Inspection on 06/01/09 for Braunton

This inspection was carried out on 6th January 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Braunton 24/01/08

Braunton 12/10/07

Braunton 08/06/06

Braunton 06/02/06

Braunton 10/08/05

Braunton 21/02/05

Braunton 20/08/04

Similar services:

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Fairfields Country Rest Home

St George`s

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Credence House

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Braunton 23 Grove Avenue Yeovil Somerset BA20 2BD     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: Barbara Ludlow     Date: 0 6 0 1 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Braunton 23 Grove Avenue Yeovil Somerset BA20 2BD 01935422176 01935422176 D.Vickery@sky.com. 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) : Braunton Residential Home Limited care home 9 Number of places (if applicable): Under 65 Over 65 0 8 learning disability old age, not falling within any other category Additional conditions: 1 0 One named service user with learning disabilities under the age of 65 Date of last inspection Brief description of the care home Braunton is a family run home providing accommodation and support for nine older people in domestic scale accommodation. Mr & Mrs Lambert, the owners, continue to be directly involved in the management of the home. Their daughter Mrs Alexandra Vickery is the registered manager. The management team, are supported by a small staff team. Residents are encouraged to maintain links with family and the wider community. The emphasis is on providing care within a homely environment. The weekly fee rate is currently 390.00 pounds per week. The home has stated that they charge the basic DSS rate and will continue to do so. Care Homes for Older People Page 4 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: 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: This unannounced key inspection was made by one inspector for CSCI. The visit commenced at 10:45 and concluded at 16:30. The proprietor Mrs Lambert was on the premises with two care staff. The home caters for nine people, staff informed the inspector that there were eight people currently in residence, a person receiving respite care had been discharged the day before. Four people were up and were seated in the lounge. Time was spent in the lounge and people were asked about life at the home. Two other people came down later in the morning, they had a hot drink served to them, they too came and sat in the lounge. Care Homes for Older People Page 5 of 30 It was a particularly cold day and the lounge / dining room felt cool, people commented that they felt cold but were uncomplaining. One radiator was noticed to be low and this was brought to the attention of Mr Lambert, who turned it up. People asked said they were well cared for and were happy at the home and enjoyed having visitors. One visitor was seen at this inspection. The television was switched on later in the morning and people listened to the news. The hairdresser visited and people enjoyed having their hair washed and set. There is an activity each afternoon between 2pm and 3.30pm. Staff were kept busy as they carried out a range of duties from completing care tasks and administering medication to catering and cleaning. Staff said they enjoy working at the home and feel they receive the training and support they need. Both staff seen had a National Vocational Qualification (NVQ) in care. A tour of the premises was made. All communal rooms and facilities were seen, private bedrooms were sampled. Bedrooms were comfortable and personalised, the home was clean and tidy. Seven people had lunch together in the dining room. Lunch was seen served and this was observed to be a pleasant social occasion. People who choose to stay in their rooms were seen later in the afternoon. The proprietors and the registered manager were seen and spoken with, records were sampled for inspection purposes. Prior to the inspection the Commission had received the Annual Quality Assurance Assessment (AQAA) completed by the management. Questionnaires were sent to the home for both people living at the home and for staff to complete. Three people in residence and four staff returned questionnaires. People living at the home indicated that their questionnaires were completed with help from their relatives. Findings and comments received are included in the body of the report. The inspector would like to thank the people living at the home, their relatives and the staff and management for their hospitality and contribution to the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 7 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 8 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. There is information available about the home for prospective people considering admission to the home. A pre admission assessment would be undertaken to ensure that care needs can be met with the service available at Braunton. Evidence: The home has block contracted beds and one contracted respite care bed with Somerset Social Services. The registered manager recognises the need to for up to date information gathering pre admission to ensure that care needs can be fully met on admission. During the past year the management have worked to develop the admission procedures for all new admissions. The home is working with social services to ensure pre admission information is available prior to any placement being accepted for respite care. Care Homes for Older People Page 9 of 30 Evidence: There have been two permanent admissions to the service in the past twelve months. The pre admission portfolios were seen for two people, these demonstrated that the home had completed a detailed assessment and had received a copy of the social services Single Assessment Process (SAP) pre admission. These documents were used to develop the individuals care plans. One person was seen at this inspection who has recently come into the home, they said that they have settled in. The feedback on the questionnaires returned to the Commission for Social Care Inspection (CSCI) indicated that people had received enough information before deciding to come into the home. One said the home had been viewed by family and another had attended for day care and respite care and knew the home. Feedback from social services monitoring indicated satisfaction from a person having a recent respite care stay. All admissions have a contract either with the home or via social services. The manager explained that terms and conditions of residency are not normally issued to social services funded people. A copy of the homes terms and conditions of residency was seen, this is a joint document with the service user guide that the home have purchased to adapt for use at Braunton. This should be completed and be made available to all people living at the home and all people admitted in the future. Care Homes for Older People Page 10 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 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 respectfully at all times. Each person has a care plan. Personal care is appropriately delivered and is tailored to meet the individuals needs. Medications are safely stored. Requirements and a recommendation is made to improve administration practice. Evidence: Eight people were in residence and all were seen during the inspection visit. Four people were in the lounge at the start of the visit. The inspector asked about their experiences of living at the home, all said they are satisfied with the care they receive. People looked well cared for and they seemed to have got to know one another during their time living at the home. One relative was seen, they were happy with the care their relative receives at Braunton. They said they are welcome to visit at any time and Care Homes for Older People Page 11 of 30 Evidence: are always made welcome. Staff interactions with people throughout the day were friendly and respectful. Care plans were in place for everyone, two were sampled in detail. The care plans held all appropriate information and contact details for families. People asked were not sure they had seen their care plans; people should be more involved with their care planning and reviews. The AQAA confirms that monthly reviews are undertaken as are checks for blood pressure and weight. Medications are securely stored. The Medication Administration Records (MAR) were examined. All had photographic identification and relevant information recorded. One MAR with a dose change notified by the surgery had the new directions written on a notelet that was stuck to the MAR. This is not best practice and could lead to the instructions being mislaid and a drug error / omission occurring. Care must be taken to ensure messages are more appropriately and safely recorded. Any change should be checked by two people and the entry countersigned after checking, in order to prevent a drug administration error occurring. On another MAR where an inhaler was prescribed to be taken twice a day showed no entries for regular administration. A reason for the omissions should always be recorded. Regulatory requirements are made to improve this practice. A collection of named and lidded pots were seen at the inspection, these pots are used to take medications out from the medications storage room to people. Medications must be administered to one person at a time and the MAR chart signed to indicate that the person has taken their medication. It was not clear that this process is being followed at all times, a recommendation to ensure best practice is made at this inspection. The AQAA indicated that there has been training and audit of medications with input from a local pharmacy. The home has also sourced nutrition training for staff . The AQAA indicates that the home are planning to look at the end of life care programme with implementation planned for the next one to two years. Three questionnaires received by CSCI indicated that people are happy living at the home and they usually receive the care and support they need . Relatives have told us that they are contacted if there are any concerns. and are happy with the medical support . Families said they escort their relative to any medical appointments. Care Homes for Older People Page 12 of 30 Care Homes for Older People Page 13 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. The people in the home are able to spend their time as they wish. Visitors are welcomed and can call at any time. The home is friendly and has a homely atmosphere, there is a social activity each afternoon. Mealtimes are social occasions and people tend to eat together. The food is wholesome and drinks are regularly served. Evidence: Four people were in the lounge / dining room at the start of this inspection visit. People were happy to be seen together to talk about the service and daily life at Braunton. One new person was seen who had recently come into the home, said they had settled in well. The television in the lounge is selectively used, some people said they prefer to watch their own televisions in their rooms. The news was switched on for people to watch, Care Homes for Older People Page 14 of 30 Evidence: most showing an interest and discussing the news of the sales and the present credit crunch. Each afternoon there is an activity, board games or dominoes are played and people said they sit around the dining table for this. Afternoon activities are run by the care staff between 2pm and 3.30pm. Seven people came together at lunchtime and sat at the dining table. Some people take responsibility for small chores such as laying the table. People all said they enjoyed their lunch. Fish in a sauce with potatoes and mixed vegetables was served followed by semolina pudding and mixed fruit, this pleased all except one person who associated it with baby food. A cup of tea was served after the meal. It was a very cold day and some people had said they felt cold, most had lap blankets. People were uncomplaining about the temperature of the lounge in the morning but it was very cool. It was noticed that one radiator was turned down low, this was brought to the attention of Mr Lambert who adjusted it. One visitor was seen and they sat in the lounge with their relative. People asked confirmed that their families and friends are welcomed when they visit. People said they sometimes go out with relatives. The AQAA indicated that religious services are organised in the home for those who wish to attend this can be in private in their rooms. Volunteer groups would be asked to transport anyone wishing to attend a service away from the home. Trips out are organised, the most recent was a trip into Yeovil to see the Christmas lights. People said they enjoyed this trip and any opportunities to go out. The hairdresser visited and most ladies had their hair done during the day. There was lots of good humour and banter between people in residence, the management and staff working at the home. People all said they were happy living here at Braunton. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure in place. Complaints are investigated in a timely manner. Staff are carefully recruited, they receive induction and abuse awareness training to reduce the risk of harm coming to people at the home. Staff also acknowledged that they understood the diversity of the individuals and the individual needs. Evidence: The home has documented two complaints since the last inspection. Both have been addressed. CSCI were aware of the complaints and following discussions the pre admission assessment process has been tightened. The Single Assessment Process is now reviewed by senior staff so that any medical terminology can be interpreted to help prevent any misunderstandings. This also ensures that sufficient detail comes to the attention of the assessor for risk assessments to be put into place on admission. The home has a contract with Care Aware advocacy service for anyone without representation or who would like representation. The home has policies and procedures in place for whistleblowing, adult abuse, and has a copy of the Somerset Safeguarding Adults protocols and guidance. Care Homes for Older People Page 16 of 30 Evidence: People living at the home said they would be able to say if there was something they did not like or were unhappy about. Comment cards from three people confirmed that they all would know how to make a complaint and would know who to speak with if they were unhappy. Staff confirmed that they would know what to do if concerns about the home were brought to their attention. Care Homes for Older People Page 17 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 is kept clean, tidy and is well maintained. There has been improvements made to the environment with the redecoration and re carpeting of the hallways and stairs. Evidence: A tour of the premises was made. The home was found to be clean and tidy and generally odour free. The appearance of the hallways and stairs is much improved. These areas have been redecorated and re carpeted since the last inspection. The lounge / dining room is well used, many people choose to spend their day in the lounge. The conservatory which adds to the communal space opens from the lounge. This was not in use as it was a particularly cold day. The lounge felt cool and some people had blankets on their knees, people said they were cool but were uncomplaining. It was noticed that the radiator was turned down low, Mr Lambert adjusted this when it brought to his attention. Care must be taken to ensure a warm ambient temperature especially in cold weather. Care Homes for Older People Page 18 of 30 Evidence: The lounge carpet looked shabby and the floor beneath is uneven. Mr Lambert explained this is where a wall was once removed and remedial work is needed before the carpet can be renewed. The AQAA indicates that this work is in the improvement plans for the next twelve to twenty four months. The conservatory leads onto a pleasant garden which is used in warmer weather. The AQAA indicated that access to the garden is down some steps and improvements to this will be made when the garden is re modeled and the access can be made wheelchair friendly. The management is planning to do this in the next twelve months. Bedroom accommodation is on both the ground and first floor. Access between floors is by small passenger lift or stairs. The home is comfortably furnished and people are encouraged to personalise their own rooms. One wardrobe was seen that had two broken drawer handles, these should be repaired or replaced. All bedrooms have en suite facilities, one that had damaged floor covering was due to be tiled with non slip tiles, Mr Lambert indicated that this work had been arranged for the coming weekend. All rooms have emergency pull cords to summon help if needed. Household safety modification includes the protection from burns on hot surfaces with the fitted radiator covers. There was one exception to this, in the lounge where the furniture has been rearranged one radiator is now exposed and requires a cover. Mr Lambert is aware of this. First floor windows have been restricted in opening in line with the Health and Safety Executive guidance for care homes. Hot water taps have failsafe devices to prevent accidental scalding. The assisted bath hot water temperature was tested and showed a temperature of only 37 degrees Celsius, the settings may be too low and require adjustment to the maximum of 43/ 44 degrees Celsius, if necessary. The upstairs bathroom is used as a laundry drying facility. The home does not have tumble drying facilities and washing is dried indoors or is line dried outdoors in warmer weather. There were no concerns raised about the laundry process at this inspection. The home is fitted with a fire alarm and fire safety equipment. The alarm was sounded at 11:45am staff quickly checked and reassured people that this was a false alarm and not a fire. Care Homes for Older People Page 19 of 30 Evidence: Infection control is well managed. Staff have received food hygiene and infection control training. Staff have access to personal protective clothing such as gloves and aprons and there are hand washing facilities. One bin was seen where the flip top lid was broken, this should be replaced. All chemicals are safely managed. The home has been non smoking since 2006. People living at the home can smoke outside the building on the patio, or adjacent to the conservatory garden door only. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was sufficient staff on duty to meet the care and social care needs of the people in residence. The recruitment process is sound and staff are safely recruited. Staff confirmed that they have received training, supervision and have access to support at any time. There is good level of NVQ qualified staff. Evidence: At this inspection there were two care staff on duty with the proprietor Mrs Lambert who was busy interviewing. The staff were spoken with, they confirmed having induction and receiving training. Both were happy in their roles and said they enjoyed working at the home. People who needed help in the morning were up, breakfasts served and the staff had just prepared the lunch and were about to finish some domestic tasks. The duty rota and staff indicated that there are a minimum of two staff on duty each morning and afternoon and one staff overnight. There is management input during the day and on call cover at all other times including the night time. Care Homes for Older People Page 21 of 30 Evidence: There is a family atmosphere and people living at the home gave a hand with tasks such as laying and clearing the table at mealtimes. There was a good rapport between staff and the people living at the home. Recruitment files were sampled for two new staff. Application packs had been issued, written references were taken up and verbal reference confirmation was made. Identification was checked and Criminal Record Bureau (CRB) checks were made before the people commenced working at the home. Staff had received induction and fire training. Copies of NVQ qualifications and other training certificates were seen on the files. The files were in a revised format and had photographic identification. At the inspection a new recruit was interviewed and was shown around the home by Mrs Lambert. The recruitment processes now being used are much improved. Staff confirmed that they have received training, supervision and have access to support at any time. There is good level of NVQ qualified staff. The home has a training matrix and a staff supervision programme. The training matrix was very detailed and it was advised that this is stored more securely , the registered manager did this at the time of the visit. Staff supervision was checked and had been undertaken for staff chosen. Staff meetings are held and staff often work with the home manager and the providers. Staff asked said they are supported and there is always someone to contact to for advice. Staff have access to training and the comment cards returned to the commission there are always training courses being offered to us. Staff said they felt supported by the management and we heard staff and management always work together to make sure the service users needs are met...communication was described as good and staff like working here. People living at the home said that staff are there when they need them and they are treated with respect and everything is very nice here and they are very happy. The AQAA states there are two full time staff and nine part time staff at the home with nine staff being permanent care workers, all held an NVQ Level 2 or above. The home had a high turnover of staff in the last year with eight staff leaving. Agency staff are used when there is a need and the AQAA showed that two shifts had been covered by agency staff in the previous three months. Care Homes for Older People Page 22 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is a family run home and it is well managed. The management of new admissions to the home and of staff recruitment has improved since the last inspection and revised systems are in place. Quality assurance is undertaken, people are consulted about daily life at the home and their independence is well supported. The home is well maintained, health and safety measures are in place and servicing is kept up to date. Evidence: This family run home is well managed. The registered providers are experienced and qualified in management and they have a significant input into the running of the home alongside the registered manager, Mrs Vickery. Mrs Vickery is suitably qualified, Care Homes for Older People Page 24 of 30 Evidence: holding both an NVQ Level 4 in business management and in care. Mrs Lambert was at the home in the morning undertaking a staff recruitment interview. Mr Lambert came to the home at lunchtime and the registered manager, Mrs Vickery came to the home in the afternoon to assist with the inspection process. The registered manager is open and clear about the running of the home. There has been open dialogue with the CSCI inspector regarding pre admission assessment and one concern that was brought to the attention of the commission. The home do not manage anyones finances. The AQAA indicates that the cost of care is always set at the local social services rate. There are charges for extras. The home has issued a letter to all people living at the home to explain that all extra costs such as hairdressing by will be passed on via an invoice. There is currently an additional charge of 22 added to all the invoices raised for extras such as hairdressing. The Commission has heard that homely remedies such as cough linctus, are charged at cost per item, there were no entries of this nature seen on the files sampled at this inspection. The AQAA indicated that environmental safety had received attention in the past year. Risk assessments are in place for the hot water and scalding risk and the risk of legionella. Staff training and supervision has been addressed. Supervision records were sampled for two staff and these showed that supervision had been undertaken. The AQAA stated that the home continues to monitor feedback from people living at the home and their families; targeting areas of concern raised at the meetings held with people living at the home. There are plans to improve the quality assurance further over the next twelve months. The plan is to use a more interactive process with families and a simplified questionnaire with people living at the home. The comment cards received by CSCI indicated that people are happy living at the home. Relatives have told us that they are contacted if there are any concerns. The home has a maintenance person and a gardener. Maintenance of the home is overseen by Mr Lambert and fire safety equipment has been serviced and checked. One free standing fire extinguisher should be secured to reduce the risk of an accident occurring should it topple over and cause an injury to someone. Accidents are appropriately recorded and are audited by the registered manager. Care Homes for Older People Page 25 of 30 Evidence: These records were seen and were up to date. There is currently no manual handling required. Proprietor Mrs Lambert and the registered manager, Mrs Vickery are manual handling instructors for in house staff training and updating. In house safety is well managed with first floor windows restricted in opening and hot surfaces such as radiators with one exception were covered. Chemicals are stored appropriately. Staff comment cards indicated that staff felt the home is well kept and well managed other comments were there is always support and care on hand from staff and management and staff and management always work together. The AQAA indicated that equipment had all been maintained in 2008. This included the fire detection and alarm system, gas appliances, the lift and hoists. Electrical safety checks had been made on the circuits and portable appliances. The heating was serviced in May 2008 and emergency call equipment in November 2008. 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 Directions for changes to a prescription must be fully, clearly and carefully recorded. A notelet on the mar charts is not a sufficiently safe method of recording a change to a prescription, it could be lost and /or lead to a drug administration error. 07/03/2009 2 9 13 Non administration of a prescribed medication should be indicated on the MAR chart with the reason for omission. The reason for the omission needs to be recorded to acknowledge that it has been considered and is not a drug error. It may require a review by the prescribing practitioner. 07/03/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 28 of 30 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 2 8 All people admitted to the home should have access to a copy of the terms and conditions of residency. Care planning should always be person centered, the people for whom the care is planned should be more involved in the care planning process. Medication must be individually prepared for administration and taken to the individual person by the person who then signs the MAR to say the medication has been taken. This is safe practice and should be adopted for safe medications management. The fire extinguisher in the hall should be secured and not be free standing as it poses a hazard and a risk of injury should it topple over onto someone foot or leg. Repairs to the wardrobe and the foot operated flip top bin should be made. 3 9 4 19 5 19 Care Homes for Older People Page 29 of 30 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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