28 Evidence: Some of the bedrooms had been personalised to a limited degree but others displayed little of the character and history of the occupant. Each person is able to lock their bedroom door for privacy and each room has safety adaptations, such as radiator guards to prevent contact burns. Liquid soap and hand towels are available for staff for hand washing and they have protective clothing available to them. Staff receive training in infection control. The home is very clean. The laundry worker understood the importance of separating soiled from non soiled laundry and there is a non touch system in place for doing this. This reduces the likelihood of cross contamination. The laundry room is very clean. There is commercial equipment, suitable in type and amount, to fully meet the needs of the home. Care Homes for Older People Page 20 of 28 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. People benefit from a safely recruited, fully trained and competence staff to care for them. Evidence: There seemed to be a comfortable relationship between people who use the service and staff with gentle care and due respect being shown by all parties. People spoke well of the staff saying: Staff very kind to me, They know what they are doing, They are good to me, and Couldnt wish for better care. People said that the call bells were answered promptly as was evident throughout the visit with delays of no more than two or three minutes being common. Staff told us there are enough staff. We saw that staff turn over is quite low and were told that, where necessary, agency staff are employed so as to ensure any shortfalls are met. Care and nursing staff are well supported by housekeeping staff. At both visits to the home there were two registered nurses, four care assistants, a cook, kitchen assistant, laundry worker and cleaner. Staff are of both gender and various ages which provides a balance, for example, people can choose to have either a male or female provide their personal care. One staff, relatively new, said her induction took place over a few days. She said how Care Homes for Older People Page 21 of 28 Evidence: good it had been saying:Very good. I knew where I was with everything. We discussed training with nursing, care and housekeeping staff. All said they received health and safety training, including fire safety, moving and handling, first aid, food hygiene and how to safeguard vulnerable adults from abuse. We looked at previous and future training arrangements and saw that staff have received training appropriate to the needs of people at the home, such as the care of people with dementia. Training is planned in advance. We asked the manager how she assured nursing is carried out correctly. She said she works along side the staff, does not stay in the office, and so is able to observe their work first hand. We were told that all care staff have either achieved National vocational Qualifications (NVQ) 2 in care or above, which is an indicator of their competence. The recruitment records of the last two staff to be employed at the home showed us that all necessary checks, to ensure staff are safe to work with the vulnerable adults at the home, had been completed prior to them starting work. Staff also have the General Social Care Council code of conduct available to inform them how they are expected to perform their work in a care setting. Care Homes for Older People Page 22 of 28 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. People benefit from a home which is well run by a competent manager. Evidence: There were many favourable comments about the manager Mrs. Hoyle. We were told by a social care professional that she runs a tight ship and by a person who uses the service: Matron is very accommodating. A regular visitor said: Nice people, well organised, communication is pretty good and they care. We found that staff were both caring and professional in their approach and clear what is expected of them. Many visitors spoke to Mrs. Hoyle as they entered the home. She is clearly well known and approachable and people told us: She goes around the home several times a day (visiting people). People who use the service were not aware of being asked their opinion of the home but we saw there had been a meeting in March which involved them, their family and staff. We were told that surveys are sent to people about once a year and saw an example where negative comments had been responded to by the Care Homes for Older People Page 23 of 28 Evidence: provider. Cards are displayed at the entrance so people can comment on the home. The manager says that currently no person is able to manage their own financial affairs. People are invoiced for any sundry items purchased and for hairdressing and chiropody. No money or valuables is kept on peoples behalf. The manager told us that formal supervision of staff is not up to date, but all staff have received some supervision. We saw some records of those supervisions. Staff are trained in all aspects of health and safety. We saw staff assisting a very immobile person to move; they did this very competently. We were shown the homes fire safety risk assessment and a file containing assessment of other risks within the building. We saw nothing within the home which might be a health and safety concern and found the standard of maintenance was high. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 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 16 22 The management must review the way complaints about the home are handled. Complaints are a method for improving quality of the service and peoples lives. 31/12/2008 2 16 17 (2) A record must be kept of 31/12/2008 all complaints made and include details of the investigation and any actions taken. As a record which protects people who are vulnerable. 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 3 Assessment of risk to people should be undertaken using recognised assessment tools, according to Department of Health guidance. All staff should be aware of how to respond to concerns not being dealt with adequately at the home (whistle blowing) Page 26 of 28 2 18 Care Homes for Older People and how they are protected under the Public Interest Disclosure Act 1998 and Department of health guidance No Secrets. 3 22 Handrails, and other adaptations to the environment, should be provided to help people maintain their independence. Care Homes for Older People Page 27 of 28 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. 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