Inspection on 29/10/09 for Brendoncare Meadway

This inspection was carried out on 29th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: Brendoncare Meadway Meadway Mead Road Winchester Hants SO23 9RF     The quality rating for this care home is:   zero star poor 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: Kathryn Emmons     Date: 2 9 1 0 2 0 0 9 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 29 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) 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. The material should be acknowledged as CQC 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 29 Information about the care home Name of care home: Address: Brendoncare Meadway Meadway Mead Road Winchester Hants SO23 9RF 01962865784 01962865784 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Brendoncare Foundation Name of registered manager (if applicable) Mrs Marilyn Bone Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 12 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 priamry care needs on admission to the home are within the following categories Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Meadway House is a care home providing personal care and accommodation for twelve residents , both male and female, over the age of sixty five years. The service in located in a residential area of Winchester and is within close proximity of the local town centre. Eleven of the rooms are ensuite and the environment is finished to a high Care Homes for Older People Page 4 of 29 Over 65 12 0 Brief description of the care home standard providing comfortable surroundings for residents. There is a passenger lift to all floors and the home is set in well maintained gardens. Care Homes for Older People Page 5 of 29 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: zero star poor 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 visited the service on Thursday 29th October 2009 from 9.00am until 5:00pm. The AQAA (Annual Quality Assurance Assessment) was received on time. We were able to use the information this contained to help us prepare for the inspection visit. The home was registered in May 2009 after a change of ownership to Brendoncare. Nine people using the service were involved in our key inspection . We spoke with them during our visit and also spoke with two staff and the new manager. We sent surveys to the service to be handed out to residents , staff and health care professionals. We received some back from residents and staff and found the surveys for health and social care professionals in a file when we visited the service and these had not been sent out. Care Homes for Older People Page 6 of 29 We ask for surveys to be sent out as this helps help us gain information about the service . We have reproduced some of these comments in the main part of the report. Care Homes for Older People Page 7 of 29 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 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 8 of 29 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 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with information regarding the service. Updating this information will enable residents and their supporters to be clear regarding the management arrangements at the service. Contracts signed by the service representative and the resident, enable residents to be confident of their rights and what service they can expect to receive. Lack of pre admission assessment means residents may not be confident that the service can meet their care needs. Staff may not be aware of the residents preferences or level of support they need. Evidence: There are two documents in place called the service user guide and statement of purpose which provide information regarding the services available at the home and what the services aims and objectives are. These have been amended to reflect that ownership of the home and the organisations aims and objectives have changed. We were told that all residents have been given a copy of the new service user guide. This now needs to be further updated to reflect the changes in the management of the Care Homes for Older People Page 10 of 29 Evidence: home. We looked at the admission details for three residents. One has been living in the service for a couple of years, one for a few months and one had stayed at the service for a few weeks a month previously. A template is used to record admission details such as name, date of admission and next of kin details, GP and social worker details. The rest of the document provides a template to record pre admission assessment details. We found that two of these had been completed but the most recent one had not been completed. This means that staff may not be clear on the residents needs and it can not be clear how the decisions was made that the resident needs could be met at the service. We found some information on a hospital discharge sheet for this resident but none of this information had been placed on the admission sheet. We saw that contracts were in place and had been signed by the residents. This means that they are entering into an agreement which informs them of their rights and what services they can expect to receive. The home provides one room which is for the use of short term stays. These are called respite stays and are for people who may need a little extra support before returning home from hospital or are in need of support while their regular carers are not in a position to support them. The manager acknowledged that anyone staying in the service needed to have a full assessment carried out to evidence that their care needs can be met. Care Homes for Older People Page 11 of 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of current care plans for all residents means that they are at risk of not receiving their assessed care and support in their preferred way. Residents have good access to health care professionals . Medication systems place residents at risk of not receiving their medication safely. Gaining more information regarding residents choices and preferences for end of life care will enable residents to retain as much control as possible. Residents are treated with respect and dignity and their rights are upheld. Evidence: We looked at care files for three of the residents. Since the last inspection visit in March a new format has been devised to enable the care plans and risk assessment and personal information to be displayed in a clearer format. We found that there were no care plans or risk assessments for one resident. For another resident we found one risk assessment for self administration of medication , but this had not been fully completed. There were also no care plans however there was a page of information stating the residents choices regarding drinks and snacks. The other file we looked at had careplans written in 2007 and these had been reviewed monthly until October 2008. The manager accepted that work needs to be carried out with care Care Homes for Older People Page 12 of 29 Evidence: plans as currently resident needs are not always known and there is no information recorded to demonstrate preferences. We spoke with three residents about care plans and they told us that they had not been involved in any care plan work and were not aware of their care plans. Two residents told us, I am looked after well and can tell the ladies what help I want and I dont recall being asked but they know what help I need . While it is acknowledged that many of the residents are able to verbally guide staff in how to provide their care this is not in itself sufficient to replace service user care plans and risk assessments. Many of the residents living at the service are able make their own doctor appointments and attend the local surgerys. We saw daily entries which demonstrated that the local doctors visited the home when requested. We saw evidence in care files that chiropodists and an optician had attended the home. Residents told us they made their own arrangements to see either opticians and dentists when needed. The manager informed us that the district nurses were in contact with the service and would attend when this was needed. When we asked residents about the health care services they received we were told I see my doctor when I want to and they arrange for my feet to be looked at, I would see my own dentist or doctor but they have one we can see and I have my feet looked at every few weeks which is excellent. The manager said that work was being carried out to ensure that all health care information regarding resdents was up to date and available for staff to read. We found that only one person had a weight sheet in place and this had one entry which had been competed a couple of days previously. We found information about a resident which indicated they were possibly depressed and needed support in this area. We found daily records indicating this person was showing signs of depression but the link between the behaviour and the identified need on the discharge information had not been acknowledged. We looked at all of the medication administration records (MAR) sheets. We found that several had signatures missing for medication that had been given. It appeared that medication had been given as we looked at the medication blister packs and there was no corresponding medication in the compartment for the time and date the signature was missing on the MAR sheet. The blister pack medication is dispensed in 28 compartments for the four weeks the medication is prescribed for. We found that some of the blister packs has the last two doses already dispensed as staff had not ordered medication in time and some medication had run out from the previous four week period so the new blister pack had been used. We saw that staff had recorded one person had run out of their pain relief so more needed to be ordered. But we found a box of medication for the same person which contained their pain relief medication. Three bottles of liquid medication were not stored locked away. Controlled Care Homes for Older People Page 13 of 29 Evidence: drug medications are recorded in a separate book. There were not always two signatures and it was not always clear what medication was being given as the space for the type of drug had the residents name written in the space. We saw a notice which referred to medication being dispensed into medication pots ready to be given. Pre dispensing medication places residents at potential risk of not receiving their mediation correctly. One staff member said pre dispensing no longer took place and the pots were only used for leaving medication with residents so they could take it when they wanted. This practice also places residents at potential risk of not receiving their medication correctly. There were no risk assessments in place to evidence if residents were able to make decisions regarding when and how they took their medication. During the inspection the manager removed all medication that was no longer needed and returned this to the pharmacy. An immediate requirement was left for action to be taken to ensure residents received their medications correctly , that there was always sufficient stock and staff completed records correctly. Residents told us they were satisfied with how they received their support and said Staff are wonderful, I get help when I need it, which is thankfully very little. Residents told us that their privacy and dignity was always acknowledged and upheld. We saw staff knocking on residents doors before entering . Staff spoke to residents in their chosen form of address and were speaking to residents in an appropriate, polite manner and were respectful. The services statement of purpose states that residents are able to live at the service until the end of their life if their needs can be met. Information regarding dying and choices around funeral arrangements were not always in place. This means that residents choices and wishes may not be known by staff and may not be caried out if the resident becomes too unwell to state their wishes. The manager confirmed that staff were going to receive more training in the production of care plans and that the deputy manager would be prioritising completing care plans following the inspection visit. Care Homes for Older People Page 14 of 29 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. Residents are supported to be as independent as possible. They retain their own identify and have control over their lives. A range of activities enable residents to spend their time engaging in fulfilling and purposeful activities. Dietary preferences are manly catered for and spiritual needs are met . Evidence: All of the residents we spoke with said they were able to spend their time how they chose. We were given examples of going out for walks collecting flowers from the garden going into Winchester and spending time visiting friends and relatives. Residents told us they were able to carry on their social lives and hobbies as well as they had before they came to live at the service. Staff told us they supported residents to be as independent as possible and residents would ask for support when they needed it. We read in the AQAA that there are evening and daytime activities and residents are also provided with trips out to the theatre and shows and for day trips out. Comments we receive included I live my life to the full and how I want to, They are marvellous here. Paper every day, sherry if you want it, all the companionship one could want. One comment card stated I wish there was more activities maybe outings and classes. The manager said that outings are provided and would look into the issue of classes as it was not clear what this referred to. We could see during the Care Homes for Older People Page 15 of 29 Evidence: visit to the service that residents could receive visitors when they wanted. Staff were available to speak with visitors and one resident told us that Your friends are always made to feel welcome as its your home. Comment cards state that the food is of a very good standard and included Its glorious, Home cooked and delicious. One comment card recorded Sometimes I would like meal times to be earlier and to have cheese and biscuits at supper time not always sweet biscuits. We were told by two other residents that snacks are available between meals . One resident told us they could choose to follow their faith and that communion service was held at the home every four weeks. Currently all of the service users are of the same faith and those we asked said they felt the communion service met any spiritual needs they had. Care Homes for Older People Page 16 of 29 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. Residents can be confident that their concerns will be listened to and acted upon. Staff are trained in safeguarding adult procedures and residents may benefit from those staff who have not received training recently to now receive this. Evidence: We saw a copy of the services complaints procedure. This was on display and also included in the service users guide. We were told by the manager that any concerns will be investigated and responded to promptly . Residents we spoke with said I never have anything to complain about it is wonderful here, You can say anything and its OK they dont mind they want it to be right for you. Staff induction files indicated that the training manager has spoken to staff about safeguarding adult issues. One staff we spoke with was able to answer scenarios and in one file we saw a certificate for this training. The manager confirmed that all staff were having their training profiles reviewed and all staff would receive safeguarding adult updates if this was needed. Care Homes for Older People Page 17 of 29 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. Residents live in clean and comfortable surroundings. They are able to personalise their bedrooms and have control over how the rest of the service is furnished and decorated. Health and safety arrangements are regularly reviewed to ensure residents and staff live and work in a safe environment. Evidence: A previous visit was made to the service a few months ago to view and approve the registration of an additional bedroom on the second floor of the service. This has increased the number of places available at the service to twelve . We spoke with residents in their rooms with their permission. Residents told us they were very happy with their rooms and had been able to personalise them with pieces of furniture, pictures, photographs and paintings. All of the rooms we saw exceeded the minimum standard, contained all the furniture the resident has requested and there was sufficient room for care to be carried out safely. One comment card recorded The garden needs more help I cant weed anymore. The grass is well looked after and the paths are good. Other residents told us they enjoyed sitting out in the garden in warmer weather and enjoyed the views from their bedrooms. The decor standard of the environment was very good and all furniture was in good repair. The service was visited on cold day and was warm in all the areas visited. There were no adverse odours noted and all areas of the home were clean and tidy . Care Homes for Older People Page 18 of 29 Evidence: We saw that there were no visible hazards which could affect residents safety as they walked around the home. Corridors were well lit and clear of furniture and equipment. There is a passenger lift in use and clear instructions on how to use were on display so staff and residents remained safe while using the lift. Residents said they were able to come and go as I please and treat this as my home. One resident told us they had needed their heated towel rail fixed and this was repaired the same day they reported this. The home employs a part time maintenance person who is also the gardener. The residents said that this person carried out most repairs promptly. Care Homes for Older People Page 19 of 29 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. Staffing levels need to be reviewed to ensure the right level of support is available for residents at all times. Robust recruitment systems will ensure residents can be confident the right people are recruited to support them. Ensuring all staff have the necessary training and induction in place may enable residents to be confident they are being supported safely and by staff who are trained and have the necessary knowledge and skills. Evidence: Two comment cards we received back stated that Sometimes staff seem a bit rushed and only one on. During the visit we were told by three different residents that This morning there is only one, One time the poor girl didnt know what to do she was so busy and The mornings seem really busy sometimes. We looked at the duty rota and could see that there were always two staff on each shift during the day time. We discussed the comments we had received with the manager who said that sometimes if there was only one care staff on duty due to sickness or holiday,they would work as a carer. In addition to the two care staff there is also a cook on duty. The manager said that they were in the process of looking to employ more bank staff and to link with another of organisations services to use staff from that home to ensure that there were always two staff on duty. The AQAA informs us that three of the fifteen staff have an National Vocational Care Homes for Older People Page 20 of 29 Evidence: Qualification (NVQ) in care and another four staff have started their NVQ. There is a training manager in place and an audit of training records has taken place. We looked at three training files and could see that some training has been carried out. It was not always clear which staff had attended what training . The manager said this was an area they needed to review and that any training needed for staff would be provided as soon as possible. Induction books were in place for the three staff files we looked at and we could see the training manager has carried out a few sessions with staff but it was not clear that the member of staff had then gone on to attend the relevant workshop. We looked at the recruitment files for three staff who had all been employed since December 2008. We found that two contained all the correct information . The other one we looked at did not contain a reference from the most recent employer, which had been another care home provider, and that the duty rota showed this member of staff had started work before the POVA check was in place (Protection of Vulnerable Adults). The manager acknowledged this and said that any new staff would not be able to work unless all references and checks were back and the recruitment had been carried out by someone no longer working at the serivce. Residents made very positive comments regarding staff and these included Their care, kindness and and attention are excellent. Nothing is to much trouble, I think the residents are well looked after and held in high esteem, the residents welfare is always put first. Everyone is so kind, Its exactly right for me. Looks after its residents cheerfully and kindly. Care Homes for Older People Page 21 of 29 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. A manager now needs to be registered to provide the service with clear leadership and consistency. Inconsistencies with paperwork such as assessments, care plans and medication means that it can not always be demonstrated that information is in place to reflect the outcomes for people using the service. Providing supervision sessions to staff will enable the manager to be clear on the development needs of staff , which if met, may enable them to provide better outcomes for residents. Development of the quality assurance systems will enable the organisation to demonstrate how they review and continue to improve and evolve the service. Evidence: The AQAA we received before we carried out the inspection advised us that the registered manager was leaving the service. The service is required to inform us of any changes in the management arrangements at the service so we are able to assess the impact this might have on the service. When we arrived at the service we found a new manager in post. The manager had been in post for three weeks and informed us that during that time they had attended many training courses. We saw from the duty Care Homes for Older People Page 22 of 29 Evidence: rota that the manager had been covering care shifts and was also covering the shift as a carer when we arrived at the service. The manager said they had on various occasions worked as a carer. This means that the manager is sometimes taken away from their role of managing the service and ensuring all systems are in place to provide good outcomes for people . The manager advised us that they were aware that they needed to be registered to manage the service and was in the process of making arrangements to submit an application. The manager said that they were aware that there was a lot of work to do to ensure that all of the systems in place worked well and provided the residents with good outcomes. The manager said that staff had been very supportive during the changes and felt that residents had not been overly affected by the changes in the management arrangements. Residents we spoke with said they like the new manager , She seems very friendly and nice to everyone. One comment card said With a new manager in place some small things hopefully will improveand another the change in manager is sad but we are all still cared for very well. The manager told us that the responsible individual carries out monthly visits to the service and produces a report. We saw reports for some months but there were a few months when we could not see a report. The purpose of the visit is to report on the conduct of the home. These should identify which staff and residents have been spoken with and what records have been reviewed. These reports form part of the services quality assurance programme. The manager confirmed that resident, staff and relative surveys surveys had been handed out and the results are then produced in a report. Residents confirmed that they have regular meetings and a staff member told us they can speak with the manager whenever they want to. In a previous report when the service was managed by a different organisation a requirement was made for supervision sessions to take place so there was a formalised process for staff to raise any issues and to have their work reviewed and development needs identified. The current organisation have been running the service since October 2008 and on this visit we found that supervision sessions are still not being carried out. The AQAA advised that supervision sessions were now taking place. The new manager stated that no supervision sessions had taken place but in the three weeks they had been in post they had produced a supervision template and is in the process of starting to book supervision sessions. Care Homes for Older People Page 23 of 29 Evidence: The manager said they were aware that some of the records needed to be reviewed so they contained sufficient information and were up to date. We were given examples of polices already reviewed and amended and we saw the administrator was in the process of reviewing recruitment files while we were carrying out the inspection. Inconsistencies with record keeping such as no care plan records for some people mean that records do not always evidence the actual outcomes for people who use the service. The manager advised that a health and safety survey had been carried out by the organisation and there were a couple of actions the service were going to take to ensure health and safety standards remain good.We found good infection control systems in place and staff were seen to wear aprons when carrying out certain tasks. Another of the areas reviewed in the health and safety survey was fire training. When we looked at the records for fire training it was not clear if all of the staff had received this training. The manager confirmed that she would review the records following the inspection to ensure all staff had received this training within the recommended timescales. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication administration 13/11/2009 records must be completed accurately to ensure residents receive their medication safely. ordering , storing and administration medication must be carried out correctly. Residents need to have their medication ordered and administered correctly and an accurate record maintained of this so they can receive their medication safely. 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 3 14 Accommodation shall not be provided to a service users unless the needs of the service user have been assessed by a suitably qualified or suitably trained person. Assessments need to be carried out so that the resident can be confident that the service can meet their needs. The manager also needs to ensure that 27/12/2009 Care Homes for Older People Page 26 of 29 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 there are suitable aids and adaptations and that staff have the necessary skills to meet the residents needs. 2 7 15 All service users need to 14/12/2009 have an up to date service user plan which records all their assessed care needs including end of life care and health are needs. These plans must be kept up to date. Staff need to be aware of a residents assessed needs so they can deliver care safely and to the residents preference and choices. 3 29 18 All necessary checks including two written references , one from the most recent employer and a CRB or POVA check must be in place before a person starts work at the service. Checks need to be in place to ensure right people are providing support to residents. 4 36 18 All staff must receive appropriate supervision sessions. All staff need to receive supervision sessions to enable their care practise to 31/12/2009 14/12/2009 Care Homes for Older People Page 27 of 29 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 be reviewed and development needs to be identified. 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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