Inspection on 13/05/09 for Broxbourne House

This inspection was carried out on 13th May 2009.

CQC found this care home to be providing an Poor 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Broxbourne House 05/06/07

Broxbourne House 28/06/06

Broxbourne House 30/11/05

Broxbourne House 27/06/05

Broxbourne House 01/09/04

Broxbourne House 14/04/04

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Abbey The

Snydale Care Home

Whiteley House

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Broxbourne House 57 Barnsley Road Wakefield West Yorks WF1 5LE     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: Tony Railton     Date: 1 3 0 5 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 30 Information about the care home Name of care home: Address: Broxbourne House 57 Barnsley Road Wakefield West Yorks WF1 5LE 01924370004 01924201016 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr M Seeratun Name of registered manager (if applicable) Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Broxbourne House provides residential care for 21 older people who may also suffer with mental health problems. The home is situated just outside the centre of Wakefield on the main Barnsley Road. Set in its own grounds, there is a garden area to the front and side and car parking to the rear. The main entrance is to the rear of the home where there is an office and corridors leading to the lounges, dining room and bedrooms. A passenger lift is provided for those who require it and there are assisted bathing and showering facilities. Shared and single accommodation is provided and most bedrooms, although not en-suite, are personalised and comfortable. The home is Care Homes for Older People Page 4 of 30 Over 65 21 21 21 0 0 0 Brief description of the care home on a main bus route and is only a few minutes from the centre of Wakefield and all services and amenities. The provider informed the Commission for Social Care Inspection in November 2008 that fees are £388-390 per week. Additional charges include hairdressing, private chiropody, newspapers and some selected activities. Information about the home and the services provided are available from the home in the statement of purpose and service users guide, copies of which can be obtained by contacting the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: Following this visit to the service we have given this service a 0 Star rating which means people living in the home experience poor outcomes. The inspection visit took place on the t13h May 2009, started at 09.45 and ended at 16.30. A further visit by the Pharmacy Inspector took place on 19th May 2009. During these visits we spoke to people living in the home and some visiting relatives and a District Nurse. Other people spoken to included the service provider, care and domestic staff and the cook. We looked at some peoples records including assessments, care plans, daily and medical records. Some peoples medicines were checked and included the medicine, ordering, storage, and recording within the home. Some staff records were seen and included application forms, references, police and POVA (Protection of Vulnerable Adults List) checks. Some staff training and supervision records were also looked at. A tour of the premises was undertaken. Other information considered included the previous inspection visit report, enforcement letters, providers action plan and service history. A short report from Wakefield Contracts Monitoring Department was also considered. The Care Homes for Older People Page 6 of 30 inspectors would like to take the opportunity to thank people living in the home, the provider and staff team for their patience, hospitality and cooperation throughout these visits to the home. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The does not currently have a Registered Manager and the service provider must tell the Commission when a manager is appointed and of any absences from the home. Despite a few improvements the care management systems in the home are still not adequate and potentially put people at risk. To make sure peoples care and support needs can be met a complete assessment should be provided before people come to live in the home. These assessments must include peoples personal, health care, and mental health support needs. Some people have a Community Assessment completed by the Local Authority showing what peoples needs are and what staff must do to meet these needs. Others do not have these assessments. Some assessments are written on sheets of A 4 paper and the information about service users is very sparse and does not contain enough information for staff to know what to do. Some people supported by the District Nurse have information kept about them that needs putting to their own records to make staff aware. Some care plans do not provide individual, specific detail Care Homes for Older People Page 8 of 30 about peoples care needs. The fail to provide staff with guidance as to how to meet care needs and then evaluate care delivery. In addition positive interventions such as the use of specialist equipment are not always recorded. This means that care plans fail to provide an accurate record of the actual care being given. The medicine administration policy and procedure needs updating and changing to show staff how to give medicines safely. Peoples care plans do not contain information regarding their when required medicines and when they should and should not be given. The daily records do not contain descriptive words to reflect peoples choices and preferences or when they make decisions about their lives. The records of food provided each day need to be expanded and improved. Also , increased evidence of variety, choice and nutritional content of the meals should be included into the menus and overall food management. Some work is needed to keep the premises in good repair and reduce the risk of cross infection. To keep people safe the staff selection and recruitment systems need to improve as they do not include asking candidates if they have committed any offences and some references are not properly addressed and there are no interview records. To make sure people are being cared for appropriately the work staff do should be supervised and proper records kept. People living in the home do enjoy some activities including recent visits to the community centre. However, there is no planned programme of activities based on peoples assessed needs. 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 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To make sure the service can meet peoples care needs these are now assessed before coming to live in the home. However, if people do not have a Local Authority assessment the assessment used by the home is not very detailed. Evidence: To make sure peoples care and support needs can be met by the home these are now assessed before coming to live in the home. However, to comply fully with the National Minimum Standards and to make sure staff know what peoples care and support needs are the quality of the homes pre admission assessments need to improve and include all the things outlined in Standard 3. Some people bring with them an assessment completed by the Local Authority that contain information about their care needs, mental health and behavior management support needs. The assessments provided by the home do not contain this information, is sparse and there is not enough to tell staff how people are to be cared for and supported. Care Homes for Older People Page 11 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs appear to be met however, there is the potential to put people at risk because of the poor quality of the care plans. People may also be at risk by the way medicines are dealt with. Evidence: The care plans seen are not very detailed and some are hand written on sheets of A 4 paper. Records show there are now some short term risk assessments and care plans for people who might have chest infections or are at risk of pressure sores, however these are not very detailed they leave people at risk . To make sure peoples dietary needs are met there are now nutritional assessments that include measuring peoples weight to make sure they are getting enough to eat. Not all the care plans and risk assessments are signed and dated every month to show they have been looked at to see if they need changing or updating. The medical records show some people are supported by the District Nurses who visit the home regularly and keep their own records, however, some information and in one case valuable advice regarding peoples health is not transferred into the care records to show staff what progress has been made or treatment provided. Care Homes for Older People Page 12 of 30 Evidence: We examined the care plans for seven people. Although the standard of care delivery appears to be satisfactory the quality of care planning remains inadequate in some cases. For example admissions records are not dated and signed. Information within health care assessments does not correspond with details recorded in the care plan such as the presence of a pressure sore. The types of specialist equipment and wound dressings in use are not described or, in some cases, not recorded at all. One highly dependent person with a neurological disorder has no mobility care plan, no hygiene care plan and no nutritional care plan. Some care plan evaluations over several years are brief and repetitive for example no change or ongoing. These care plans require proper review and rewriting to reflect an up to date picture of peoples current needs. Some high risk areas such as use of bed safety rails have not been reviewed since 2005 and there is no evidence of relative input or agreement. Another admission record for someone admitted in February 2009 is only partially completed on the front page and the rest of the admission document is blank. Some care plan entries are vague and non specific for example assist with care of teeth or encourage to use same toilet. However, specific detail on the persons preferences and abilities are not available. The visiting District Nurse said the staff in the home are very good and always helpful. They went on to say that staff are caring and get in touch with them very quickly if anyone living in the home has any problems. The District Nurse went on to say they considered the staff in the home have a good relationship with the Surgery, the GP and District Nurses. On the day of the visit people living in the home were observed to be treated with dignity and having their wishes respected. People appeared to be well cared for, and were calm and not agitated in any way. There appeared to be enough staff available to meet peoples care and support needs in a relaxed and unhurried manner. The inconsistent standard of peoples records did not reflect the good work carried out by staff in the home. To make sure people remain safe and are protected by the way medicines are dealt with staff require further training in how to give medicines safely. Policies and procedural guidance on medicines and best practice are not available . Staff must have access to this important information. Medication Care plans need to be specific with regard to as required medicines and how staff can safely administer certain medicines. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People participate in some activities despite not having a designated activities coordinator or planned programme of activities. Peoples choice of menu could be improved and more information about the meals provided and a better record kept. Evidence: On the day of the visit people were observed enjoying their meals in relaxed and pleasant surroundings. People said they like the meals provided. One person says they get plenty to eat. Another said if they dont like the meal they can have something else. To show people what the meals and the menu is displayed on the notice board in the dining room. Discussion with the newly appointed cook found they have never worked in a residential care home for older people. Cook agreed they might benefit from further training regarding the nutritional needs of older people. Seconds were offered and accepted. The menus only include the lunch options and there are no records of the evening meal, breakfast, supper or snacks. There are no details of the type of vegetable, potato for example mashed or roast, or any desserts or choice of desserts on the menus. Daily food records are kept in a kitchen diary but these are difficult to read and interpret. In the absence of any forward planning there is repetition of vegetables with frozen peas, swede and carrots being provided most days. Staff have to work backwards through handwritten dairy entries to work out Care Homes for Older People Page 14 of 30 Evidence: what people have been given at mealtimes. This is not cost or time effective and has led to items such as bacon being unavailable. Also the lack of records fails to provide an accurate, balanced account of the choice, variety and nutritional content of food provision. Cook described home made desserts and bread and it sounds as though people are offered choice but this is not planned or recorded. Cook has no knowledge of how to supplement and fortify diets where needed. Whole milk is always used but no butter or cream. Care staff were observed assisting people with their meals in a relaxed and unhurried manner. The staff rotas show there are enough staff planed to be available to meet peoples care and support needs and the providers says that they also provide some activities. There was evidence of an activities organizer visiting the home on one day a month. The provider said the home does not have an activities coordinator and there is no planned programme of activities based on peoples assessed needs, preferences ad choices. People were observed being treated with dignity and having their choices respected, however this in not reflected in the daily records or record of activities as they do not contain descriptive words to show peoples choices or any decisions they make about how they live their day to day lives. 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. What people say is taken seriously and acted upon and they are protected from abuse by the Safeguarding policy and procedures. Evidence: To protect people living in the home from abuse there is a Safeguarding Policy and procedure for staff to follow that includes reporting any suspected incidents to the Local Authority. To further protect people staff training records show they have all had Safeguarding Training. Discussion with three carers confirmed this and found they have a good understanding of what constitutes abuse and how to report it. To make sure peoples concerns are taken seriously and acted upon there is a complaints policy and procedure for staff to follow. The complaint policy is accessible as it forms part of the Service User Guide that is found in peoples bedrooms and is displayed in the entrance to the home. Discussion with four visiting relatives found they know how to make a complaint but have never had to do this as they are happy with the care and services provided. The record of complaints shows there has been one complaint received since the previous inspection visit. The record of complaints shows this was appropriately documented and acted upon. The Commissions Service History shows no complaints have been received about the service since the previous inspection visit. Discussion with a visiting District Nurse found they know how to make a complaint but have never had to do this. They said the staff are very good and if there has been any minor concerns these have been dealt with quickly and effectively. Discussions with people living in the home found they are happy and never had to make a complaint. Care Homes for Older People Page 16 of 30 Evidence: What people said was taken seriously and was acted upon. The service history also shows the home has not had to make any Safeguarding Referrals to the local authority since the previous inspection visit. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in clean and pleasant surroundings that are homely and comfortable and safe, however people could be better protected from cross infection. Evidence: On the day of the visit people were observed relaxing in warm and pleasant surroundings that are comfortable, clean and safe. People were observed having their meals in relaxed and comfortable surroundings with tables set with cloths, condiments and flowers. Two people living in the home enjoyed helping set the tables and making them look nice. A tour of the premises found all areas of the home clean and free from any unpleasant odours. Peoples bedrooms are personalized and clean However two bedrooms ceiling lights were observed not to have light shades fitted and these must be provided. To protect people living in the home the provider said they would monitor the water outlet temperatures in the bedrooms as two were to hot for people to use safely. The call bell system was operational however this can be overridden and switched off away from the point of activation. Upgrade of the system should be considered and staff aware that they must attend calls. The provider said the sluice room ventilator has been cleaned since the previous inspection visit. The extractor fan was observed to be fully operational. However the extractor unit in the shower room was out of order. Some bags in the clinical waste in the clinical waste bin which was overflowing, were not double bagged. In addition several soap and paper towel dispensers were empty including the sluice room. This room that contains an open Care Homes for Older People Page 18 of 30 Evidence: hopper was very offensive smelling. The provider said they would provide the clinical waste policy and make sure all staff are aware of what they should do to prevent cross infection in the home. Also he would provide clear procedural guidance on how to clean commodes and buckets within the sluice room. Washed medicine pots were drying on the kitchen radiator. This practice creates an infection risk. For the benefit of people living in the home the garden has been improved and now has plants and flowers for people to enjoy. The certificate displayed shows the homes kitchen has a Five Gold Stars Awarded following a visit from the Environmental Health Department visit last year. The cook and service provider and staff team are to be commended for their efforts in maintaining such good standards of hygiene in the kitchen for people living in the home. Care Homes for Older People Page 19 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care and support needs appear to be met and they and their relatives are happy with the support they receive, however, people need to be confident that the people supporting them are trained, qualified and the work they do is supervised. Evidence: There were enough staff available to meet peoples care and support needs in a relaxed and unhurried manner. People living in the home say the staff are very good and caring. Some visiting relatives said the care staff are wonderful , always pleasant and helpfully. One visiting District Nurse says they have a very good relationship with staff in the home and they are always welcoming and helpful. On the day of the visit staff were observed to be confident and competent. However, to make sure people remain safe and their needs are fully met the training records show that some staff are ready to have some update training. Records show and the service provider confirmed there is further Infection Control, Catheter Care, Palliative Care Awareness and Medication training planned for 2009. Records show some staff have not received any training in caring for those with Dementia and Mental Health problems. People are protected from abuse as the staff training records show the have Safeguarding Training provided by the Local Authority. People are further protected by the way staff are recruited and selected as records show there are police and POVA (Protection of Vulnerable Adults List) checks taken up before they are employed. However, the homes selection and recruitment procedures and documentation require Care Homes for Older People Page 20 of 30 Evidence: improvement. For example reference request forms should request how long the applicant has been known to them and in what capacity. Also designation of the referee would provide clarity as to exactly who they are. Copies of reference request letters are not kept which makes it difficult to prove these have been requested. In one case it appeared that a carer had commenced work at the home before their references were received. Copies of applicants previous qualifications and training are not always requested. Records of interview are not kept, these are needed to demonstrate good practice in equal opportunities and that any concerns have been explored. The Rehabilitation of Offenders section of the application form does not ask staff to make a declaration and infers that some convictions may be exempt which is not correct. Care Homes for Older People Page 21 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home where they are treated with dignity and their wishes are respected,however, information about them should be kept properly to ensure they are safe. What people think about the home and the services it provides should be sought and a report published reflecting what they, their relatives and others say about the services provided. Evidence: The home is currently without a Registered Manager and the service provider must tell the Commission when someone has been appointed and the management arrangements made for the running of the home in the absence of a manager. It was found that peoples views about the quality of care provided are not sought or a report published telling others what they, their relatives and other visitors to the home say about the quality of care provided .To make sure people are cared for properly the work staff do must receive supervision. Records demonstrate and staff confirmed that some of them are not receiving formal supervision at least six times a year. For example a carer who had commenced in January and another in February 2009 had Care Homes for Older People Page 22 of 30 Evidence: no formal supervision notes. Information within the homes policy and procedure manual is old without any evidence of review or update. The content of some documents does not reflect actual practice in the home for example in selection and recruitment, infection control and the prevention of pressure sores. There is no nutritional policy in place. The maintenance checklist shows the equipment in the home is checked regularly and the Health and Safety of people living in the home is promoted and protected. Staff training records show they have moving and handling and infection control training and there is update training planned in these areas. Care Homes for Older People Page 23 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be developed and reviewed in conjunction with the person or their representative. Nutritional risk assessments must be in place and where a risk is identified a specific care plan must be in place directing staff in the actions they are to take to prevent further deterioration in the persons health. 31/08/2007 Care Homes for Older People Page 24 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 3 14 Pre admission assessments must be completed for all people before coming to live in the home. And include all of the information outlined i Standard 3 of the National Standards for Older People. This Requirement is outstanding from the previous inspection visit. To ensure the home can meet peoples personal and health care needs. 01/09/2009 2 7 15 Ensure that written care 01/09/2009 plans clearly identify how peoples needs in respect of their health and wefare are to be met. This must include people who are on respite arrangements. To make sure peoples healthcare needs are met. 3 9 13 Arrangements must be put in place to ensure that care plans include detailed 01/09/2009 Care Homes for Older People Page 25 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action information and instructions for staff in respect of the administration and management of medicines , including the reasons to give medicines on an as and when basis and what constitutes as required for the named person. To make sure peoples helthcare needs are met in relation to medicines. 4 25 13 To make sure people are safe the water outlets must be monitored to make sure they are not to hot. To keep people safe. 5 31 38 The registered provider must tell the Commission about the day to day management arrangements in the absence of a registered manager. To make sure the care management systems in the home meet peoples personal and health care needs. 6 31 39 The Registered provider needs to inform the CQC of the appointment of a new manager. The homes manager must be registered with the CQC 01/09/2009 01/09/2009 01/08/2009 Care Homes for Older People Page 26 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 33 24 What people say about the home and the services provided must be sought formally and a report provided showing what they , their relatives and other stakeholders say about the quality of care provided and the results published. To make sure people have a say in how the home is run and to reflect any changes to the way the home operates as a result of their comments. 01/09/2009 8 37 17 Revise and expand the menues and records of the food provided to fully demonstrate the variety, choice and nutritional content of meals an snacks. To provide a record of the meals people are provided. 01/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Whenever possible a full community assessment completed by the placing authority should be obtained for everyone coming to live in the home to make sure the home can meet peoples mental health and behavioral care and support needs. The medication policy should be updated in line with 2 9 Care Homes for Older People Page 27 of 30 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 current professional guidance so that staff can understand how to handle and administer medicines safely. 3 9 A system should be in place to check expiry dates of medicines and medication with limited use once opened. This makes sure medication is safeto administer by reducing the risk of contamination. Individual medication care plans should be developed and agreed which reflect the personal preferences and expressed lifestyle choices of people living in the home. These care plans should be regularly reviewed in line with changes in peoples medication, health and wellbeing. People would benefit from a planned programme of activities based on peoples assessed preferences and choices. To show people have a say in what they do and make decisions about their lives descriptive words should be used in the daily records to reflect and show peoples choices, preferences and any decisions they make about their daily lives. All staff including the catering team should be provided with training in elderly nutrition to include the specific needs of those people with Dementia. To make sure people are comfortable and live in homely surroundings lampshades should be provided in peoples bedrooms. To make sure staff respond appropriately to peoples requests the home should consider upgrading the call bell system To further prevent cross infection paper towels and toilet rolls should be available in all bathrooms and toilets. To protect people from cross infection a review should be undertaken of the clinical waste policy and all staff made aware of what they should do with clinical waste to prevent cross infection. People should be cared for by 50 of staff that have a National Vocational Qualification. The documents provided for staff recruitment and selection should be improved to make sure people are safe and a record of staff interviews should be kept and include asking Page 28 of 30 4 9 5 12 6 14 7 15 8 19 9 22 10 11 26 26 12 13 28 29 Care Homes for Older People 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 prospective candidates about any criminal convictions. 14 30 To make sure people remain safe and cared for properly mandatory training should be updated regularly and other associated training arranged for staff to attended and in particular Medication Training,Dementia and Mental Health Awareness training. To make sure people are cared for properly and keep them safe staff training and update training should be provided for those that require it and proper records kept in a descent and presentable order. What people say about the home and the services provided should be sought formally and a report provided showing what they , their relatives and other visitors say about the quality of the care provided. 15 30 16 33 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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