Inspection on 16/04/09 for Blyth House

This inspection was carried out on 16th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blyth House 21/05/08

Blyth House 18/08/06

Blyth House 29/10/05

Blyth House 18/05/05

Blyth House 21/12/04

Blyth House 24/08/04

Blyth House 16/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Blyth House 16 Blyth Road Bromley Kent BR1 3RX     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: Wendy Owen     Date: 2 0 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 30 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 30 Information about the care home Name of care home: Address: Blyth House 16 Blyth Road Bromley Kent BR1 3RX 02084603070 02084661627 blythhouse@tiscali.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) : Chislehurst Care Limited care home 16 Number of places (if applicable): Under 65 Over 65 16 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category of service only: Care home with nursing (CRH - 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 - Code OP Date of last inspection Brief description of the care home Blyth House provdes nursing care for service users in the category of Older Persons. The home has been registered to the current provider since September 2002. The home was previously registered under the Registered Homes Act 1984. The premises have been adapted and are purpose built. It has bedroom accommodation on the two floors. Communal areas are located on the ground floor with the laundry located in a separate building at the rear. All rooms are for single occupancy. A garden is located to the rear of the building with hard parking to the front of the building. The rear garden is accessed by a side gate. The top floor of the building is used as staff accommodation and is therefore not part of the registered premises. The home operates with qualified nurses and care assistants throughout the twenty-four Care Homes for Older People Page 4 of 30 Brief description of the care home hour period. Residents are supported by GP services and specialist health provision, such as the Community Psychiatric Nurse. Fees ranged from £605 for single and £750. Additional charges are made for hairdressing, magazines, papers, toiletries and clothing. The home has developed a Statement of Purpose and Service Users Guide and this provides prospective residents and their representatives with information on the care provided. Inspection reports available from the home on request. 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: The last key inspection was completed on 21st May 2008. This unannounced visit to the home was undertaken as a part of the inspection process for the year 2009/2010. In writing the report, consideration has also been given to information received throughout the year such as comments from people who use the service, reports of incidents and complaints. The registered manager facilitated this inspection. An expert by experience, a person who has some personal understanding of the needs of older people accompanied the inspector during she visit. She observed practices, routines and spoke to a number of people about the care they received and she also undertook a tour of the building. We also looked the the records and had discussions with the manager, area manager Care Homes for Older People Page 6 of 30 and staff. All registered adult services are now required to fill in an annual quality assurance assessment (AQAA).It is a self-assessment that the provider (owner) must complete every year. The completed assessment is used to show how well the service is delivering good outcomes for the people using it. Some information from this AQAA is included in the report. What the care home does well: What has improved since the last inspection? What they could do better: There is one requirement outstanding from this inspection relating to medication issues. Further requirements have been made during this inspection, a number of which detail the need to improve the health and safety of individuals. There is a need to ensure people have the full information about the fees charged and who is responsible for paying all or part of the fees. Information should also be provided in other formats to ensure everyone has access to information. Care plans have improved, although making them more specifc and personalised would Care Homes for Older People Page 8 of 30 ensure peoples needs are fully met. There is a need to ensure risk assessments reflect current needs in regards moving and handling of individuals and that poor practice in this area is stopped to ensure people are not placed at risk. Whilst medication practices have improved some poor practice leaves peoples health needs at risk. There continues to be a lack of consistency regarding the provision of food in the home. This aspect of care must be reviewed to ensure people have a sufficient amount of food of a good quality at regualr intervals throughout the day. The use of agency staff without making the required checks places vulnerable people at risk and therefore must be improved. There is also a need to ensure there is evidence of the supervisory arrangements in place where staff commence employment with a POVA1st only. A number of these requirements relate to the keeping of accurate and up to date records so that people can be assured of a consistent quality of 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.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. All new people admitted to the home are provided with the information they need to make a decision on whether the home is right for them. Individuals needs are assessed ensuring staff have the information they need to support and care for them appropriately. Evidence: There is evidence from surveys and records kept by the home that people who are living there have been appropriately assessed and, wherever possible, they or their representatives have visited the home to decide if it is right for them. A relative wrote in a survey: I visited the home two or three times beforehand. Manager very helpful. She found time to show the family around and answer all questions. Care Homes for Older People Page 11 of 30 Evidence: Information is also provided in the form of a Service Users Guide, Statement of Purpose and contract or terms and conditions of residency. This information could be provided in more suitable formats, particularly for those who have poor sight. We also noted that the contract provided by the home does not have full details of the fees and, in particular, how the fees are broken down and who is making contributions eg nursing contributions etc. However, one person wrote of the contract: It was clear and given when first there. We viewed the records of two people who had recently arrived to live in the home and found asssessments in place for all three signed and dated by the manager. When an individual is then admitted into the home a long term assessment of need should then be developed along with a care plan. The manager also confirms in writing, after the assessment, that they are able to meet the persons needs. 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. Generally people have care plans developed that give staff the information they need to care for them and peoole feel they are well cared for. People have access to healthcare that meets their needs. However, some of the practices, including medication and moving and handling place vulnerable people at risk. Evidence: The expert by experience observed residents throughout her visit. In her report she wrote that the standard of personal care appeared to be good. Everyone looked groomed, all appropriately dressed for the time of year and the temperature of the environment. The six surveys received also showed that people felt they received a good standard of care and support. Staff listened and acted upon what was said and staff were generally available when needed. The surveys were also positive about the medical support they required to ensure their health needs were being met. Care Homes for Older People Page 13 of 30 Evidence: Comments included there is time to discuss care and general well-being and address concerns as and when they arise. I have been happy in my time here. There is a cheerful atmosphere. Of the medical support and, in particular, dealing with serious infection one person wrote positively. throughout the time the nursing care was excellent. Other medical ongoing problems get close attention too. Better than in hospital. We spoke to one health professional who told us that the care at Blyth House was pretty good and that pressure sores seem to improve when people are cared for there. We looked at three care plans and supporting information at random, including risk assessments. It was clear that there had been a good deal of work on these to make them more personalised and to ensure staff had the information they required to meet peoples needs. The current format includes a long term assessment of need which supports the care plan. Unfortunately, on viewing three residents records one of these was missing the long term assessment that provides the suporting information to the care plan. Most of the documentation had been signed by the person it was relevant to and a member of staff and the records showed that risk assessments had been reviewed and updated. However, one of these did not reflect the current moving and handling requirements and so there is a potential for the wrong hoist and sling to be used. During the course of the inspection we observed some poor moving and handling practice on two occassions by two members of staff. The practice of using an underarm lift is potentially dangerous for quite frail individuals. Some gaps were found in the information, that if made more specific, would reduce the risk of needs being left unmet. This includes giving information about the frequency of taking a diabetics blood sugar level and ensuring information is provided about a diabetic diet. However, there is evidence from discussions with staff and people living there that they are aware of the persons needs and are providing appropriate care. An audit of the medication administration records (MARs) was undertaken with the nurse on duty. A list of authorised signatures was in place, although did not correspond to how MARs were signed. Some individuals are prescribed controlled drugs and on viewing these we found them to be adminsitered and recorded safely. Care Homes for Older People Page 14 of 30 Evidence: A homely remedies list is also in place and signed by GP with records of administration and receipt. Currently none of the people living there are self-medicating. We looked at the MARs which were mostly pre-printed. Where there were hand written records two signatures were in place. Where creams are to be adminstered they are now signed by the by carers responsible for administration. However, some prescribed medications had not been signed for on the MAR because they were not always required. These should have either had the reason for non-administration recorded or request it be changed to as required. For instance one person had diazapam to be administered each night but it was not adminstered as it was not needed. This requires staff to have the information by word of mouth rather than rely on the actual records. There was one gap in the receipt of medication (levothroxine) and when looking at the blister pack for one person a glicazide tablet fell out. This was one that had been recorded as administered. These gaps place frail peoples health at risk. People felt that they were treated with respect and dingity. We oberved personal care taking place behand closed doors and generally staff spoke to peole with courtesy, kindness and sensitivity. However we did observed poor practice at lunch-time and this is commented on in the relevant section. Care Homes for Older People Page 15 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 live in an environment that provides flexible routines during the day with some stimulation. People are provided with food that is adeqaute in its quality and quantity although lack of consistency means this cannot always be assured. Evidence: The expert by experience observed practices, interactions and routines throughout her visit. She also spent time with people during the lunch-time meal and spoke to a number of people including relatives. People were generally happy and felt they could spend their day as they wished. Verbal feedback and information provided in surveys showed that people thought there were enough activities and stimulation even though there is only an activity co-ordinator working part time. No activites were observed that day until a member of afternoon staff put on an audio book in the lounge during the afternoon. One relative felt that more could be done for people who spent most of their time in their rooms. There is some regular entertainment for people and staff are now more involved in this apsect of the persons care. The AQAA acknowledges that more could be done, they find it very difficult to encourage people to participate. Care Homes for Older People Page 16 of 30 Evidence: Interactions with staff were found to be generally positive. The expert sat in the dining room waiting for the lunch time meal to be served. Tables were pleasantly laid with live flowers and table cloths. It was disappointing to observe that people had to wait for 25 minutes at their table before lunch was served. A food delivery had arrived and the cook halted service until she had put the delivery away. Perhaps this could have been avoided with a little more thought about peoples needs. Staff were seen to be assisting those that needed it with sensitivity and in a caring way. However, staff must be careful not to take over. We observed a person eating well with a spoon and the staff member suddenly taking over when she was doing very well herself. The care plan detailed that the person could eat independently. Another observaton included a person being given a vomit bowl at the table due to nausea. It would have been more appropriate for the persons dignity and for the comfort of others who were still eating that the individual be moved away so this could be done discreetly. In previous inspections we recorded that changes to the menus had been made without making a record of this and once again the menu had been changed that day. There was no record of the change. Instead of a ploughmans an egg salad had been provided and instead of lemon pancake and ice cream sponge and cream given. We were told people didnt like pancakes. Therefore the menu should be changed and why could people not be offered ice cream? People said they were enjoying the meal and surveys showed general satisfaction with the food provided, although verbal feedback durind the day showed mixed feedack about other meals. There was also a lack of consensus over the provsion of a snack and drink at supper time. We spoke to the manager and area manager about this and reminded them about making accurate records of the food provided and the need to ensure people are not going more than 12 hours between their last meal of the evening and breakfast the next morning. More importantly is the need to ensure diabetics have their required intake to maintain their blood sugars and ultimately their health. Care Homes for Older People Page 17 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. People feel that they are listened to and any concerns responded to with sensitivity and effectively. People living in the home are protected by staff who understand poor care. The employment of agency staff without confirmation of the required checks means that vulnerable people are potentially placed at risk by the use of unsuitable staff. Evidence: A complaints and adult protection procedure have been developed which enable people to raise concerns and ensure they have their concerns dealt with in a sensitive and effective manner. Surveys showed that they were aware of how to raise concerns and that the manager was approachable and willing to listen. Staff spoken to generally understood their role in protecting people living in the home although staff who are new to the home should have some guidance as part of their induction to ensure they are aware of what abuse is and how they can protect people. The AQAA and discussions with the manager confirmed that there had been no complaints made since the last inspection nor has the Commission been made aware of any concerns. As part of the inspection we also looked at the recruitment practices to ensure people living there were being cared for by staff who were suitable. Care Homes for Older People Page 18 of 30 Evidence: We found that these had generally improved where permanent staff had been employed, although a more robust system for checking application forms and for recording the supervisory arrangements in place for staff commencing work with a POVA1st only is required. A more significant gap relates to the use of agency staff. The manager told us that, whilst she has confirmation in writing about the checks completed on agency nurses used, confirmation checks are not made on the use of care staff. This means that unsuitable people are providing care to very vulnerable individuals. We also noted that where the organisation has its own bank staff the manager does not request any confirmations about the checks or training of these staff supplied. Care Homes for Older People Page 19 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. People live in a comfortable, safe and generally well maintained environment. Evidence: The expert by experience undertook a tour of the home and wrote in her report the following: ..... The Home Manager gave me a tour of the home. I was then able to move around the home to observe the environment. Generally the home was in good decorative order. Some rooms had been decorated, and appeared to be fairly recent. The curtains and bedspreads matched, carpets recently renewed. One person said it is very nice here. The most disappointing area was the dining room and lounge which appeared tired in decoration, however there was works being carried out on a new conservatory close by. Several residents indicated they were looking forward to using it. We also noted that the hall and stairway carpet had been replaced since the last inspection; a new front door fitted and a more open frontage with the trees cut down at the front of the home and a new bath fitted. The scores on doors from environmental health inspection gave the home a four star rating in October 2007 meaning the food and hygeine practices should be safe with people protected agains the risk of infection. Care Homes for Older People Page 20 of 30 Evidence: The expert also wrote twice I observed people being assisted to move from chair to chair with carers lifting the person from their upper arms. The inspector also observed this poor practice. There were a number of aids and adaptations used and all appeared to be in good working order. The home on arrival did not have any unpleasant odour. Everyone looked groomed, all appropriately dressed for the time of year and the temperature of the environment. It was a pleasant temperature in all areas of the home. A relative told me that it was always appropriately temperature controlled , windows open when necessary. Care Homes for Older People Page 21 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. People are cared for by staff in appropriate numbers and by staff that understand their needs and are kind and sensitive. Training is provided but it is not always implemented or monitored to ensure people are kept safe. Recruitment practices have generally improved, although the use of unchecked agency staff means that vulnerable people are placed at risk. Evidence: People who we spoke to stated they were happy with the staff who care for them. The expert wrote in her report that The people at Blyth House are generally happy, find the staff caring and helpul, and are pleased to be in such a happy place. One person wrote The care to residents and the general care and upkeep of the home is of a very high standard. Staff are kind and friendly and the atmosphere is good. Staffing levels show the home to be staffed efficiently with particular attention paid to busy times of the day. We noted that the manager has changed staff breaks to ensure a more effective cover is acheived so that people can be monitored throughout the day. Care Homes for Older People Page 22 of 30 Evidence: The AQAA detailed that over 50 of care staff have acheived an NVQ 2 or above. At the last inspection a requirement was made to improve the recruitment practices. Four staff files were chosen at random to audit this apsect, all of them relating to permanent staff. These had generally improved and were more robust. There is still some room for improvement that would further safeguard people, including more in depth screening of application forms and evidence of the supervisory arrangements in place for new staff commencing work with a POVA1st only. The area that concerns us however, is the lack of checks made on the agency and bank staff used. The manager told us that whilst she received confirmation in writing from the agency regarding the checks completed on nurses she did not have such confirmation for care staff used. This means that vulnerable people are potentially placed at risk by the use of unsuitable staff. We viewed the training matrix and spoke to staff about the quality of the training provided. At the last inspection we required staff to be provided by moving and handling training by a competent person. It is clear that there is a training programme in place, although some of the training needs to be monitored to ensure it is implemented correctly eg moving and handling training. It is also good practice to ensure that core training is provided in a more timely fashion for new staff ie moving and handling and adult protection to ensure new staff donot follow poor practices. Care Homes for Older People Page 23 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 is managed with openness and transparency. There are effective systems in place to monitor the quality of the care provided, although closer monitoring is required in some of the areas to ensure people are kept safe. Evidence: The manager of the home has been in place for a number of years and has the qualifications and experience to manage effectively. People told us that she is approachable and manages any issues sensitively and effectively. She also periodcally attends training to update her practice. Effective quality assurance and quality monitoring systems, based on seeking the views of residents are in place to ensure people receive a consistent quality of care which is continually improving. Staff spoken to told us they were supervised regularly with practice and training Care Homes for Older People Page 24 of 30 Evidence: discussed during these meetings so they can improve the care for people and keep up with good practice. We noted that training has been provided in effective handwashing and that staff had a good understand ing for their roles in respect of infection control. Records with regards to health and safety are generally of a good standard, although the moving and handling practice observed places frail people at risk. The manager told us that a fist aid risk assessment had been developed and staff training is determined from that. The system for managing peoples monies have not changed and so continue to ensure they are proteced from financial irregularities. We have commented throughout the report on the areas that have improved and areas required for improvement. Requirements have been made in the relevant section of the report. There is a need to ensure that record keeping and monitoring is improved, particularly around recruitment and medication so that any risks to individuals are reduced. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 There must be accurate 01/07/2008 records of all prescribed medication in the home including medication received in the home and medication carried forward from one month to the next. Records must not be signed for before medication is administered to the individual. Failure to maintain accurate records of prescribed medication may result in an individual?s health being adversely affected. Care Homes for Older People Page 26 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 2 5 There msut be a records of the fees charged and a breakdown of who is responsible for paying and how much. This will give people clear guidance on what the charges are and what they are espected to pay. 17/07/2009 2 8 11 Closer monitoring of the moving and handling practices must be undertaken to halt the use of illegal practices. Poor practices means people can be harmed when staff support them to move. 12/06/2009 3 8 13 Moving and handling risk assessments must be reviewed and reflect the current practice and equipment used. Peoples safety may be placed at risk by the use of the wrong equipment. 12/06/2009 Care Homes for Older People Page 27 of 30 4 9 13 All presecribed medication must be given as prescribed by the health professional. This must be accurately recorded. Failure to adminsiter and record prescribed medication may result in the deterioration of an individuals health and wellbeing. 12/06/2009 5 15 16 People must be provided 12/06/2009 with a healthy, varied diet and nutritious diet and at regular times throughout the day. There must be accurate records of the food provided. People receive food that helps them maintain their health and well-being. 6 23 23 Bulbs must be replaced in the lighting To ensure there is adequate lighting in all areas of the home. 29/05/2009 7 29 19 There must confirmation in writing received by the manager that the required checks have been made on agency and bank staff being used by the home. This will ensure that people are protected by being cared for by staff who are fit and suitable to do so. 05/06/2009 8 30 18 There msut be evidence of the supervisory arrangements in place for staff who are employed by 05/06/2009 Care Homes for Older People Page 28 of 30 the home with a POVA1st prior to the full Criminal Records Bureau check being received. People can be assured that they will be protected and in safe hands. 9 37 17 There must be accurate and up to date records in place. Accurate records will ensure people receive a consisitent service without risks to peoples health, safety and well-being. 12/06/2009 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 1 The Service Users Guide should be made available in other formats so that people have the opportunity to understand what the home is offering. Care plans should be made more specifc to ensure staff have the full details of the individuals care needs. Staff should be aware of peoples needs and ensure they promote independency in such tasks as eating and drinking. Menus must reflect accurately the choices on offer each day and there should be some choice of main course and desserts. 2 3 7 15 4 15 Care Homes for Older People Page 29 of 30 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). 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