Inspection on 27/01/10 for Blackwater Mill Residential Home.

This inspection was carried out on 27th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blackwater Mill Residential Home. 06/03/09

Blackwater Mill Residential Home. 06/10/08

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Blackwater Mill Residential Home. Blackwater Mill Country Retirement Home Blackwater Newport Isle Of Wight PO30 3BJ     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: Annie Kentfield     Date: 2 7 0 1 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Blackwater Mill Residential Home. Blackwater Mill Country Retirement Home Blackwater Newport Isle Of Wight PO30 3BJ 01983520539 01983520539 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Buckland Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 50. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: either, whose primary care needs on admission to the home are within the following categories: Physical disability (PD), Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Blackwater Mill Country Retirement Home is a registered care home that provides personal care for up to 50 older people. Buckland Care Ltd owns the service. The home is a substantial detached three-storey property set in extensive landscaped grounds, that includes a lake. It is located in rural Blackwater approximately two miles south of Care Homes for Older People Page 4 of 30 Over 65 50 0 0 50 0 6 0 3 2 0 0 9 Brief description of the care home Newport town centre with its shops and amenities. There is a wide range of sitting rooms, separate dining room and all bedrooms have en-suite facilities. The building is accessible and there is ample parking space. Details of fees and any other charges are available from the home. Care Homes for Older People Page 5 of 30 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: We made an unannounced visit to the home on 27 January 2010. This was with one inspector who was in the home from 9.30 am to 5.30 pm. The inspection visit involved five residents, three members of staff, two visitors and the manager and deputy general manager. We also looked at some of the care records, medication records, staff training and recruitment records, records of other inspection visits and information and notifications sent to us by the home. Before the visit we received the annual quality assurance assessment. This is a self assessment completed by the home and gives us information and a picture of the service. We received feedback surveys from 4 members of staff and 9 people living in the home. We also received positive comments in a letter from a relative and visitor to the home. We consulted with the Local Authority Social Services Department who have contact Care Homes for Older People Page 6 of 30 with the home. Care Homes for Older People Page 7 of 30 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 Care Homes for Older People Page 8 of 30 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 30 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 30 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. People do not move into the home unless their care needs have been assessed and the home is confident they can provide a service to meet the assessed care needs. The home does not provide intermediate care but does offer short periods of respite care. Evidence: We looked at the pre-admission records of three recently admitted residents. We found that detailed assessments of care needs were available and there was evidence that the family or other representatives were involved in the assessments where people were not able to fully contribute to the assessment themselves. The assessments included moving and handling, weight, past medical history, mobility and other support needed. This information is used to make an individual plan of care. Care Homes for Older People Page 11 of 30 Evidence: The home does not provide intermediate or rehabilitative care but does offer short term or respite care when needed. We received feedback from two people who receive respite care and they expressed their satisfaction with the care provided by the home. One person told us: the staff have been consistently caring and pleasant, even at times when they are under pressure, such as meal times. The home is not registered as a service offering a specialist service in dementia care. However, there are people living in the home who have dementia care needs as part of their care plan. In the interests of ensuring that staff have the skills and knowledge to meet the needs of people living in the home, we have made a regulatory requirement that staff receive suitable training and information about meeting the care needs of people with dementia. The certificate of registration that is on display is out of date. We have arranged for an updated certificate to be sent to the home to indicate that the registered manager post is currently vacant. Care Homes for Older People Page 12 of 30 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. People living in the home receive care that respects privacy and dignity. People have access to health care services as required. Person centered care plans are being developed to ensure that people receive care in the way they prefer. The management of medication has improved but the home does not have consistent management systems in place to ensure that improvements are sustained and embedded in practice. This may put people at risk of not receiving their medication, as prescribed, at all times. Evidence: Following our previous inspection visit we made regulatory requirements about care planning, recording of food and fluids, management of medication, and management of creams and ointments to ensure safe procedures for infection control. The annual quality assurance assessment (AQAA) that we received from the home told us that since the last inspection the home has introduced a key worker system and staff have received training in recording and report writing. The AQAA also told us that the home has taken action to ensure that care plans are individual and person Care Homes for Older People Page 13 of 30 Evidence: centred to include a new section with relevant personal information about each resident and a clinical assessment. The AQAA also confirmed that daily food and fluid charts and dietary assessments are monitored and kept up to date, also that a new procedure is in place for all prescribed creams and ointments. We noted that the home has a new audit checklist system in place to monitor care and practice in all areas. We looked at the audit checklist for 15 December 2009 and this told us that all care plans are reviewed monthly and any gaps in care records are highlighted for staff action. In December it was noted that staff were reminded to ensure that monthly weight records must be recorded as two gaps were noted. In addition, one care plan was missing personal all about me information. The audit also noted that the food and fluid chart for one person had not been fully completed for each day. The audit checklist for the home is a comprehensive document and shows us that action is being taken by the home to ensure that care records are completed and care plans reviewed on a regular basis. However, the home does not have a registered manager at present. This means that the day to day monitoring of practice in the areas of health care and medication may not be consistently and regularly carried out by a person qualified to do this. This also means that outcomes for people living in the home are not consistently good because the home has not sustained improvements to the management of medicines. During this visit we looked at three care plans to assess how the home meets peoples assessed care needs. The plans of care that we looked at contain more detail of how people wish to receive their care, with more information about personal choices and preferences to guide care staff on how care is to be provided. The care plan for one person contained a dietary and nutritional assessment for the management of diabetes. This care plan contained detailed information about how the resident wishes to receive their care, for example, what time they liked to get up and go to bed, their preferences for receiving care from a male carer etc. The deputy manager told us that this care plan had been agreed in consultation with the resident. However, not all of the care plans contained this level of information or personal detail. Another care plan contained relevant information about emotional and psychological care needs. However, the care plan did not contain sufficient guidance for care staff on how they identify the risk of relapse or manage events safely because the care plan did not contain a written plan about relapse indicators. Discussion with a member of staff demonstrated that staff have information and knowledge about how to manage any risks or events but this had not been recorded in the care plan and therefore had not been reviewed regularly. Another care plan that we looked at did not contain any Care Homes for Older People Page 14 of 30 Evidence: information or a risk assessment for the bed rails that were being used. This means that the resident may be at risk of harm because the use of bed rails had not been fully assessed for any possible risks and staff did not have written guidance on the management of any risks as part of the plan of care. The home told us in the AQAA that they use a nationally agreed care management tool to provide appropriate end of life care. We saw evidence of this process in practice. However, we were told that staff have not yet received specific training in using this care management tool or training in good practice in end life care. The deputy manager told us that key workers have not yet completed all of the information in the new care plans to record peoples wishes and preferences about end of life care and other relevant information. We were told that this work is ongoing. We looked at the management of medication in the home. We confirmed that staff who were responsible for dispensing medication on the day of our visit, had received suitable training in the safe administration of medication. However, we noted that some staff had completed their medication training in 2005. We were told that the home does not have a procedure in place for updating medication training or an internal procedure for regularly assessing the competency of care staff who dispense medication. The medication in the home is stored in two lockable trolleys, kept in a locked room when not in use. Any controlled drugs are stored appropriately and the controlled drug register was maintained and up to date. We observed staff dispensing medication at lunchtime, and noted that the medication administration records were updated as each medicine was given. The audit records for the home show that in December, some gaps in recording medication were found, and the home action plan has highlighted the need for staff to ensure that medication record sheets are signed for every medicine given. We looked at the medicine records for one person and we found that a medicine that must be given every 72 hours had been given at the wrong interval on one occasion in January. The record sheets did not contain an explanation as to why this happened. The deputy manager told us that this would be addressed with senior staff. We found that two people were using medicines that they managed themselves. However, we did not find a risk assessment that had assessed whether it was safe for people to look after their own medicine to ensure the safety of the residents and others. This means that there is a potential risk to people in the home because of poor medication management. At the last inspection we made a regulatory requirement to ensure that all prescribed creams and ointments are safely managed. We were told that the home now has a Care Homes for Older People Page 15 of 30 Evidence: new system in place to make sure that all creams and ointments are properly labeled, rotated to ensure they are in date, and only used by the person named on the prescribing instructions. Care Homes for Older People Page 16 of 30 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 are offered an organised and varied programme of social activities and the opportunity for religious worship. Visitors are welcome. A choice of well presented meals are offered and provided in an attractive setting. Evidence: The home employs an activities co-ordinator and there is a planned programme of social activities and events that take place Monday - Friday. People in the home have the choice of taking part in communion each month and the activities co-ordinator told us that other denominational services could be arranged if requested. The activities programme offers a mobile shop, knitting, music, chat, scrabble and other games, crafts, exercise, and bingo. There is a Movie Night on Thursdays. People have access to a visiting hairdresser and podiatrist. Comments from people in the surveys indicated that there were always or usually activities they can take part in. One person commented that they would like more opportunity to go out and also to go out into the garden. The home has previously told us that they planned to make an accessible path/walkway around the lake so that Care Homes for Older People Page 17 of 30 Evidence: people can easily access this area. We were told that there are technical difficulties in getting permission to do this at present. The annual quality assurance assessment (AQAA) completed by the home told us that the home plans to improve social events for residents by arranging more outings and evening activities. The home has an open visiting policy and visitors we spoke to told us we are always made welcome by staff and are offered hot drinks etc. Overall, feedback about meals in the home was positive and several people commented: the food is excellent. Two people said that the food was usually good and one person commented: meals could be kept hotter during transit between kitchen and bedrooms. Meals can either be taken in the large and attractive dining room on the ground floor, or some people prefer to have their meals either in their room or in one of the sitting rooms upstairs. We observed staff taking meals to people upstairs, these were carried on a tray, however, one meal was covered with a plate lid, but one tray and meal did not have a plate lid. This process could mean that meals arrive upstairs considerably less hot than when they were first plated up. People we spoke to confirmed that they are always offered a choice of main meal, and dessert. The dining room has a large daily menu blackboard. On the day we visited, the menu board had not been written up. The lunchtime meal looked well balanced, freshly cooked and well presented. A member of the kitchen staff speaks to each resident daily to help them make a choice from the menu. At the last inspection visit we observed that people taking their meals upstairs are served their main meal and pudding at the same time, this is still in practice. Hot and cold drinks and snacks are provided throughout the day and two people told us that staff will make them a drink at other times when requested. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure, however, the information has not been updated. Staff are aware of what they must do to protect people from the risk of harm and abuse and safeguarding awareness training is ongoing and part of the staff training programme. Evidence: There is a formal complaints procedure and this is on display in the home. However, the information about how people can contact the Care Quality Commission is out of date and does not give people the correct address and telephone number if they wish to contact the commission. In the annual quality assurance assessment we were told that the home has received 13 complaints, and that all of these have been resolved within 28 days and 5 complaints have been upheld. A record of all complaints and the action taken is kept in the home. We looked at the staff training matrix as provided by the home and this indicated that 15 staff have completed safeguarding awareness training and further training dates have been arranged. We were told that new staff also cover safeguarding policy and procedures during the 12 week induction programme Skills for Care. We were told that one member of staff has completed training in the Mental Capacity Care Homes for Older People Page 19 of 30 Evidence: Act and Deprivation of Liberty Safeguards. The training programme told us that training for more staff in the Mental Capacity Act is planned. In the interests of ensuring that staff have an understanding about how the Mental Capacity Act may affect residents in the home who do not have the capacity to make important decisions about their care; training will provide staff with the relevant information and knowledge. We have received information from the home about events that have happened in the home, these are called notifications and are a legal requirement. This demonstrates that the home is aware of the need to report incidents that affect the safety and well being of people living in the home. Since the last inspection there have been some specific concerns about practice in the home and these were referred to the Local Authority Social Services/Safeguarding Team. The registered persons worked with the Local Authority during a period of investigation and the investigation is now closed. Since we visited the home in January we have received two complaints about the home with regard to allegations of poor practice. These allegations have been referred to the Local Authority for investigation and the outcome is not yet known. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides people with a warm, clean, homely and well maintained environment that meets their needs. The home has an operational policy and procedures for staff to follow to promote and maintain good hygiene and the risk of infection. Evidence: Residents and visitors we spoke to and comments from the surveys confirm that people are very satisfied with the home environment. People told us: The accommodation is first class! The rooms, both private and public, are kept clean and tidy. The care given willingly and efficiently by the housekeeping staff is outstandingly good. Residents and visitors also commented that the home is always fresh and clean. We spoke to a member of staff who showed us the operational procedures that are in place for staff to follow with regard to hygiene and infection control. Staff have access Care Homes for Older People Page 21 of 30 Evidence: to gloves and aprons and there are special procedures in place to control infection and reduce the risk of cross infection. The entrance to the home contains information for all visitors about the importance of good hygiene and antiseptic hand spray is provided. Shared toilets and bathrooms are equipped with liquid soap, paper towels and antibacterial hand gel. The home has a well equipped laundry room and a separate sluice room. These rooms are kept locked when not in use to ensure the safety of residents in the home. Care Homes for Older People Page 22 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels are adequate although there are sometimes periods when staffing levels are stretched and people may have to wait for assistance. The home is committed to providing training to ensure that staff are qualified and experienced for the work they do. However, staff have not received any training in caring for people with dementia or end of life care. Staff recruitment procedures are sufficient to demonstrate that new staff are suitable to work in the home. Evidence: At the time of our visit the home had 48 residents and the staffing rotas told us that there are usually 7 members of care staff on duty during the day and 4 care staff at night. In addition, the home employs staff who are responsible for cooking, cleaning and laundry, each day. The manager of the home was working, in addition, from Monday to Friday, 9am to 5pm. However, since we visited the home in January, the manager has left and the responsible person for the home has told us that the post is being advertised. People we spoke to told us that usually staff are available when they need some help or assistance. One person told us that there are certain busy periods during the day when they know that staff will not be available to respond quickly to a request for help, particularly mealtimes. Another person told us that a quicker response to calls for attention could improve the service. People we spoke to were positive in their Care Homes for Older People Page 23 of 30 Evidence: feedback about the caring and kind attitude of staff and several people told us that the staff work very hard and are always busy. We were able to confirm from records in the home that new staff receive an induction and have received training in moving and handling as a priority when they first start working in the home. There is a staff training programme and we looked at the training matrix of training that had been completed and the records for training that is planned. The home was able to confirm that almost all of the staff have now completed fire safety training. Further training in infection control, the Mental Capacity Act and medication was planned for January 2010. The records show that staff have not done any basic training in dementia care awareness, or palliative care. Care staff are working with end of life care pathways but have not received specific training in this area. We were told that this would be arranged at a later date. Although the home does not provide a specialist dementia care service, there are people living in the home who have dementia care needs and outcomes for people may not be consistently good if staff do not have the knowledge and awareness of meeting dementia care needs in a way that meets current good practice guidance. Information in the AQAA told us that approximately 50 of the care staff have achieved an NVQ (national vocational qualification) in care, at level 2 or above. We looked at the staff recruitment records for three new members of staff. These confirmed that satisfactory checks are carried out to ensure that staff are suitable to work in the home. The home told us that new staff start on a 12 week induction programme - skills for care following their initial induction to the home. There are systems in place to supervise and support staff and we were told that formal supervision or an appraisal takes place for all staff every 8 weeks. In the absence of a registered manager, supervision of staff is being carried out by the two deputy managers, one of whom has done some supervisor training as part of their level 3 management training. Care Homes for Older People Page 24 of 30 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 does not have a registered manager. This means that people may be at risk of poor or inconsistent practice in the home because of the lack of consistent day to day management of the home by someone who has been assessed as qualified and competent to do this. There are quality assurance and auditing systems in place and these are being developed further. The health and safety of residents and staff is promoted and protected by internal monitoring systems. Residents financial interests are protected. Evidence: We spoke to the deputy manager and administrator and we confirmed that the policy of the home is that staff do not act as financial or legal appointees for residents. Fees and additional expenses are invoiced to people or their representatives. This ensures that peoples financial and legal interests are protected. The home has not had a registered manager since the end of 2008. Three managers have been appointed but have not continued in the post. This means that the day to Care Homes for Older People Page 25 of 30 Evidence: day management and running of the home has not been consistently managed by someone who has been assessed as fit and competent to be the registered manager by The Commission. The absence of a registered manager does not promote good outcomes for people living in the home. For example, we have highlighted further concerns about the management of medication in the home and this reflects on the management of the service. Following the inspection visit we wrote to the registered provider about our concerns about the management arrangements for the home and because the home has not had a registered manager for over 12 months. The responsible person has told us that the post of manager is currently being advertised. The responsible person also keeps us informed of any incidents or events in the home that may affect the health and well being of the residents. This is a legal requirement. We saw evidence of quality monitoring systems such as the audit checklist and monthly inspections of the home by the providers representative. A customer satisfaction survey was carried out in March 2009 and we looked at the survey outcomes. The survey highlighted some areas that could be improved based on feedback and comments from people. We were told that an action plan for improvement based on the survey findings is due to be summarised later in 2010. The annual quality assurance assessment confirmed that there are systems in place to check that equipment and fire safety equipment in the home is regularly serviced and properly maintained. We were told that staff have undertaken fire safety training and staff complete health and safety training annually (this is a health and safety workbook that staff work through). The deputy manager confirmed that the home has complied with the requirements of a food safety inspection that was carried out in October 2009. We received the annual quality assurance assessment (AQAA) from the home. However, the self-assessment was completed by the acting manager at the time and not the responsible person for the home. The AQAA did give us a picture of the home and some statistical information. It also told us about areas of practice that need to be improved. For example, the home has aimed to improve record keeping by providing staff with training in report and record writing. We also found that the home has taken action to ensure that equality and diversity are promoted by developing information about choice and preference in the individual care plans. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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 9 13 Arrangements for the administration of medicines must be safe at all times. People living in the home must receive their medication safely and as prescribed, at all times. 31/03/2010 2 30 18 Staff working in the home must receive training suitable for the work they do. In the interests of meeting the care needs of all service users; staff must receive suitable and specialist training as required. 30/04/2010 3 38 13 Unnecessary risks to the 31/03/2010 health or safety of people must be identified and so far as possible, eliminated. Where it has been identified that the use of bed rails is required for the safety of a resident; a clear plan of care Care Homes for Older People Page 28 of 30 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 must be in place that follows current good practice guidance, and provides information for staff on how the risks are to be managed, and regularly reviewed. 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 9 The management of medicines in the home should be reviewed in line with current good practice guidance: The Handling of Medicines in Social Care produced by the Royal Pharmaceutical Society of Great Britain. Care Homes for Older People Page 29 of 30 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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