Inspection on 19/05/09 for Carrington House

This inspection was carried out on 19th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carrington House 25/11/08

Carrington House 04/11/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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: Carrington House Carrington House Vandyke Rd Leighton Buzzard LU7 3HQ     The quality rating for this care home is:   one star adequate 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: Angela Dalton     Date: 1 9 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Carrington House Carrington House Vandyke Rd Leighton Buzzard LU7 3HQ 01525853211 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Resicare Homes Limited care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 60 The registered person may provide the following categories 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 Physical Disability - Code PD Dementia Code DE Date of last inspection Brief description of the care home The service was newly registered in May 2008. It can accommodate 60 people over 3 floors. There are lounge areas throughout to ensure people who use the service can meet relatives in private. The service offers a choice of bath and shower facilities. There is a garden area which has garden furniture and is used for barbeques in better weather and a conservatory. The hairdresser has use of a designated hairdressing Care Homes for Older People Page 4 of 29 Over 65 0 60 0 60 0 60 2 5 1 1 2 0 0 8 Brief description of the care home room which caters for people who use a wheelchair. There is also a craft room to be used as people who use the service wish. 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: One inspector conducted this unannounced site visit on 19th May 2009 between 10am and 7.40pm. Three people were case tracked. We followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process cross references all the information gathered to confirm that what we are told is happening is actually occurring, and, reflects the Statement of Purpose, which contains the aims and objectives for the service. We spoke to the people who use the service, their relatives, members of the staff team and the manager. The previous key inspection was conducted in November 2008 followed by a random inspection shortly afterward. This was in response to a Safeguarding of Vulnerable Adults alert in relation to pressure care. A service user receiving care from the District nursing Team and care staff had been admitted to hospital with severe pressure wounds. We focused the random inspection upon how associated needs were being met such as nutrition, mobility, pressure relieving equipment and how records of individual needs were being documented. Care Homes for Older People Page 6 of 29 Weekly fees range from 457 pounds to 600 pounds but personal costs such as toiletries, chiropody and hairdressing are not included. We received some surveys from people who use the service and their comments have been included in the report. We were present for lunch and observed several aspects of care delivery. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments have improved but some developments are needed to fully reflect individual requirements. Evidence: Assessments have improved since the previous inspection in November 2008 which was in response to a safeguarding of vulnerable adults alert but some further developments are needed. We conducted a random inspection and focused upon how needs of individuals with pressure care requirements were met. There are defined sections which staff complete to provide a foundation for the care plan. Following the safeguarding alert assessments now detail how associated needs are met such as continence, nutrition, and mobility. Staff have an understanding that pressure care is not an isolated need and other factors lead to an improvement or deterioration. Care Homes for Older People Page 10 of 29 Evidence: We looked at records of two people who had recently been admitted. There was a body map reflecting that there had been some bruises on admission, but no further information reflecting whether there was an impact upon pressure care or skin care. The other assessment did not reflect that pressure care had been considered although all other areas had been assessed. We were told that because the person was mobile, continent and ate a good diet that pressure care was not a current issue. The assessment should reflect this was assessed but not a current need. There was a lack of clarification on the care plan of one person who had a cosmetic prosthetic body part and although the assessment made reference to it there was no reflection of any care required. District nurses complete visits and staff record their findings. Each person receiving input from the district nurse is assessed by them and has a specific care plan. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The medication system does not ensure the safety of people who use the service. Evidence: Care plans have been redesigned and as a result are more easy to read. Staff are able to identify improvements or deterioration. Each need is reviewed regularly and care plans are updated as necessary. Risk assessments are placed next to the relevant section in the care plan so that any corresponding information can be related to individual needs. An example of this working well was that the risk assessment regarding moving and handling was placed next to the care plan on mobility. However, more information is needed to explain what individual food and fluid intake should be. Staff are seeking advice from service users GPs and the dietician where necessary. Staff were able to give examples of how the risk of falling had been addressed. One person liked to rise early and would try to get ready independently often resulting in a fall. Staff now assist with an early morning routine which has reduced the level of falls. Assistive technology has been purchased and sensors have been fitted to identify if there has been a fall. These are activated after 5 seconds so that staff can quickly Care Homes for Older People Page 12 of 29 Evidence: intervene.The manager plans to determine whether the use of this equipment is to be considered under the Deprivation of Liberty aspect of the Mental Capacity Act. Where necessary service users are referred to the Falls Prevention Clinic for further support. We spoke to 5 relatives who praised the way care was delivered. Staff are very patient Care is superb.The girls are friendly, they always have a smile and nothing is too much trouble. They dont neglect anyone. I dont know where my Dad would be if he wasnt here. They work with him, they love him - hes not just a number. The care here is second to none. Its not perfect but nothing is too much trouble. Everything we ask for is put into effect as soon as they can. The bed is changed every day and they are managing to tailor care for people. Some concerns were raised following the inspection by relatives regarding response times to buzzers, as staff took a long time to see people, especially during the evening as people were preparing for bed. Sometimes people were not receiving drinks or they were arriving cold. At other times food was cold but following a meeting food has improved and the manager told us that this would continue to be monitored. Some relatives highlighted that clothing had gone missing and had not reappeared: the manager told us they will replace any missing items. We were told at the previous inspection that the Stay Put system was being used: a personalised button was sewn into clothes and scanned as opposed to using name tapes but this is an optional system that relatives pay for on admission to the home. When we visited the laundry we saw that name tapes were being used and the laundry assistant had no knowledge of this system being used. The relatives we spoke to were unaware of this system and were sewing name tapes into clothes. The manager will discuss the option to purchase the stay put system with relatives. We looked at Medication Administration Records (MAR) for five people. The recording of medication has improved and amounts of medication reconciled, however, some issues were identified. Medication is stored in four trolleys - one in each lounge. On checking one trolley we found the temperatures were not being recorded daily. Medication must be stored at 25 degrees Celsius unless otherwise stated. Out of 22 recorded temperatures (1st April 2009 to 6th May 2009) medication was being stored at a higher temperature on 11 occasions. Records were not present from 6th May 2009 to 19th May (day of inspection) On 4 occasions it was recorded at 30 degrees Celsius. We have been sent records from the communication book to reflect that some recorded temperatures were incorrect but there is no evidence of any action being taken to purchase a new thermometer. The thermometer reading was 30 degrees Celsius during the inspection and the lounge was very warm. One of the trolleys did not have a thermometer and staff had written temperature could not be recorded or Care Homes for Older People Page 13 of 29 Evidence: unable to take with no evidence of any action being taken to address this issue since 3rd April 2009. One trolley had no temperature sheet to reflect that medication was being stored correctly. Medication records were on a landing on the first floor. The manager stated that they medication was being organised in a quiet part of the home for return. No staff were with the records to ensure confidentiality was observed. The home has employed a member of staff who was formerly a Pharmacy Technician to oversee medication. They have worked at Carrington House for six weeks and stated that they had not seen the Royal Pharmaceutical Society guidance for administration of medication in care homes. They are currently being trained in the medication system used by the home. The manager plans to offer additional training to support them in their role and also aims to provide a specific area for medication to be stored to comply with regulations. At the previous inspection one persons family were ordering and overseeing medication. Both the service and the family were informed by the Commission that this practice must cease unless the service user was assessed as competent to self administer the medication. The service now administer medication but the family continue to order the medication and the service do not keep a copy of the prescription as a receipt. The registered manager is accountable for ensuring that there are safe procedures for the receipt, recording, storage, handling, administration and disposal of medication. This cannot be assured if the service is not overseeing the process and the situation must be addressed. Staff are not consistent in the way in which medication is administered. Sometimes two staff are responsible for the administration of medication and sometimes one member of staff is responsible. There is no consistent system in place and this must be addressed to minimise any possibility of the risk of errors and confusion 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples wishes could be better observed with regard to meal presentation and activity information. Evidence: The Activities Co-ordinator has been in post for seven weeks an previously worked as the cook. She seemed enthusiastic about her new role and has begun to develop an in house newspaper with bulletins about whats on and contributions from residents. People we spoke to were aware of the newspaper and some had already submitted articles. There is no weekly schedule of activities. We were told that the darts game and ball game that was occurring during the inspection was only happening because we were there and did not normally take place.The activities co-ordinators records demonstrated that this was not the case and the manager was able to update us with regard to the activities that took place in some of the lounges for people to participate in. A local beauty therapist visits the home regularly to offer treatments to those who would like them. The activities co-ordinator told us that they had planted containers for the garden and made birthday cards. People who use the service told us that they would like to know what was happening so they could choose to attend an activity or not. There are plans Care Homes for Older People Page 15 of 29 Evidence: for the activities co-ordinator to obtain some information from the National Association for Providers of Activities for Older People (NAPA). There is no evidence of how activities are tailored to the specific needs of people e.g. dementia. The home has links with the local church and a Communion service is held monthly. A couple we spoke to have weekly visits from their local vicar. Relatives and people who use the service raised the issue that the home has no dedicated transport to enable people to go out. The activities co-ordinator plans to contact the local Buzzer bus (dial a ride) service so that days out can be planned. She told us that she was arranging a trip to a local garden centre and that there had been visits to 2 church fetes. Relatives reported that activities were poor and the new activities co-coordinator was often recalled to their previous role in the kitchen. The manager told us that there is a range of activities available throughout the day. We observed the activities co-ordinator spending time in the kitchen during the inspection. The manager told us this member of staff assists people who need help to eat at lunchtime. The co-ordinator is currently working early shifts but plans to implement an activities programme to enable care staff to offer activities at times to suit individuals. People told us that there had been a meeting about food as a new supplier had been tried but they did not like the meals. We were told that food sometimes arrived cold and this had been discussed. This issue was raised at the previous inspection and the manager told us that they planned to purchase a heated trolley. Following the inspection we have been informed that a heated trolley was available when the inspection occurred. People told us that the food had been served hot over the past 5 days and relatives believed that this coincided with surveys arriving from the Commission for completion. We observed lunch during the inspection - beef casserole or chicken and leek pie. We were told it was hot and tasty. The cook told us that if someone wanted an alternative that this could be prepared. We were told that cups of tea did not arrive hot all the time especially at night when delivered to bedrooms. Some relatives told us that people who use the service get missed out of tea and drinks when in their bedroom. During the inspection we observed staff offering frequent drinks and refilling peoples jugs of juice in their bedrooms. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not protected from abuse. Evidence: There is a designated complaints and compliments folder. Staff were observed to have a good rapport with relatives. The relatives we spoke to, and those who had completed surveys, stated that they were listened to and knew who to talk to if they had concerns. In November 2008 the service was involved in a Safeguarding Alert investigation regarding pressure care. Social Services responded and an embargo was placed on the home to prevent any new admissions. This has since been lifted and vast improvements have been made to ensure that the situation is not repeated. Other agencies were also investigated as part of the alert. Several meetings took place and the manager was open and approachable throughout the process. Staff have all received pressure care training and safeguarding training to ensure that they are equipped to deal with any future issues. During the inspection we identified that there is potential for a safeguarding alert to occur. There was no protocol in place and senior staff were working on a need to know basis. This must be formalised to ensure that all parties are protected and the situation can be monitored and managed. The manager told us that there had been no complaints since the previous inspection. However, we were told by service users and their relatives that there had been a Care Homes for Older People Page 17 of 29 Evidence: meeting because of concerns about the food. This should have been recorded as a complaint. The service does not deal with peoples finances. Staff have all received Mental Capacity Act training. This has raised the issue of internal doors being accessed by keypad and people not being free to come and go. The manager plans to review the policy of compartmentalising the home as they recognise that this falls under the Deprivation of Liberty aspect of the Mental Capacity Act. They will display signs to advise staff to be approached to open the doors in the meantime as advised by the trainer. It is easier to enter the home by pushing a large door release button than to leave by entering a code into a keypad. Again, the manager plans to review this practice. 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 environment meets the needs of people who use the service. Evidence: The home was clean and odour free. One relative told us that although the home had been open for a year it still smelt new. Another told us beds were changed daily and the home was very clean. Bedrooms had been personalised and there was a friendly atmosphere. Staff have adequate protective clothing to prevent cross infection. All staff have an awareness of infection control. Most people seemed to spend their time in a particular lounge but it was not clear whether this was through choice or staff direction. There were lists of service users attached to door frames of each lounge. We observed some people walking in the corridor and a relative told us that this was part of their family members exercise but staff were not seen to walk with people around the house to minimise the risk of falls. We have received regular notifications of falls and any injuries sustained by service users.The manager told us that a risk assessment is undertaken for all people who are at risk of falls. One relative told us that they would like to see their parent going for regular walks with staff assistance to prevent deterioration with mobility. Care Homes for Older People Page 19 of 29 Evidence: We found incontinence pads were stored in bathrooms, either in their plastic packaging or in boxes. They were placed into bedrooms during the inspection to ensure dignity was better observed. Toilet rolls were stored on toilet cisterns causing people to have to turn to access them. We were told that the free standing toilet roll holders had all been removed to be cleaned. The manager has since stated in the response to the draft report that their absence would have had little impact on the service users. We believe that for people experiencing difficulties with mobility, vision and orientation that easy access to toilet rolls should be available. The toilet in the foyer has a broken lock with a handwritten sign warning users to be careful not to be locked in. It is awaiting repair. Each lounge had a medication trolley in it and associated paperwork which detracted from the homely element. One lounge had a filing cabinet with paperwork for staff use: the manager stated that this had been placed there at staffs request. We advised the manager that the home should aim to provide convenience for service users as the office should accommodate staff. One lounge carpet had a noticeable pull in it which may cause a trip hazard. Assistive technology has been purchased in the form of sensors to alert staff if someone has fallen in their bedroom floor and requires help. Cordless telephones have been purchased to enable staff to summon aid quickly if necessary but the phone can still be heard ringing in corridors and is loud enough to be heard in bedrooms if situated by the speaker. Medication files were on a landing as a staff member had been working in a quiet space. These were unattended and open for anyone to look at the information. The home has 2 offices for staff, empty bedrooms and accounts offices which could have been used. Some bedrooms only had one chair instead of two. One relative was sitting on a commode chair as there was no alternative seating.The manager should ensure alternative seating is available. If a service user has refused to have two chairs in their room this must be recorded. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are equipped to meet the needs of people who use the service. Evidence: The rota reflected that adequate staffing levels are deployed. Although there has been a high staff turnover in the past six months the service is retaining more recent recruits as the home begins to settle. Most of the management team work 9-5 shifts with weekends off although they spend time working on the floor. Two relatives told us that staff appeared to have little time to interact on a 1 to 1 basis with people who use the service. We observed staff spending time with people who use the service during the inspection. All staff have achieved or are working towards an NVQ and the Annual Quality Assurance Assessment (AQAA) told us that out of 28 permanent staff 6 have achieved an NVQ Level 2. We checked some staff files and all required checks were conducted. At the previous inspection in November 2008 we identified that the application forms would benefit from development to ensure that a more comprehensive work and educational history was recorded. This has not occurred. All staff receive supervision every 6 weeks. A rolling training programme is in place: Staff have received Safeguarding training, Stoma care, pressure care and Mental Capacity Act training since the previous inspection. Relatives and service users were all complimentary about staff and informed us how Care Homes for Older People Page 21 of 29 Evidence: kind, caring and approachable they were. One survey stated staff caring as concerned for clients welfare. 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 health and safety of service users is not assured. Evidence: The manager has an obvious presence in the home and all the service users and relatives we spoke to were happy to raise any concerns. They are registered with the Commission and own another local service. The manager completed the Annual Quality Assurance Assessment (AQAA) and also seeks the views of family and people who use the service. The Activities co-ordinator plans to organise regular service user meetings to ensure that any concerns or compliments from service users can be acted upon. Staff appeared to work well together and reported that morale had improved since the Safeguarding alert last year. We checked fire records and were informed water temperature records were kept. However, we observed that some bedroom doors were being wedged open with a variety of objects including a metal doorstop, a rolled up incontinence pad and a walking frame. Towels had also been placed over the top of doors in the kitchen and the laundry to reduce the noise from doors closing. This Care Homes for Older People Page 23 of 29 Evidence: practice does not ensure the safety of service users if there was a fire. A safe alternative must be sought. We spoke to one person who had an electric recliner chair. This must be risk assessed to ensure that staff know how to operate it safely and ensure that the individual is not at risk as accidents have occurred in other care services. We found two chest freezers on the first floor were both unlocked. They were locked during the inspection to minimise any risk. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 Assessments must be comprehensive and consistent. Assessments must reflect that core issues have been reviewed such as pressure care, skin care and personal effects. If there is not a current need the assessment should reflect that this has been identified and will be reviewed. 30/06/2009 2 9 13 The Registered Manager must ensure medication is ordered and dispensed in a consistent manner. Royal Pharmaceutical Society guidelines must be observed. The registered manager is accountable for ensuring that there are safe procedures for the receipt, recording, storage, handling, administration and disposal 30/06/2009 Care Homes for Older People Page 26 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action of medication. Where family members order and dispense medication there is a transfer of accountability. 3 9 13 Medication must be stored at the correct temperature. To ensure it is safe for service users to take and is kept in accordance with the manufacturers licence. 4 12 16 People who use the service must be aware of what activities are available and when they will be provided. They must suit individual needs. Activities should reflect that individual likes and dislikes have been sought and an informed choice can be made as the range of activities is publicised. 5 15 16 Food and drink must be properly prepared to arrive hot to the individual. All service users must be assured of receiving regular drinks. People are entitled to receive hot food and drink. Food and drink must be appetising and attractive to encourage those with a 30/06/2009 30/06/2009 30/06/2009 Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action limited intake to eat and drink. 6 18 13 When a safeguarding risk is identified a robust protocol must be in place. Vulnerable people must be protected and staff must be equipped accordingly. 7 38 13 Fire doors must not be wedged open. A safe alternative must be sought to ensure that people who use the service can leave their door open if they wish. 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 30/06/2009 30/06/2009 1 10 The manager should ensure that service users clothes do not go missing and an adequate laundry clothes identification system is in place. Complaints that have been received and dealt with should be recorded e.g. complaints about the quality and temperature of food and drink. The environment should reflect that the home is run for the convenience of service users. Application forms should be developed to include a comprehensive educational and work history. 2 16 3 4 19 29 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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. 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