Inspection on 18/06/09 for Cairndhu Rest Home Ltd

This inspection was carried out on 18th June 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cairndhu Rest Home Ltd 18/07/08

Cairndhu Rest Home Ltd 18/07/07

Cairndhu Rest Home Ltd 06/07/06

Cairndhu Rest Home Ltd 13/03/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cairndhu Rest Home Ltd 6 Warren Road Blundellsands Liverpool Merseyside L23 6UB     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: Lorraine Farrar     Date: 1 8 0 6 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: Cairndhu Rest Home Ltd 6 Warren Road Blundellsands Liverpool Merseyside L23 6UB 01519248427 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Noemail Cairndhu Rest Home Ltd care home 17 Number of places (if applicable): Under 65 Over 65 17 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 17 Date of last inspection Brief description of the care home Cairndhu is registered to provide personal care and support for seventeen older people. Staff are available in the home twenty-four hours a day to assist the people living there; meals and laundry facilities are also provided. The house is a semi-detached property in a residential area of Blundellsands. It fits in well with local houses and is not immediately distinguishable as a care home. It is well located for getting to local facilities including shops, cafes, pubs, Crosby Beach and public transport. Cairndhu is owned and managed by Veronica Parker who has worked in the home for Care Homes for Older People Page 4 of 29 Brief description of the care home many years. She is assisted by a deputy manager and a staff team who are experienced carers and well known to the people living there. Accommodation within Cairndhu is provided over three floors. Private accommodation is available in either single or double bedrooms, with a lift providing access to the upper floors. Shared accommodation is all downstairs and consists of a sitting room to the front of the house and a large dining room with lounge to the back of the house. The home also has a large front garden with parking and rear gardens with seating areas. 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: We gathered information for this inspection in a number of different ways. Before we visited Cairndhu we sent a self-assessment form to the manager to complete and return to us. This gave her the opportunity to explain the areas the home is doing well in, how they have improved in the past year and plans they have for future improvements. The form also provides information about records in the home, staffing and the support people receive. We also looked at any information we have received about Cairndhu since our last inspection and reviewed the last inspection report. This information all helped us in planning our visit to the home and in writing this report. Care Homes for Older People Page 6 of 29 We carried out an unannounced visit to the home for seven and a half hours on the 18 June 2009. During our visit we spent time looking at the support the people living at Cairndhu receive. This included looking at the support they get with their daily lives, health and personal care, medication, money, activities and environment. We talked to ten of the people living at Cairndhu, four of their visitors and four members of staff, including the manager. An Expert by Experience accompanied us for part of the visit. An Expert by Experience is a person who has experience of using services for older people and has received training in taking part and contributing to our inspection process. Following the visit, the expert prepared a report of their findings which we took into account in writing this report. It currently costs between three hundred and forty nine pounds and three hundred and ninety pounds each week to live at Cairndhu. What the care home does well: What has improved since the last inspection? What they could do better: The training offered for staff needs to improve within Cairndhu. Staff need to receive regular training in basic areas of care practice and in more specialist areas, based on the needs of the people who live there. This would help to ensure that staff are as up to date as possible in how to support people safely and well. Records relating to the people living in Cairndhu need to be better maintained. This includes their care plans and assessments relating to potential risks or their health. These records must be reviewed regularly in order to ensure that any changes to the persons support needs are quickly noted and acted upon. A lack of thoroughly completed care records could lead to people not getting the support they need in a timely manner. Upstairs windows need to have restrictors fitted. This will help to prevent accidents occurring that could be prevented. Care Homes for Older People Page 8 of 29 Records relating to regulation need to be completed thoroughly. This includes an annual assessment of the service the home are providing and notifications to ourselves of any serious incidences within the home. This helps to ensure that the service the home are providing can be audited clearly and that senior staff are aware of their responsibilities under Care Home Regulations 2001 and are able to meet them. 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. sufficient information is obtained about and provided to people to help everyone to decide if Cairndhu is the right place for the person to live. Evidence: The people living at Cairndhu are very positive about the home. Their comments included, I wouldnt want to be anywhere else. Its great and I couldnt have come to a better place. Had heard about it. I really like it. The expert by experience commented in her report, I was welcomed by friendly staff and immediately felt at ease in the situation. One of the people living there and a relative of another person explained that they were able to visit and look around the home before making their decision to move in. The relative told us they found a nice atmosphere. Like walking into somebodys house. Care Homes for Older People Page 11 of 29 Evidence: Before anyone moves in senior staff meet with them and carry out an assessment of their support needs. They also obtain copies of the persons social services assessment and care plan. This means they have the information they need to make sure that the persons needs can be met at Cairndhu. An information pack about the home is given to everyone who needs it and is available in peoples bedrooms. This gives them information about how the home is run including who the staff are, how to raise a concern and social activities in the home. In addition it provides people with information about benefits and the local area. This information pack is printed in capital letters, which could make it more difficult for people to read. The use of plain type face may make this easier. The information provided to people and obtained about them helps everyone to decide if Cairndhu is the right place for the person to live. It also helps staff to plan how they will provide support for the person. Cairndhu does not provide an intermediate care service. 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. The people living at Cairndhu receive support with their health and personal care in a way they prefer. However a lack of consistent record keeping could lead to changes to their support needs not being noted and acted upon quickly. Evidence: The people living at Cairndhu told us that they get the support from staff that they need. One person informed us, We are very well looked after whilst another told us the support they get is, very good. Individual care files are in place for all of the people living at Cairndhu and we looked at a sample of these. We found that care plans are written and reviewed with the person and they are asked their opinion. This is good practice as it enables people to be as involved in their care as possible. Plans are brief and the information they contain varies. There is guidance about the support the person needs during the day with personal care and their health and how they prefer this support to be delivered. However assessments for areas of their health such as their weight or pressure areas Care Homes for Older People Page 13 of 29 Evidence: are not always reviewed monthly. Not all areas of risk in a persons life are covered by a risk assessment that identifies the risk and the actions needed to minimise this. For example where people have specific lifestyle choices such as smoking, this should be covered with a risk assessment for the person and others it may affect. A clear review sheet is in place that should be completed monthly to record any changes to the persons health, medication or support needs. However we found that this review is not always carried out. One persons plan had not been reviewed since April 2009. Other records were not dated. As peoples support needs and their health can change rapidly as they age, it is important that their assessments and plans are reviewed on a regular basis, so that any changes can be quickly identified and acted upon. In meeting the people living at Cairndhu it was evident that they had received support where needed, to meet their personal care needs. The expert by experience commented that, all the residents looked well cared for. However she noted that the slippers one person was temporarily wearing appeared ill fitting and could be unsafe. Staff provided them with support whilst walking to minimise the risk in this. Records and discussion with the people living at Cairndhu showed that they get support to seek advice from health care professionals, such as the GP or dentist, when needed. In discussion with staff they displayed a good awareness of peoples individual support needs and their choices and were able to explain how they meet these. Throughout our visit we observed that staff supported people in a way that respected their right to dignity and privacy. Daily records showed that people are able to get up and go to bed when they wish. One person explained, its up to you when you go to bed and that if they have difficulty sleeping, staff always make them a cup of tea, check on them and ask if they need anything. We looked at a sample of medication, medicines storage and record keeping in the home. Most of this was stored correctly and records had been completed. However some medication stored in the fridge, for a person who had not long moved in, was not labelled as to whom it belonged to. Whilst staff were aware of this, using medication that is not clearly labelled could lead to errors occurring. 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. The people living at Cairndhu receive support to live a lifestyle of their choice so they maintain control over their daily lives in the home. Evidence: During our visit some of the people living at Cairndhu were engaged in different activities as they chose. Some people spent time in their room reading or watching TV, others spent time in one of the lounges. The expert by experience commented that it was nice to hear some residents chatting / laughing sitting next to each other in the front lounge. Later in the afternoon a visitor led a singing session in the front lounge. However comments were mixed about activities arranged by the home. A lot of people were looking forward to an annual barge trip with lunch and one person explained they have, plenty of entertainers. The expert by experience noted that people sitting in the back lounge had the TV on all day but did not appear to be particularly watching it. She commented that, I did feel that perhaps there was a boredom problem for some. In discussion one person explained to her that they cannot always choose the programme as there are others to consider. She suggested that staff have a daily Care Homes for Older People Page 15 of 29 Evidence: discussion with people as to what programmes are on and choose programmes of interests, rather than the TV being left on all day. We saw a number of visitors to the home during our visit. People are able to see their visitors in private or in the lounges as they prefer. A visitor we spoke with told us that they are always made welcome and can visit at any reasonable time. A Catholic communion service is held in the home weekly and a Church of England service monthly. The manager also explained that they have had three Catholic masses in the past year and confirmed that they would support people from different religions to see their minister, if they wished. The people living at Cairndhu told us that they can make their own decisions whilst living there. People are able to get up or go to bed as they please and can choose whether to eat in the dining room or their bedroom. One person explained that they are registered to use a postal vote and the manager explained that they encourage people to manage their own money or have support from a relative with this. People told us that they like the food with one person describing it as lovely and another as very good. A choice of meal is not routinely cooked, however people explained that if they do not like the main meal, you get something different. Whatever you like. Although there are set mealtimes within the home the expert by experience noted that if people were not ready for their meal at these times they were able to eat later. We observed that people are given plenty of drinks throughout the day, with some enjoying an afternoon shandy. The expert by experience ate lunch with the people living at Cairndhu. She noted that staff were attentive and that when one person had to break off in the middle of their meal staff ensured it was re-heated for them. She described the meal as, tasty and hot and explained that it appeared to be enjoyed by everyone. She did however observe that the pudding of strudel and custard may not have been a good choice as some people were struggling to cut it up. 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. The people living at Cairndhu are confident that any concerns they have will be listened to and acted upon. This helps people to feel safe whilst living there. Evidence: Information on how to raise a concern or complaint is made available to people in their information packs. In discussion with some of the people living there and their relatives it was clear that they know how to raise concerns and are confident they will be listened to. A couple of people told us, We have nothing to grumble about whilst others told us they would speak with the manager. They told us she is, very obliging, goes out of her way and she is very good, explains. A visitor also told us they would speak with the manager, explaining they find her, very receptive. A copy of local authority safeguarding adults procedures is available in the home and staff we spoke with were able to explain the actions they would take if an issue arose. No concerns or complaints have been raised about the service since our last big inspection there. However, clear recording sheets are available to monitor, and act upon any that may arise. This open approach to concerns and complaints helps to ensure that the people living at Cairndhu feel safe and confident in the home and the staff supporting them. Care Homes for Older People Page 17 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cairndhu provides a warm, comfortable and homely environment, that had adaptations to meet peoples needs. However parts of the environment could present a risk to peoples health and safety. Evidence: Situated in a residential area of Blundellsands, Cairndhu is set back from the road and provides a peaceful environment with well maintained gardens that people can sit and relax in. It is well located for easy access to public transport, a local busy shopping area and the beach. Downstairs there is a front lounge with TV and to the rear of the house is a linked dining room and second lounge with patio doors leading out into the garden. Both lounges have music centres and televisions. The expert by experience commented in her report that, the house felt bright. It was nice to see two lounges available for people. Most of the bedrooms are single. Where bedrooms are shared, screens are provided for privacy. Bedrooms are located over the three floors of the house with a passenger lift to get to the upper floors. The manager told us in the self assessment form that decoration of bedrooms is on-going. During our visit work was underway to redecorate Care Homes for Older People Page 19 of 29 Evidence: an empty bedroom. We looked at some rooms that had recently been refurbished and found that they had been completed to a good standard. The expert by experience noted that, rooms were comfortable and that people are able to have their own belongings in their room. We observed that if they wish to, people can have a phone and kettle in their room. This all helps people to remain as independent as possible. However some of the upstairs bedrooms that we visited did not have window restrictors fitted. This could present a risk of falling out of the windows. There are bathrooms and toilets provided throughout the home. Although none of the bedrooms have en-suite facilities, they have washbasins and commodes can be provided. A shower room has recently been created on the first floor. This provides people with an accessible shower that they can use with or without support from staff. It has been refurbished to a good standard with domestic style fittings where possible. The expert by experience noted in her report that toilets and bathrooms were, clean and fresh, with no bad odours. She noted that some areas of the home would benefit from more thorough cleaning, in particular the staff sleep in room and dining chairs following lunch, but added that it did feel like, home from home. Aids and adaptations are provided to support the people living there. These include call buzzers, ramps, handrails and bath chairs. The laundry is located in the cellar and provides washing and drying facilities. However the laundry room is also used to store clean towels and bedding and the floor paint is becoming worn away. Alternative storage for clean linen would lessen the risk of infection. Gloves, aprons and disposable bags are all available to help staff deal with any potential outbreak of infection. However some bathrooms do not contain liquid soap and paper towels. The addition of these would help to prevent or limit a potential outbreak of infection. Throughout our visit the people living at Cairndhu were seen to use their own bedrooms and the communal areas as they chose with no restrictions on where they can go. When people have visitors they are able to meet with them in communal areas or in their own bedrooms as they prefer. 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. The people living at Cairndhu have confidence in the staff team who support them. However a lack of planned training for staff means that they are not up to date in how to support people safely and well. Evidence: The people living at Cairndhu told us that they like the staff who work there. One person told us, they are there for me and another that staff are, very nice. We have a good laugh. We and the expert by experience noted that staff were friendly and provided support to people when needed. The staff rota showed that there are two carers working during daytime hours with an additional carer at busier times. There is also a cook and domestic on duty and the manager and deputy are available throughout the day. At night there is one carer and a carer sleeping on the premises to help with any emergencies. The people living at Cairndhu told us that there are enough staff to support them and to provide help when needed. One person explained, Very good. Just shout and they come. Very obliging. It was clear from observing daily life in the home that staff have built up good relationships with the people living there. In discussions with staff they displayed a good knowledge of peoples support needs and of how they like to spend their day. Care Homes for Older People Page 21 of 29 Evidence: Records showed that before the manager appoints a new member of staff, a series of checks are carried out. These include obtaining copies of references, Criminal Records Bureau (CRB) checks and a check on the protection of vulnerable adults list. These checks help to ensure staff are suitable to work with people who may be vulnerable. Most of the staff working at Cairndhu have obtained a recognised qualification in care (NVQ). However at our inspection in 2008 we identified that staff had not had manual handling training since 2006. This training needs to be updated regularly to ensure that staff are aware of the latest guidance on how to support people in a way that is safe for both the person and themselves. We therefore gave the home a requirement that this training should be completed for staff by the end of August 2008. At this inspection we found that the training had not taken place. Although booked for the week following our visit it is a matter of concern that staff training is not taking place at required intervals. Other than fire training there was little evidence that training for staff had been completed within the past year. Staff were in the process of completing training in medication and a first aid course was also booked for the week following our visit. However we saw no evidence that the home are planning regular staff training that covers areas of basic care practice as well as training around the more specialist needs of the people living at Cairndhu. For example staff last had training on safeguarding adults in 2006 and no training had taken place around infection control or the new Deprivation of Liberty laws. In order for staff to meet peoples care and support needs in a way that is safe and follows good practice guidance, it is important that they undertake regular training to keep them up to date. 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. Cairndhu has a motivated manager but record keeping is not maintained to a high standard. The gaps this leaves could affect the safety of people living there and the service they receive. Evidence: Veronica Parker is the registered owner and manager of Cairndhu. She has many years experience within the field of care for older people and has worked at the home for some time; she also holds a management qualification. Lines of accountability within the home are clear and this information is passed to the people living there and their relatives in the homes statement of purpose. The people who live at Cairndhu, their visitors and staff told us that they find the manager approachable and that she supports them when needed. Ms Parker has a very good knowledge of the support needs of the people living at Cairndhu and is motivated to provide them with an individual service in which they can feel at home. However Ms Parker does not always ensure that records in the home are up to date and well maintained. This could have Care Homes for Older People Page 23 of 29 Evidence: an adverse affect on the service people receive. It is a requirement of the Care Homes Regulations 2001 that the registered person must notify us of any incidences in the home that affect the wellbeing of the people living there; they also need to notify us when anyone living in the home passes away. It was noted at our last inspection in 2008 that we had not received any notifications from the home. During the past year Cairndhu have notified us when people living there have passed away. However they have not notified us of other incidences, for example where someone sustains a serious injury. Before we visited the home we asked the manager to complete a self assessment questionnaire to assess how well the home is operating. Although the form was returned to us completed, the information recorded was limited with some sections blank and others not providing sufficient information about future plans for the home or about improvements that had been made. It was not clear that the manager had referred to national minimum standards for care services when completing the form. This was identified following our visit to the home in 2008, however no improvements were evident in the form completed this year. In not providing notifications when required and in not completing the self assessment form the home is failing to comply with regulations that help to make sure that the people who use registered services are safeguarded. There are some systems in place at Cairndhu for checking the quality of the service they provide. A system is in place for checking monthly health and safety records, care records and medication. However this had not been completed since the middle of May 2009 and as identified elsewhere in this report, care plans were not as up to date as they should have been. A full check of the building is carried out regularly and was last completed in June 2009. Areas such as cleanliness and the state of the equipment in the home are looked at but we were concerned because some of the problems we found had not been identified in these checks. Surveys of people who use the service and their relatives as well as visiting professionals were last carried out in March 2008. The manager advised that she intends to send these out again soon. This provides people with a formal way to comment on the service provided and help plan future changes and improvements. Staff at Cairndhu do not act as appointee for any resident of the home. This is good practice as it helps people to be as independent as possible, with support from their families if needed. Some people have lockable storage in their room to store money if they choose and the home has a safe storage facility that people can use. 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 30 13(5) Training for staff in moving 30/08/2008 and handling people must be arranged. This will help to ensure that staff can support people safely. 2 31 37 Completed notification forms 10/08/2008 must be sent to CSCI for all incidences that are outlined in Regulation 37 of the Care Homes Regulations 2001. This will help to ensure the home is open and honest about how they are operating. 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 15 A system must be set up to ensure all care plans are reviewed monthly. This includes assessments relating to peoples health and wellbeing. This will help to ensure any changes to a persons support needs are quickly noted and can be acted upon. 14/08/2009 2 13 All medication dispensed by 14/08/2009 staff must be clearly labelled with the persons name. This will lessen the risk of an error occurring. 3 19 13 Window restrictors must be fitted on all upstairs windows. This will lessen the risk of an accident occurring. 14/08/2009 4 26 13 Liquid soap and paper towels must be provided in bathrooms. 14/08/2009 Care Homes for Older People Page 27 of 29 This will lessen the risk of an outbreak of infection. 5 31 36 Completed notification forms 07/08/2009 must be sent to CQC for all incidences that are outlined in Regulation 37 of the Care Homes Regulations 2001. This will help to ensure that a clear audit trail is available to demonstrate how the home is operating. 6 32 24 A clear system for regular quality assurance checks of the service must be in place and regularly completed. This will help to ensure that any issues that arise are quickly identified and dealt with. 28/08/2009 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 1 1 Consideration should be given to making the information pack available in plain typeface rather than capital/block letters. This may make it easier for people to read. The laundry room floor should be repainted and alternative storage found for clean linen. This will lessen the risk of an outbreak of infection occurring. 2 26 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. 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. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!