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Inspection on 07/07/09 for Brook House Nursing Home

Also see our care home review for Brook House Nursing Home for more information

This inspection was carried out on 7th July 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents` needs and wishes are assessed with them before they move to the home. The activities coordinator arranges a programme of activities which brings interest and diversion to residents` days. One family member said `she brings happiness to the home`. Staff have had training in safeguarding vulnerable adults and people knew who to speak to if they had concerns and how to make a formal complaint. The home is homely and clean. There is an ongoing refurbishment programme, providing a pleasant environment for people to live in. Although the furnishings in some rooms are old the proprietor said in the annual quality assurance assessment that there were plans to replace these over the coming year. People are encouraged to personalise their rooms. One resident said `I like my room, it overlooks the garden`. Infection control standards are good reducing the risk to residents of acquired infection. Recruitment procedures are thorough protecting residents from unsuitable staff.

What has improved since the last inspection?

There has been an ongoing refurbishment programme. A new bath room has been installed. Access around the home and to the garden for people with disabilities has been improved. New height adjustable beds have been purchased. Medication records have been improved and the medication people are given is recorded accurately.

What the care home could do better:

All residents must have an up to date care plan which they have agreed and which describes the care and support that they need. Residents` risk of developing pressure damage must be assessed, an accurate care plan must be developed and action must be taken promptly if a resident develops pressure damage. The care plan must be updated regularly and accurate records must be kept of the progress of wound healing. Controlled drugs must be stored securely at all times. Residents should be offered a choice of main meal. There must be sufficient staff on duty to meet people`s needs in a timely way and to provide reassurance and support for people with dementia. All staff must have training in dementia care to ensure they have the skills and knowledge to care for this group of residents.The home must address the requirements of this report. The home will be included in our improvement strategy and we will ask for an improvement plan when this report is finalised.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brook House Nursing Home 28 The Green Wooburn Green Buckinghamshire HP10 0EJ     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: Chris Sidwell     Date: 0 7 0 7 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 29 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 29 Information about the care home Name of care home: Address: Brook House Nursing Home 28 The Green Wooburn Green Buckinghamshire HP10 0EJ 01628528228 01628529892 brookhousecare@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Centurion Health Care Ltd The registered provider is responsible for running the service care home 35 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 35 0 dementia old age, not falling within any other category physical disability Additional conditions: 35 0 35 The maximum number of service users to be accommodated is 35. The registered person may provide the following category/ies of service only:Care home with nursing - 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 - (OP) Dementia (DE) Physical Disability (PD) Date of last inspection Brief description of the care home Brook House provides nursing care for up to 35 older people. The home is located in the village of Wooburn Green and is close to pubs and local shops. There is a bus route into High Wycombe near by. Care Homes for Older People Page 4 of 29 1 3 1 2 2 0 0 8 Brief description of the care home Accommodation is in mainly single bedrooms, some with en suite facilities. A few shared rooms are also available. There are communal bathrooms and toilets located around the building. The home has spacious lounge areas and an enclosed garden. 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: 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 home last had a unannounced key inspection on the 18th September 2007 and an unannounced random inspection on the 13th December 2008. This inspection was conducted over three days and included a review of the information we hold about the service and an unannounced visit to the home on the 7th July 2009 of eight hours. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment (AQAA) in which she described the way in which the home ensures that the views of people who use the service are included in what they do, the way they ensure equality and diversity is respected, what they do well, the evidence to show it Care Homes for Older People Page 6 of 29 and their plans for improvement. This was completed in full and returned on time. Questionnaires were sent to the home for distribution to residents, staff and visiting professionals. Nine residents, two members of staff and four healthcare professionals returned these. Residents and families were spoken to on the day of the unannounced visit. Discussions took place with the newly appointed manager, the administrator, care and ancillary staff. Feedback was given at the end of the visit. Comprehensive telephone feedback was also given to the proprietor the following day, who sent us some additional information. Care practice was observed and the care of four residents was followed through in detail. The environment and accessibility of the home for people with disabilities was checked. The homes approach to equality and diversity was considered throughout. What the care home does well: What has improved since the last inspection? What they could do better: All residents must have an up to date care plan which they have agreed and which describes the care and support that they need. Residents risk of developing pressure damage must be assessed, an accurate care plan must be developed and action must be taken promptly if a resident develops pressure damage. The care plan must be updated regularly and accurate records must be kept of the progress of wound healing. Controlled drugs must be stored securely at all times. Residents should be offered a choice of main meal. There must be sufficient staff on duty to meet peoples needs in a timely way and to provide reassurance and support for people with dementia. All staff must have training in dementia care to ensure they have the skills and knowledge to care for this group of residents. Care Homes for Older People Page 8 of 29 The home must address the requirements of this report. The home will be included in our improvement strategy and we will ask for an improvement plan when this report is finalised. 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 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 10 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 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 to residents to help them decide whether they wish to move to the home. Peoples needs and wishes are assessed before they move to the home, to ensure that they can be met. Evidence: There is information available to prospective residents in the form of a statement of purpose, which describes the services provided by the home and a home brochure. Prospective residents and their families are welcome to visit the home and stay for a trial period before deciding whether the home is for them. All but one of the people who returned the surveys said that they had received enough information about the home before they moved. One resident commented that I had to make enquiries and was then given a copy of the service users guide and statement of purpose. The care files of four residents who have moved to the home since the last inspection were checked. Two had been assessed by a qualified nurse to identify with them their needs Care Homes for Older People Page 11 of 29 Evidence: and wishes for care before they moved to the home. The assessment documentation prompts staff to take note of peoples faith and cultural wishes as well as their health and social care needs. There was no record in the files to show that the other two people had been assessed at the time of the unannounced visit to the home. Both had moved to the home before the appointment of the new manager and she was uncertain as to why a pre assessment had not been undertaken. We have since however been shown the missing assessments. The home does not offer intermediate care. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents personal care needs are met, promoting their dignity and self respect. Their healthcare needs are not described fully in their care plans and are not always met, putting them at risk of not receiving appropriate care to meet their needs. Although medication was generally managed satisfactorily, controlled drugs were not stored securely putting the home at risk of loss or theft of controlled medication. Evidence: The care of four residents was looked at in detail. All had care plans although they varied in completeness. The front admission sheets for all four were incomplete and peoples cultural and faith needs were not identified on two. Although the documentation has an area in which to note whether someone has a power of attorney this was not completed. Two of the four care plans were not up to date and did not contain relevant information to describe the care needed. One lady had fallen several times. Her care plan had not been updated since the fall and stated that no help was needed. Whilst the staff recognised that she needed help this was not recorded. One lady had developed a pressure sore. Her care plan on moving to the home stated that Care Homes for Older People Page 13 of 29 Evidence: her skin was intact. An entry a week later states small dressing applied to sacrum. A care plan was not developed and the wound deteriorated. An entry six weeks later states she has a severe pressure sore, when she is seen by the tissue viability nurse. There was no information in the care plan to show what action had been taken initially or why she was not referred to the tissue viability nurse sooner. There are instructions from the tissue viability nurse filed in the care plan folder although these have not been incorporated into the homes care plan. The evaluation of the wound was poorly recorded and it was not clear in the care plan whether she had one or two sores. She had not had a nutritional risk assessment and had lost 2.6 kgs in three months, since moving to the home. When spoken to, the resident said that she was happy in the home and that staff came when she rang her bell. She was aware that she had pressure damage but could did not feel any discomfort. She said that she usually enjoyed the food at the home and felt that she ate well. The proprietor felt that the recorded weight loss may have been a recording error. The resident had the appropriate pressure relieving mattress although the records did not show when this had been installed. Observation of the lounge area showed that residents were left unsupervised between 14:00 and 15:50 on the day of the unannounced visit. One lady who was blind and had dementia called out continuously. Her care plan stated that she should be reassured, sat with other residents and liked listening to her walkman. This was not provided and it was unclear whether this was the current care plan. Some staff were observed to be impatient with her although most were kind. The activities coordinator helped her at lunch and was observed to be doing so with patience and explaining what she was doing as she offered her meal. Four general practitioners returned the surveys sent out as part of the inspection. Three said that residents needs were usually met and one said that they were always met. Of the nine residents or family members who returned the surveys, five said that they always received the care they needed and four said usually. Three families spoken to said that they were happy with the care given and that they felt that their family members care needs were met. Two however did express concerns about staffing levels. One resident spoken to said the care staff are very kind. Residents personal care needs were met and all were well presented with clothing in a good state of repair. There are medication policies and procedures in place and the staff spoken to were aware of these. Records are kept of medication delivered and disposed of by the home. Residents individual medication administration records were completed in full and appropriate steps were taken to ensure that supplies were received regularly. Care Homes for Older People Page 14 of 29 Evidence: Appropriate procedures were in place to deal with variable dose medication such as warfarin. None of the residents managed their own medication at the moment although there are policies and procedures in place to support this if residents wish. The staff spoken to said that medication was never given covertly. If a resident did not want to take their medication, this would be recorded. If the medication was essential and the resident lacked capacity, the doctor and family would be told and a way forward agreed. There is a controlled drug cabinet. This was not locked on the day of the unannounced visit as the lock had broken. Staff said the handyman had been notified. The cupboard contained controlled drugs. These were checked and the numbers were found to be correct. The home must ensure that controlled drugs are stored securely, to prevent loss or theft. We have subsequently been assured by the proprietor that the lock has been repaired A requirement was made at the last inspection that accurate records must be kept of medication administered to people using the service. This requirement was met at this inspection. Care Homes for Older People Page 15 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. People can choose how they spend their day and are supported to take part in activities in the home if they wish. The standard of food is good meeting residents nutritional needs although the choice is limited, reducing their choice and enjoyment of the meals. Evidence: Residents spoken to said that they had a choice as to when they got up and when they went they went to bed and how they spent their day. An activities coordinator is in post and she arranges a programme of daily activities. Residents and families spoke highly of her efforts. The chef was knowledgeable about residents likes and dislikes. There is a varied menu, although no choice of main meal. The proprietor and chef stated that if a resident did not like the main meal on offer a substitute would be offered. The chef said that a cooked breakfast is available. Supper is a light cooked supper or soup and sandwiches. There was no one requiring a special diet for health or cultural reasons at the time but the chef said she would be able to prepare one if necessary. Of those who returned the surveys, one said they always liked the food, six usually and two Care Homes for Older People Page 16 of 29 Evidence: sometimes. On the day of the unannounced visit the main meal was liver, new potatoes and broccoli. Most residents were observed to eat the liver but two when asked whether they enjoyed their meal said not really I do not like liver. Residents should be offered a choice of main meal. Care Homes for Older People Page 17 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. The safeguarding procedures in place should protect people from harm. Peoples concerns are listened to and in most cases addressed. Evidence: People in the home know who to complain to. There is a copy of the complaints procedures in the home. Everyone who returned the questionnaires said that they knew how to make a complaint. The complaints records were checked and showed that verbal and written complaints are recorded. There were four written complaints since the last inspection, all of which had been responded to within the timescales set by the homes policy. The response showed that action, had in most cases, been taken. The home has a copy of the local multi agency safeguarding policies and procedures and staff have a received training in safeguarding vulnerable people. There are whistle blowing policies and procedures in place and the staff spoken to said that would have no hesitation in reporting any concerns. The manager said in the annual quality assurance assessment that they have not made any safeguarding referrals since the last inspection. We have not been notified of any safeguarding referrals made to the local authority, which is the lead agency in these matters, since the last inspection. Care Homes for Older People Page 18 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. The home is homely, clean and there is an ongoing refurbishment programme, providing a pleasant environment for people to live in. Infection control standards are good reducing the risk to residents of acquired infection. Evidence: The home is an older building, overlooking the village green, which has been adapted to meet the needs of people with disabilities. Rooms vary in size and many have ensuite facilities. The standard of the furnishings varies and the manager said that she had asked for new furniture and soft furnishings for some rooms. The dining and lounge areas are pleasantly decorated and have been refurbished since the last inspection. There has been an investment in height adjustable beds. The bathrooms and shower rooms have been upgraded during the last year. The home was clean and tidy on the day of the unannounced visit and there were no offensive odours. There are infection control policies and procedures in place and the home has a copy of the latest guidance from the Thames Valley Health Protection and the Department of Health guidance. There are separate paper towels soap and hand sanitizer for the use of carers in residents ensuites and bathrooms. People do share hoist slings. This should be reviewed. Staff were observed to be wearing protective clothing appropriately. Care Homes for Older People Page 19 of 29 Care Homes for Older People Page 20 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. There are insufficient staff to meet residents needs in a timely way and to ensure that residents who have dementia are supervised to reassure them and protect them from potential harm. Staff have training in safe working practices but there is a need to ensure that staff complete dementia care training if residents needs are to be met. Evidence: There is a staffing rota in place to show the staff on duty. The manager said that the home aimed to have two Registered Nurses and six carers on duty in the morning, one Registered Nurse and five carers in the afternoon and one Registered Nurse and two carers at night. The proprietor confirmed that this was the case when they were full and had thirty five residents. The home had thirty residents on the day of the unannounced visit. There were two Registered Nurses and three carers on duty in the morning and one Registered Nurse and three carers in the afternoon. The manager and proprietor said that this was due to staff sickness. Examination of four weeks staff rotas between the 22 June 2009 and the 19th July 2009 showed that there were insufficient staff to meet the planned levels on a regular basis, with 3 -5 shifts needing to be covered on a daily basis after the initial rota had been done. Most of the shifts were covered by current staff working additional shifts. This was the scenario at the last unannounced random inspection undertaken on the 13th December 2008, when staffing levels were below that which was planned and a requirement was made then Care Homes for Older People Page 21 of 29 Evidence: that there should be sufficient staff on duty at all times to ensure that people using the service receive the support and assistance they need in a timely manner. Of the nine surveys received four people said staff were always available, four said usually and one said sometimes. Two people commented that they have to wait to go to the toilet which one said is distressing. One person who was unable to use the call bell and said it is difficult to summon help when it is needed. One family member spoken to said that they were happy with the care of their family member but had had to get help for another lady who was unsupervised in the lounge and kept trying to get out of her chair. They were concerned she would fall. The annual quality assurance assessment showed that there were twenty one people who needed help to go to the toilet and 12 people with dementia living at the home. There were insufficient staff on duty to supervise residents in the lounge on the day of the visit. This is described in the health and personal care section of this report. The training records showed that staff have had training in safe working practices. The proprietor said that eight members of staff had signed up for a distance learning course in dementia care. The annual quality assurance assessment stated that nine of the then twenty one care staff held the National Vocational Qualifications in Care at level 2, not yet meeting the standard that fifty percent of staff hold this qualification. We have since been given updated information to show that eleven of the now sixteen carers hold this qualification, meeting the standard that fifty percent of staff hold this qualification. The recruitment files of three members of staff who had started at the home since the last inspection were checked. All had the required documents. There was evidence of the staff members identity and work permits were in place where necessary. Criminal Records Bureau disclosures and references had been sought before the staff member started work. The application form showed the staff members work history and interview records were kept. Care Homes for Older People Page 22 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. The management arrangements in the home have lacked stability over the last year, creating uncertainty for residents and their families and a lack of progress to improve on some aspects of care for residents. Evidence: The registered manager in post at the last inspection left the home in June 2008. A manager was appointed approximately six months later but left in May 2009. A new manager was appointed in June 2009 and was on duty on the day of the unannounced visit to the home. She is a registered nurse, an experienced care home manager and holds the National Vocational Qualifications in Management at level 4. She said that she would be registering with us. The staff spoken to said that she was approachable and that the atmosphere in the home had improved since her appointment. The annual quality assurance assessment completed by the previous manager stated that regular quality assurance checks of the homes operation were undertaken on a Care Homes for Older People Page 23 of 29 Evidence: random basis. It was not possible to ascertain on the day of the unannounced visit what the monitoring consisted of. A care plan audit had last been undertaken in April 2008 and a medication audit by the pharmacist in October 2008. The proprietor visits the home regularly and had recorded the outcome of her visits in full up to March 2009. A summary sheet was available for April and May and there was no recorded visit available for June 2009. Regular family and resident meetings are held to ascertain peoples views and minutes are kept. The last meeting was on 4th March 2009. Three family members were spoken to and they said that they were able to raise their views although two said that they had raised concerns about staffing levels which they felt had not been fully addressed. The home does not manage any money on behalf of residents. All expenditure is invoiced to families. The manager has not yet had training to implement the new regulations relating to the Mental Capacity Act and the Deprivation of Liberty regulations. The deputy and administrator have undertaken the training and the home now has copies of the appropriate referral forms and will begin the process of speaking with residents, their families and those who have power of attorney, to make the necessary applications if appropriate. There are health and safety policies and procedures in place and regular meetings are held. Maintenance records were up to date and the training records showed that staff had had training in safe working practices, including moving and handling, fire safety and infection control. The last Fire Safety Officers visit was on 1st April 2009 when seven deficiencies were noted and a return visit is scheduled. The manager said that three had been addressed and a further four were being addressed but had not been addressed as yet. The last Environmental Health Officers visit was on 28th February 2008 when all matters were satisfactory. We undertook an unannounced focussed inspection on 13th December 2008 when three requirements for improvement were made. Two had been met at this inspection but one had not. A requirement was made at that time that sufficient staff are to be on duty at all times, to ensure that people receive the support and care they need in a timely manner. It was not demonstrated that this had been met on the day of this unannounced visit and a further requirement has been made. The home will be included in our improvement strategy and we will ask for an improvement plan, when this report is finalised. Enforcement action may be considered if the home does not meet this requirement. Care Homes for Older People Page 24 of 29 Care Homes for Older People Page 25 of 29 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 27 18 Sufficient staff are to be on duty at all times. This is to ensure that people using the service receive the support and assistance they require in a timely manner. 09/01/2009 Care Homes for Older People Page 26 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 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 Prospective residents needs must be assessed before they move to the home. To ensure that they can be met. 30/09/2009 2 7 15 Residents must have an up to date care plan which describes the care that they need and how it is to be given. To ensure that residents needs are met. 31/08/2009 3 8 12 Residents risk of developing 31/08/2009 pressure damage must be assessed, an accurate care plan must be developed and action must be taken promptly if a resident develops pressure damage. The care plan must be updated regularly and accurate records must be kept of the progress of wound healing. To minimise the risk to Care Homes for Older People Page 27 of 29 residents of developing pressure damage and to ensure that it is treated appropriately if it does occur. 4 9 13 Controlled drugs must be stored securely in line with the guidance issued by the Royal Pharmaceutical Society of Great Britain. To minimise the risk of theft or loss of controlled drugs. 5 27 18 There must be sufficient staff to meet peoples needs in a timely way and to supervise and safeguard people with dementia from harm. To ensure peoples needs are met in a timely way 6 30 18 Staff must have training in dementia care. To ensure they have the knowledge and skills to care for people with dementia. 30/10/2009 31/08/2009 31/08/2009 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 Care Homes for Older People Page 28 of 29 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. 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