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Inspection on 07/10/09 for Carshalton Nursing Home

Also see our care home review for Carshalton Nursing Home for more information

This inspection was carried out on 7th October 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

All of the feedback that we received from the people that we spoke with during the inspection was very positive. People who use the service and their relatives were particularly complimentary about the staff team and the homely relaxed atmosphere in the home. They told us that staff were caring and friendly saying "staff are always welcoming, they always offer you a drink when you arrive", "this place is so friendly, a lot less clinical than other homes" and "this place is a bit more homely than some, all the staff know your name".

What has improved since the last inspection?

Although the people who use this service seem to like it , there have been ongoing problems for some time. We have always considered that much of this is due to the disorganised management arrangements in place. However, since our last visit a new manager has been appointed and we have acknowledged that there have been some signs of improvement. Care planning in the home has improved with more information now available to staff to help them support residents. The plans have been compiled with input from residents and their families to ensure that they are reflective of the way that people wish to be supported. Work has been done to find out about people s past lives and achievements and this helps staff to understand more about them and also to plan activities which will interest them. Activities in the home have increased and people tell us that there are more things going on now for them to join in with if they want to. Some residents have been cooking; gingerbread men and fairy cakes, others have been able to out of of the home accompanied by staff or relatives. Staff training and supervision has improved. The manager is compiling a training schedule in order to identify where staff need further training and all of the care staff are beginning to have regular supervision sessions. There is some redecoration and refurbishment ongoing in the home although there is still a considerable amount to be done to ensure that the home is a pleasant place for people to live in. We have questioned the way that some of this work is prioritised and the home is currently producing an action plan for the future.

What the care home could do better:

Now that the new manger is in post we have recommended that she should work with the providers to establish a team and define their individual roles and responsibilities. This would also involve delegating some tasks to the senior nurses in the home. The staff have all worked in the home for some time and know the residents well,however we would like to see more opportunity for people to influence the care and services that they receive and exercise more choices in their daily lives. An example of this was that residents are not given the opportunity to choose what they would like to eat and plan the menus. We recommended that the home should consider ways that they could be more involved.At this inspection we raised some concerns about fire safety. We were not able to see any evidence of staff having attended fire drills, although they all seemed to be aware of the procedures to be followed, and there was no fire risk assessment available. We were also concerned about the fact that we have had to repeat two requirements. The first is in relation to visits to the home by the registered provider. Records of these must be available for inspection so that we can see that they have occurred and also what actions have been taken as a result. The second relates to the information that the home is required to send us if any untoward incidents happen in the home. This information allow us to monitor the home and to plan our future inspection activity.

Key inspection report Care homes for older people Name: Address: Carshalton Nursing Home 28 Salisbury Road Carshalton Surrey SM5 3HD     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: Alison Ford     Date: 0 7 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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 31 Information about the care home Name of care home: Address: Carshalton Nursing Home 28 Salisbury Road Carshalton Surrey SM5 3HD 02086692592 02086699558 sweethomes@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sweet Homes Ltd care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care home with nursing - Code N 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 (maximum number of places: 33) Dementia - Code DE(E) (of the following age range: 65 years and older) (maximum number of places: 10) Date of last inspection Brief description of the care home Carshalton Nursing Home is registered to provide care for up to thirty-three older people who may have dementia. As an existing care home the facilities would not meet the requirements of a newly registered home. A large proportion of the accommodation is provided in what were previously designed to be shared rooms, without en-suite facilities and others are Care Homes for Older People Page 4 of 31 Over 65 10 33 0 0 1 3 0 7 2 0 0 9 Brief description of the care home smaller than would now be acceptable. There is only one lounge/dining area and this is in the form of a conservatory, which despite fans, is sometimes uncomfortably hot. There is a shaft lift to ensure accessibility throughout the home and the conservatory overlooks the rear garden. There is limited off-street parking however, the home is in a quiet road and close to public transport links. At the time of this inspection we were told that fees range from £525- £850 per week. Any extra charges payable for services such as hairdressing would be discussed prior to admission. A copy of the homes Statement of Purpose, Service User Guide and the latest inspection report can be obtained from the homes Registered Providers or the latter can also be obtained from the Commission For Social Care Inspection from their website. www.csci.org.uk Care Homes for Older People Page 5 of 31 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: This inspection was an unannounced visit by two inspectors lasting about five hours. During this time we spoke to several of the residents in the home, and two of them at length, to try and find out what it is like for those people who use the service. We also spoke with some relatives who were visiting , the homes new manager, the senior nurse on duty and the three care workers. During the day the providers daughter who is acting as his representative was also in the home to talk with us. We walked around the home and garden and, looked at a sample of care plans and other documents that the home is required to keep. We looked at medication storage and administration procedures and also at the complaints records, staff training schedules and fire safety records. When writing the report we have also taken into account information that we have received about the service since our last inspection in June 2009. Care Homes for Older People Page 6 of 31 The home also sent us their Annual Quality Assurance Assessment (AQAA). This is a self assessment which tells us how well the service considers it is achieving its aims and objectives and meeting the needs of the people who live there. It also provides us with some numerical information about the service. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Now that the new manger is in post we have recommended that she should work with the providers to establish a team and define their individual roles and responsibilities. This would also involve delegating some tasks to the senior nurses in the home. The staff have all worked in the home for some time and know the residents well,however we would like to see more opportunity for people to influence the care and services that they receive and exercise more choices in their daily lives. An example of this was that residents are not given the opportunity to choose what they would like to eat and plan the menus. We recommended that the home should consider ways that they could be more involved. Care Homes for Older People Page 8 of 31 At this inspection we raised some concerns about fire safety. We were not able to see any evidence of staff having attended fire drills, although they all seemed to be aware of the procedures to be followed, and there was no fire risk assessment available. We were also concerned about the fact that we have had to repeat two requirements. The first is in relation to visits to the home by the registered provider. Records of these must be available for inspection so that we can see that they have occurred and also what actions have been taken as a result. The second relates to the information that the home is required to send us if any untoward incidents happen in the home. This information allow us to monitor the home and to plan our future inspection activity. 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 31 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 31 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. Although no one is admitted into the home without some form of assessment taking place these are not always sufficient to ensure that placements will be suitable. This home does not offer intermediate care facilties therefore standard 6 does not apply. Evidence: At our last visit we saw that residents all had an assessment completed by their care manager prior to them coming to live in the home. They had also been visited by a member of the homes staff although the assessment details that we saw, relating to this visit, were limited. Information that we were given throughout the year highlighted the fact that care mangers have not always visited the home prior to a placement being made. This had resulted in some people coming into the home and it not being able to meet their Care Homes for Older People Page 11 of 31 Evidence: needs. This highlights the need for a thorough assessment to be undertaken by the home, prior to offering anyone a place there. There have not been any new admissions since this time therefore, it was not possible to judge whether this had improved since that time. The home does not offer intermediate care facilities, this standard does not apply. Care Homes for Older People Page 12 of 31 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. Care plans provide enough information to ensure staff are able to deliver appropriate care to residents. The home must ensure that staff are able to access and contribute to them. Residents are receiving their medication as it has been prescribed however, monitoring processes could be improved. Evidence: Nearly all of the residents were in the lounge during our visit. They looked well cared for and were dressed appropriately for the time of year. Their clothes were nicely laundered and we noted that some of the ladies had make up and their jewellery on. All of them had well brushed hair and dentures and spectacles were clean. Relatives that were visiting told us people always look nice. One lady was currently being nursed in bed and she looked clean and very comfortable. The home has recently changed the format of their care plans. The Standex system has been purchased and all of the information from the old care plans has now been Care Homes for Older People Page 13 of 31 Evidence: transferred. The new acting manager has written the majority of these and those we looked at were comprehensive and well organised. We were able to see that residents or their relatives had contributed to the process and that there was evidence to show that they had read them. We could see that other health care professionals are asked to contribute to the care of residents such as the GP, tissue viability nurse and optician. Appropriate equipment is in place for those people who are at risk of the development of pressure sores. During the inspection we noted that some of the staff had difficulty producing care plans that we asked for as they were all locked away and only some staff had access to them. These care plans must be seen as working documents which allow all of the staff to have the information which helps them to support people. We discussed this with the manager who agreed to make them more accessible to staff. We were also assured that, now that they had been set up, all of the staff were able to add to them and record necessary information. We did see that staff had a good understanding of the needs of the residents. Most of them have worked in the home for some time and they have built good relationships with them. We looked at medication storage and administration procedures. No errors were found in the recording of either daily medication or controlled drugs and they were appropriately stored and disposed of. We noted that some medication is given on a when required (PRN) basis. Although the member of staff we spoke with was very clear when this should be, we have recommended that there should be guidelines established so that all staff are clear when and how to give medication prescribed in this way. There was also a degree of confusion where the signature of one staff members could be mistaken for the symbol used when medication has not been give. The manager told us that she undertakes a monthly medication audit however, we have recommended that this should be undertaken more frequently and asked the home to review their medication audit procedures. This would also include monitoring the practises of those people who administer medication and providing training where necessary. During our visit we saw that staff were very respectful toward the people that they were caring for. All of the feedback that we have received from people who use or visit the service has been very positive about the attitude and professionalism of the staff. We were told staff always treat my mother well staff are always welcoming and you can always speak to the staff here if you have a problem and they will listen to what you say. Care Homes for Older People Page 14 of 31 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. There is beginning to be an increase in the amount of activities and events available for people to participate in. Generally they find the food there acceptable but there is a lack of choice and no way for them to influence the meals that they are served. Evidence: Previous inspection reports have highlighted the lack of activities that are organised for people in this home. At this visit, residents and their relatives and friends told us that things are beginning to improve and there are more opportunities available for them to participate in social and recreational activities. People told us I like the sing songs and a man comes to play music sometimes. Some people have been able to be taken out of the home and other trips are being planned. Some residents have also been able to take part in cookery sessions, making gingerbread men and fairy cakes. During the course of our visit we saw care staff sitting reading with residents and playing games with them. The current low number of residents is giving staff much more time to spend interacting with the people that they support. The lunchtime meal was served during our visit. It looked well presented and and appetising and the one meal that was liquidised was served with the various Care Homes for Older People Page 15 of 31 Evidence: components separated. People told us the food here is OK and the food always looks nice. We looked at the homes menus which showed that they serve a variety of typical British style meals. We noted that there was one Asian person in the home and we were told that their family sometimes brings in food for them. All of the residents and their families that we met told us that they are not involved in planning the homes menus. Staff told us that they know about peoples dislikes so they dont have to ask about choices. We are recommending that the home should find a way to enable the people who are using the service to help to plan the menus and make choices about what they would like to eat. Staff told us that they keep records of what people have to eat but those that we looked at were not always complete. The service is required to keep records of the meals that are consumed by those people using the service in order for any authorised person to judge that they are offered an adequate nutritionally balanced diet. Care Homes for Older People Page 16 of 31 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. The home has a complaints procedure and staff would always respond to any concerns. There are procedures in place to ensure that residents are protected from harm. Evidence: At our last inspection visit we were concerned that anyone who used or visited the service might not have access to information about how to raise any concerns that they might have. The complaints procedure is now displayed in the entrance hall and those relatives that we spoke with were confident that should they have any concerns they would be addressed by the staff in the home. They said that they would feel quite comfortable speaking with staff about any worries that they might have. The procedure is also in residents bedrooms although the format means that most of them would probably not be able to read it. The information that we have from the home tells us that they are trying to develop a process for dealing with any complaints which will help to improve standards. All of the staff have had training in recognising and reporting abuse and appropriate checks are undertaken prior to the employment of any new staff, in order to protect residents. These checks are also repeated every three years in line with recognised good practice. Care Homes for Older People Page 17 of 31 Evidence: The Commission has not received any complaints directly since the last inspection however, we have been made aware of one concern that is currently being investigated according to the local authority safeguarding guidelines. This has resulted in them highlighting several concerns about the home and placements are currently suspended. Care Homes for Older People Page 18 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is warm and clean however it would benefit from further redecoration and refurbishment. There are some concerns about the way that the need for this work is being prioritised. Evidence: We undertook a tour of the home. As an older home this building would not meet the standards expected of a newer building. Room sizes would not comply with current standards and there is only one communal area which is a conservatory. This serves as both the sitting room and dining room and historically it has always been difficult to control the temperature, particularly its being very hot in the summer. Various options have been tried and we are told that two new air conditioning units have now been ordered. Since the new manager arrived there has been an attempt to tidy up the home. Unwanted furniture has been removed and folders and files have been put away into cupboards. However, it would still benefit from new furniture which we have been told will be ordered. Since our last visit new net curtains have been put up however, they are not really ideal and are going to be replaced with blinds. Although we can see that there has been some financial input into the home recently Care Homes for Older People Page 19 of 31 Evidence: in an attempt to make it more comfortable for the people who live there we have expressed some concerns about the way that the work has been prioritised. A very large gazebo has been built in the garden. This is currently furnished with unwanted armchairs and bedroom furniture although we were told that this was a temporary arrangement until new garden furniture arrived. We noted however that some of the residents bedrooms would benefit from being decorated and refurnished , and that the purchase of nursing beds would make them more comfortable and help staff when they were delivering personal care. We saw that some of the bedrooms are very impersonal and suggested that, for these people, their relatives might be encouraged to bring in possessions from home to help personalise them and make them look more homely. Also given the local authoritys reluctance to place people in shared rooms, the providers might consider removing extra beds and dividing curtain rails. We also recommended that the fluorescent lights in corridors should be replaced by lights which are more domestic in style. Bathrooms are still not well appointed and equipment that is used to help those with limited mobility enjoy a bath, although functional, is old and worn. Bathing for residents should be a pleasure that many of them would not have been able to enjoy in their own homes and an effort should be made to ensure that this is so. The providers will be compiling an action plan for the local authority which will illustrate how further work will be undertaken. Despite the area not being as aesthetically pleasing as some other homes, people tell us that they are quite comfortable and they like the cosiness of all being in the same room. Relatives told us its less clinical than other homes and I chose it for my mother because its like being in a big family. There is a garden gate to the rear of the property which is designated as an exit point in the event of a fire. We noted that there was a combination lock on this and also a padlock. This would be a hindrance in the event of a fire; at our request it was removed. The providers are reminded that fire exit doors must be able to be opened without the use of a key. We noted that there are no hand washing facilities in the laundry room. To comply with infection control guidelines, a requirement has been given to install this. On the day that we visited the home was clean and tidy and free from malodour. Care Homes for Older People Page 20 of 31 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. There are currently sufficient numbers of staff available to meet the needs of the residents. Staff training has improved and the manager is aware of areas where more training is still required. Evidence: Staffing levels have been maintained despite the current low occupancy levels. This has enabled them to spend more time interacting with residents rather than just delivering personal care. While we were in the home we saw staff sitting reading magazines with residents and playing interactive games with them. Both the residents and their relatives were very complimentary about them and told us how kind, caring and helpful they always were. The majority of them have worked in the home for some time; staff turnover is very low and this continuity of care plays an important part in making people with dementia feel safe and happy. Our last inspection raised concerns about the lack of staff training and the the manager and provider showed us how they were planning to address this. Progress has already been made with staff receiving training in moving and handling, fire safety, food hygiene, medication, infection control, dementia. and recognising and reporting abuse. Two thirds of the care staff have an NVQ qualification to at least level 2 and some have progressed above that. Care staff were able to confirm that supervision sessions have started to be held on a regular basis although as yet formal Care Homes for Older People Page 21 of 31 Evidence: appraisal has not been introduced. The manager is currently completing a training needs analysis which will identify areas where more training is needed and this will include more training relating to dementia. We have previously been able to confirm that staff were not being employed without all of the necessary checks being carried out and no new staff members have been employed since that time. Care Homes for Older People Page 22 of 31 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. Management practices within the home have previously been very disorganised. The appointment of a a new manager is helping improvements to be made. Evidence: Since we last visited a new manager has been appointed by the home, although she had only been in post for a month at the time of this inspection. She told us that she has many years nursing experience in various specialities and appeared to demonstrate an understanding of the issues that concern us about the home. She is being supported by the daughter of the Registered Provide who is acting as his representative. We did consider that they seemed sometimes uncertain about what they were each responsible for and also about roles that could be delegated to senior staff. We have made a recommendation that they review the way that they and the staff all work together. Both of them are going to undertake a management course. The providers daughter was able to show us a satisfaction survey that people who use or visit the service will be invited to complete. We have recommended that the results Care Homes for Older People Page 23 of 31 Evidence: of this should be available to all interested parties. The manager may also wish to consider holding regular meetings for residents and their relatives in order to gain their views and give them the opportunity to influence the service. We were told that the providers daughter visits the home regularly however there were no reports available of these visits for us to see. Providers are legally required to undertake these visits in line with Regulation 26 of the Care Standards Act and we have issued this requirement previously. At our last visit we also made a requirement for them to inform us of any untoward incident affecting the health or welfare of any resident, in line with Regulation 37. At this inspection we were informed of a serious injury which had occurred about which we had not been notified. This information is important to us in as much as it helps us to monitor the home and plan our inspection activity and a failure to supply it may lead to enforcement action being taken against the home. The information the we have been given tells us that generally equipment and services are being maintained appropriately. This included the fire fighting equipment. However although staff were able to produce up to date records showing that the fire alarm is tested regularly, there was no fire risk assessment available. We also received a mixed response from staff when they were asked about fire drills. The manager and providers daughter assured us that fire drills were being conducted however they were not able to produce any records supporting this. None of the staff we met could recall the last time they participated in a fire drill although they were clear about what they would do in the event. Fire drills must be undertaken on a regular basis for all staff including night staff, we recommend at least four times a year, and an up to date record of these must be maintained. A fire risk assessment must be completed in line with fire safety regulations. We have made requirements for the home to comply with this. When we looked in the kitchen we found some out of date food in the freezer. It was promptly disposed of. Some other items were not properly stored or labelled. The manager told is that there had been some problems in the kitchen and a staff member had recently been dismissed because of poor standards. However the manager and provider must ensure that their monitoring procedures include kitchen practices. We have made a requirement regarding the storage, labelling and disposal of unwanted food in order to minimise the risk to residents. Care Homes for Older People Page 24 of 31 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 31 26 There must be records 30/06/2009 available to show that The Registered Provider visits the home. As evidence to show that they are happy with the standard of care being provided by the home. 2 38 37 The Care Quality Commission 30/06/2009 must be informed of any incident affecting the health and safety or wellbeing of anyone in the home. In order to monitor the situation in the home and plan any future inspection activity. Care Homes for Older People Page 25 of 31 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 17 Records must be kept of the meals that are eaten by those using the service. In order for anyone authorised to do so, to check that they are nutritionally well balanced and adequate. 30/12/2009 2 19 23 Hand washing facilities must 30/12/2009 be provided in the laundry. In line with control of infection good practice guidelines 3 19 23 Designated fire exits must be able to be opened without the use of a key. In order to ensure the safety of residents and staff in the event of a fire. 30/10/2009 4 19 23 The redecoration and refurbishment plan must continue. 30/12/2009 Care Homes for Older People Page 26 of 31 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 In order to make this a suitable and pleasant environment for people to live in. 5 37 26 A system must be put in place whereby an unannounced visit to the home is carried out at least once a month in accordance with the requirements set out in regulation 26 (1)(2)(3) of the Care Home Regulations 2001. In order to provide an ongoing evaluation of how the home is operating and of any areas that need addressing. 6 38 37 A system must be put in 30/11/2009 place to ensure that any occurences as isted in Regulations 37(1) of the Care Homes regulations are reported to The Care Quality Commission without delay. In order that The Commission can monitor the wellbeing of the people who are using the service. 7 38 23 There must be evidence of compliance with the Regulation Reform ( fire safety) Order 2005 in 30/11/2009 30/11/2009 Care Homes for Older People Page 27 of 31 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 accordance with regulation23(4)(a) To show that risks from fire have been identified and minimised. 8 38 26 A copy of the report referred 30/11/2009 to in requirement number 10,must be supplied to The Commission, the manager of Carshalton Nursing Home, and each of the directors or other persons responsible for the management of the organisation in accordance with regulations 26(5)(a)(b) and (c) of the Care Homes Regulations. As evidence of the continued monitoring of the service. 9 38 23 A system must be put in 30/11/2009 place to ensure that there are records of every fire practice, drill or test of equipment ( including fire alarm equipment) conducted in the care home and of any action te remedy defects in the fire equipment. These records must be kept in the care home and be available for inspection at all times. Care Homes for Older People Page 28 of 31 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 As evidence that staff have been instructed in the procedures to be followed in the event of a fire. 10 38 26 A system must be put in place whereby each unannounced visit to the home is recorded in the form of a written report which shall contain detail on the conduct of the home in accordance with regulation 26(4)(c) of the Care Homes regulations 2001. In order to provide an ongoing evaluation of how the home is operating and of any areas that need addressing. 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 30/11/2009 1 9 It is recommended that the monitoring of medication practices in the home should be increased in order to minimise the risk of any errors occurring. It is recommended that guidance for the use of as required medication is introduced. It is recommended that the home should find a way to enable people who use the service to have some influence over the meals that are served, It is recommended that fluorescent lighting in the corridors should be replaced with lighting that is more domestic in Page 29 of 31 2 3 9 15 4 19 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 style. 5 38 It is recommended that the management team of the home review their roles so that they are certain of their individual responsibilities. It is recommended that the results of surveys, which are undertaken as a part of the quality assurance system, are made available to all interested parties. 6 38 Care Homes for Older People Page 30 of 31 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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