Inspection on 13/10/09 for Castlegate House

This inspection was carried out on 13th 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 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Castlegate House 28/01/10

Castlegate House 07/05/09

Castlegate House 21/05/07

Castlegate House 01/06/06

Castlegate House 23/11/05

Castlegate House 28/06/05

Castlegate House 05/10/04

Castlegate House 14/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Castlegate House 49 Castlegate Grantham Lincs NG31 6SN     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 Jessop     Date: 1 4 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 32 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 32 Information about the care home Name of care home: Address: Castlegate House 49 Castlegate Grantham Lincs NG31 6SN 01476560800 01476565672 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Castlegate House Rest Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 20 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 20 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 faling into any other category - code OP Dementia - Code DE Date of last inspection Brief description of the care home Castlegate House is an adapted, partially listed building situated a short walking distance from the town of Grantham. The home provides personal care for up to 20 residents. The bedrooms, which are mainly situated on the ground and first floors although two bedrooms are located between floors accessed by several steps. Access to these floors is by way of a shaft lift. There are two lounges and a separate dining Care Homes for Older People Page 4 of 32 Over 65 0 20 20 0 0 7 0 5 2 0 0 9 Brief description of the care home area. Further seating is provided in two hallway areas. There is car parking for four vehicles at the side of the home and a small fenced terraced area with seats and plants providing an outside area for residents to sit. Fees charged by the home for care range from: £351.00 - £435.00 per week. A copy of the service user guide and statement of purpose can be obtained from senior staff working at the home. Care Homes for Older People Page 5 of 32 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 was an unannounced visit which formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of the people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission. The visit lasted approximately nine hours over two days and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Two Regulatory Inspectors attended on the first day and one on the second day. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us very brief information about their own assessment of how well they are meeting the standards and their plans to improve aspects of the service. Care Homes for Older People Page 6 of 32 We spent from between 10.25am to 12.25am in the music room with the very vulnerable people who live in the home, to see what life is like in the home. We made notes every five minutes on their state of being (mood), their interaction with their surroundings and other people including staff interaction with the people who live there. We made notes every five minutes of what we observed. The details and outcome of this are included in the main body of this report. The main method used to carry out this inspection visit is called case tracking, this includes following the care of a sample of four people through their care records and assessing their care. We spoke to six people who use the service and three members of staff. As the home does not currently have a full time manager we fed back the outcome of the visit to the senior carer at the end of the first day. We also fed back our findings to the Area Support Manager on the second day. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The Responsible Individual must ensure that their is a suitably competent manager in charge of the home. Alternative arrangements must be made for a representative of the company to oversee the home on a more regular basis. This is ensure that their is clear direction and leadership, monitoring and quality auditing to improve the quality of life and care to people living in the home and to reduce the significant risks that have been identified. The care given to people who have dementia must be improved to ensure that it is person centred and raises the quality of their life and experiences. These issues were also identified at the Key Inspection in May 2009. Systems must be in place to ensure that staff monitor that people in the home are drinking sufficient fluids to reduce the risk of dehydration and developing pressure sores. Sufficient and appropriate use of equipment must be provided to the staff to enable them to safely move and handle people in the home with the minimum of risk. Staff must also ensure that they do not use the wrong techniques. If the staff are unable to Care Homes for Older People Page 8 of 32 reduce the risk after having reported the matter to the management, they must alert the appropriate authorities. The care plans and risk assessments including nutritional and weight monitoring must be reviewed on a regular basis or when their are significant changes to the needs of the person in order to reduce any risks. The Care Quality Commission must be informed when an accident has taken place to someone living in the home. This will enable us to monitor events in the home. Systems must be in place to ensure that any information relating to residents and staff is stored securely and confidentially. The Statement of Purpose and Service Users Guide must be kept up to date to enable people to make a fully informed choice about whether they want to move in or not. 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 32 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 32 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. There is out of date information available which does not enable people to make a fully informed decision about moving into the home. Evidence: The home had a Statement of Purpose and Service Users Guide provides some information about the home and services provided. However they were not up to date and referred to the previous Care Quality Commissions address and phone number. The Service Users Guide was in very small print did not include the complaints procedure. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people say they are happy with the service, their care needs are not being reviewed and therefore their safety is being placed at risk. Evidence: We looked at the care records of six people living in the home. We saw that none of the care plans, risk assessments, or evaluation tools had been reviewed since the previous manager worked in the home. The care plans that we saw on file had not been dated so we could not tell when these were written or how up to date they were and some of the documents in the files did not have the persons name on. One care plan that we looked at had not been reviewed since April 2009, another was reviewed in June 2009. We asked the person in charge of the home if they could produce any evidence that the care plans and risk assessments for these people had been reviewed. The person stated no, the previous manager used to complete and review the care plans and risk assessments, I have not had any training and so havent done this. We could not see any evidence to show that the person, their family or advocate had been involved in identifying their care and support needs. We could see that staff had written a daily report on the care that had been provided which was was dated, Care Homes for Older People Page 12 of 32 Evidence: timed and had a signature. Some of the records showed that a nutritional assessment and nutritional intake monitoring was required, however the assessments had not always been completed and although nutritional intake was being monitored and recorded, the comments included ate all and ate little. We also saw that five people had records to monitor their fluid intake however again there was nothing to show why this was taking place or what staff would do if they had concerns. We saw that glasses of juice had been left next to some of the residents. During our two hour observation we saw that one resident only had two short sips of the coffee served to her and did not drink any of the juice. Later the staff came along and took the cup away and at no time did anyone prompt or offer a drinks to any of the residents. We later found out by looking at a care record, that one of the residents has a very high risk of getting pressure sores and infection. Where people had been assessed for a risk of pressure sores and where a high risk had been identified, we could not see that the persons weight had been monitored and the waterlow assessments had not been reviewed for several months. One person who had a very high risk of pressure sores we saw that their weight had not been monitored between April 2009 and September 2009. Another person who is currently being treated by the district nurse for pressure sores had no up to date care plan, risk assessment and their weight had not been monitored and recorded. Moving and handling risk assessments had not been reviewed. One residents moving and handling assessment was last reviewed in February 2009. The person in charge of the home at the time of our visit told us that senior care assistants are responsible for giving medication. They told us that this took place after they had received training and had their practise supervised by the manager. We looked at the medication records and found them well maintained with no gaps in the records. The home received regular pharmacy inspections the last being on the 21/7/2009. The report had some concerns about gaps in the records and temperatures of the drugs fridge. As a result, all of these issues had been addressed and we could see that daily records were being kept and the temperatures were within the recommended limits. We were told that the people were encouraged by the staff team to self medicate but on the day of our inspection visit all the people needed a degree of support to ensure this was done safely. People we spoke with told us, I am very content and the staff are very friendly and Care Homes for Older People Page 13 of 32 Evidence: I am well looked after here. Care Homes for Older People Page 14 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not provided with sufficient, meaningful stimulation or activities to ensure that their individual needs are met. Evidence: The care plans and assessments did not include detailed information about individual interests, hobbies or what people like to do, including their normal daily routines. Throughout our visit the people we saw were either in their bedrooms, or in the lounges either watching television, reading or sleeping. There were no formal activities taking place and we saw no planned activity programme although we did see a member of staff having a game of dominoes with some of the people around a table in the dining room before lunch. A member of staff put a Vera Lynn music CD on and started to to talk to some of the people about Vera Lynn. We saw staff asking the people what they would like to have for lunch and talking to the people as they gave out the midmorning drinks. We also saw one person being collected to be taken to a local older persons club, and the person collecting her told us I always find the staff helpful and flexible and we work very closely together. One person told us I like to keep myself to myself and the staff respect my wishes. Care Homes for Older People Page 15 of 32 Evidence: During the two hour observation of residents in the music room we noticed that a music CD was left on and the residents sat around the room with no other form of stimulation. One resident was quite agitated and persistently asked why am I here, am I supposed to be here, I think Ive gone barmy and what are they doing to us. The staff popped in and out of the room and from time to time made comments to the residents but the staff did not stay in the room for more than a couple of minutes and then left again. People were not given any items of comfort to hold and nothing was available to occupy people. We spoke with the staff at the end of the inspection and fed back that peoples lives could be enhanced by implementing some simple forms of appropriate stimulation for people who have dementia. We told the staff that we would be returning the following day to complete the inspection. When we returned the following day, we found that the residents were again sitting in the music lounge with nothing to do. We observed the staff going around with the tea trolley offering people cups of tea. One care worker handed a resident two biscuits from the tin saying mind my fingers. Two of the residents were seen struggling to hold the biscuits and drink the tea at the same time as they didnt have anywhere to put the cup or the biscuits. Other than during the tea round, we did not see snacks available to people to help themselves. Meals were served in the dining room, a table in an alcove outside the kitchen or taken to people in their rooms on a tray. Tables had clean table cloths. People we spoke with told us I like the meals, they are well cooked and suit my wishes. There is a notice board outside the kitchen showing the days lunch menu. Care Homes for Older People Page 16 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service does not have a robust complaints procedure and residents are not protected by the adult safeguarding policies and procedures. Evidence: There was an up to date complaints procedure displayed on the wall at the entrance to the home. There was a complaints procedure in the statement of purpose but it was out of date and referred to defunct inspection services and there was no complaints procedure in the service users guide. We asked the senior carer on duty if we could see the record of complaints received as we were notified on the Annual Quality Assurance Assessment that three complaints had been received in the last 12 months. The record of complaints could not be produced, so therefore we could not establish if they had been resolved or if complaints had been upheld. None of the people and staff had any complaints about the home during our visit. We did not see any assessments relating to the residents mental capacity which makes sure that people are enabled to make choices and makes sure that peoples rights are respected. Staff were also not fully aware of this subject. The home had an up to date copy of Lincolnshire County Councils Adult Protection procedures. We spoke with two care workers who told us that they have received training on how to safeguard people and how to report concerns however we had previously been told by the staff that they had used unsafe moving and handling Care Homes for Older People Page 17 of 32 Evidence: procedures as the equipment to move them safely had not been provided but had not reported this as a safeguarding concern. There has been three investigations carried out by the Lincolnshire County Councils Adult Safeguarding Team. The outcome was that there was evidence of neglect, wrong techniques being used, poor practises being used, poor recording and peoples rights were not being upheld. Care Homes for Older People Page 18 of 32 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. The home provides a comfortable, homely environment to the people who live there, however, the poor storage of equipment puts people at risk. Evidence: Since our last visit to the home we saw that some of the carpets had been replaced. The dining room floor has been fitted with a more suitable floor covering that looked clean. Some of the bedroom carpets have also been replaced. The bedrooms we saw looked cosy and contained personal items. The bathrooms and toilet doors had pictures on them to help people find their way. We saw some of the communal corridors and hallways were being used to store equipment. We saw several hoists stored in the corridor leading to some of the bedrooms. We also saw a disused washing machine left in the hallway. Most of the home looked clean and we did not detect any unpleasant odours apart from in one bedroom. We spoke with staff to find out if they had received training on infection control procedures. Both staff were aware of how to make sure that they work in accordance with safe procedures. Care Homes for Older People Page 19 of 32 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 training and management of the home is inadequate and does not ensure the residents are properly cared for. Evidence: The Annual Quality Assurance Assessment told us that seven care staff have an National Vocational Qualification (NVQ) level 2 or above, however we could not find any certificates on files to evidence this. The staff spoken with told us they have completed an NVQ. Staff records were difficult to find but we could see they included an application from each person, two references were obtained, notes had been taken at interview and an induction to prepare them for their work had been completed. We could not establish that a Criminal Record Disclosure (CRB) had been obtained however the Area Support Manager told us that the certificate numbers were stored on file however we did not see any evidence of this. Staff confirmed that they had not started work in the home until their CRB had been returned. We interviewed two care staff who work at the home. They told us that the atmosphere in the home has improved over the last few months and said that they are working extra hours in order to help to improve the quality of the service provided. We saw evidence that staff have completed moving and handling training Care Homes for Older People Page 20 of 32 Evidence: recently however staff were not always providing safe moving and handling to people as they said that the equipment was not available. We spoke with staff and asked them if they feel supported and who do they seek advice and support from. They said they used to ask the provider who is now off sick, but they said that the providers brother comes to the service once a week to give them support. One care worker we spoke with said we give people a choice, I find it good as the residents are quite happy, the meals are fine and the residents get lots of drinks. They told us that they had received training in health and safety, fire safety, food hygiene, first aid and dementia care. Care Homes for Older People Page 21 of 32 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. The management of the home is insufficient and puts people at risk. Evidence: Since the registered manager stopped working at the home, the provider took over the day to day management of the service however has since become ill and is on long term sick leave. The provider told us on the telephone that he is handing over the business to his brother, however CQC has not received any written request for the registration to be changed into his brothers name. The deputy manager is currently acting as the manager and the providers brother has sent an Area Support Manager who works for his other group of care homes into the service once a week. CQC has not been notified formally about who to communicate with and despite several attempts to contact the providers brother our telephone messages have not been responded to. The deputy manager told us that the previous manager used to write and review all the care plans and that this has not been done since she left several months ago. Care Homes for Older People Page 22 of 32 Evidence: We could find no quality assurance procedures or see evidence that monthly monitoring visits were taking place as required. The last report of a visit was on the 18/7/2009 and previous visits had taken place in March, May and June 2009. There were policies and procedures but they were duplicated, out of date and refereed to old regulatory and inspection authorities, which no longer exist. Personal money being kept on behalf of the people living in the home were up to date and well maintained with clear records, signatures and balances kept. We went up the office on the second floor where some of the records are stored. The office door was not locked and we found records on the desks and in unlocked cabinets that contained confidential information about staffing issues and recruitment files. The Area Support Manager told us during the visit on the 14th October that he had found a lockable cabinet in which the records would be safely stored. We saw that there had been 27 accidents recorded up to the 15/09/09, however only one accident has been reported to CQC. Moving and handling risk assessments had not been reviewed. One residents moving and handling assessment was last reviewed in February 2009. There were several documents on file with differing advice. The Manual handling assessment dated January 2009 states that a hoist is required to move the resident. During the visit we observed this resident being drag lifted from the armchair. The staff pulled the resident by the arms from the chair. We later interviewed both staff who said that they are aware that this method of moving the resident is unsafe however they stated that they have asked the provider to purchase specialist equipment to be able to assist people from the chair however this had not been provided. Another senior carer confirmed that she had asked the provider several months ago to purchase handling belts however they had not been provided. We saw that there had been regular tests of the fire system as well as regular fire drills and monthly monitoring of hot water temperatures but this was last recorded in July 2009 but showed safe hot water temperatures. There was an alcohol hand rub bottle at the entrance to further prevent infection. We found records throughout our visit were either not available, difficult to find, not well maintained or not up to date. Care Homes for Older People Page 23 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 You must ensure that each 05/08/2009 resident has an up to date care plan, which contains detailed information in respect of the persons health and welfare. This will ensure that the persons individual needs are fully met. 2 12 16 You must make sure that their is a meaningful way to stimulate and communicate with all of the residents who have dementia. This will enhance their quality of life and provide them with comfort. 03/07/2009 3 15 16 You must make sure that 03/07/2009 drinks and snacks are available to the people who use the service at all times. People who require assistance with meals must be offered drinks and snacks on a regular basis. This will ensure that people have sufficient nutritional intake throughout the day and night. 4 38 13 You must ensure that 02/07/2009 comprehensive risk assessments are carried out. Page 24 of 32 Care Homes for Older People 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 You must ensure that a risk assessment is carried out on all specialist equipment such as recliner arm chairs. This is to ensure that risks to service users are identified and so far as possible eliminated. Care Homes for Older People Page 25 of 32 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 8 13 Nutritional screening and 30/11/2009 monitoring must take place on a periodic basis and adequate records must be maintained of weight gain or loss and specific nutritional intake. This will ensure that peoples health and well being is monitored, appropriate action is taken where concerns are identified and accurate records are being kept. 2 10 4 Food and snacks must be served to people in a dignified manner. This will ensure that peoples choices are respected and their independence and dignity is maintained. 30/11/2009 Care Homes for Older People Page 26 of 32 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 3 12 16 People living in the home 30/11/2009 must be consulted about the programme of activities provided by or on behalf of the care home. This will ensure that the range of activities provided is what they want and enhances their quality of life. The Care Quality Commission must be supplied with a summary of the complaints made over the last 12 months and the action that was taken in response. This to enable the Care Quality Commission to monitor any complaints. 30/11/2009 4 16 22 5 17 12 Assessments must be 30/11/2009 undertaken to establish the persons mental capacity when reviewing their care. This will make sure that so far as practicable, people are enabled to make choices and decisions with respect to the care they receive. Arrangements must be put 30/11/2009 in place to ensure that all staff know how to recognise and prevent service users being placed at harm or risk. 6 18 13 Care Homes for Older People Page 27 of 32 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 This is to make sure that people are safe at all times. 7 19 13 Arrangements must be put 30/11/2009 in place to ensure that people living in the home are free from hazards to their safety by the correct and safe storage of hoists on the first floor. This will ensure that staff and people living in the home are protected from possible hazards. 8 22 23 Suitable equipment must be available for moving and handling people. This will ensure that they are moved in a way that is safe for both the service user and the staff. 9 26 16 All areas of the home must be free from offensive odours. This includes all bedrooms. This is to make sure that the environment is pleasant and clean for people to live in. 10 29 17 All records in relation to staff employment must be available at all times for the purpose of the Care Quality Commissions inspection. 30/11/2009 30/11/2009 30/11/2009 Care Homes for Older People Page 28 of 32 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 This is to ensure that staff are correctly recruited. 11 31 8 A suitable person must be appointed to manage the care home. This is to ensure that the home is adequately managed. 12 31 38 Notice must be given to the Care Quality Commission of the name of the person appointed to manage the care home and the date on which the appointment is to take effect. This is to ensure that the home is adequately managed. 13 33 26 Regular monthly 30/11/2009 unanannounced visits must be carried out and reports must be supplied to the Care Quality Commission. The reports must include seeking the opinions of the people living in the home, an inspection of the premises and examining records of events or of any complaints received. This will ensure that there are robust quality monitoring systems in place. 30/11/2009 30/11/2009 Care Homes for Older People Page 29 of 32 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 14 33 24 A quality assurance system must be established for evaluating the quality of services provided at the home. This is to ensure that the views of the people living in the home are gained and action taken to address any issues or requests. 30/11/2009 15 36 18 All staff must be appropriately supevised to make sure they are competent to carry out safe care to people. This will ensure the safety of both the service users and the staff. 30/11/2009 16 37 17 All records maintained in relation to service users or staff must be kept securley in the home. This is to ensure that confidentiality is maintained at all times and personal information about people is protected. 30/11/2009 17 38 37 The Care Quality 30/11/2009 Commission must be notified about the occurrence of any death, outbreak of infectious diseases, serious injury or illness of a service user or any event which adversely Care Homes for Older People Page 30 of 32 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 affects the wellbeing or safety of any service user, any theft, burglary or accident or any allegation of misconduct by the Registered Person or any other person working in the care home. This will enable the Care Quality Commission to monitor the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 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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