Inspection on 30/11/09 for Castlemead Court Care Centre

This inspection was carried out on 30th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Castlemead Court Care Centre 01/11/07

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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: Castlemead Court Care Centre Wolverton Road Newport Pagnell Buckinghamshire MK16 8HW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Chris Sidwell     Date: 0 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Castlemead Court Care Centre Wolverton Road Newport Pagnell Buckinghamshire MK16 8HW 02083135000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Excelcare Holdings The registered provider is responsible for running the service care home 79 Name of registered manager (if applicable): Type of registration: Number of places registered: 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 to be accommodated is 79. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age- not falling within any other category (OP). Date of last inspection Brief description of the care home Castlemead Court Care Centre is a care home built in 2007. It has three floors and is located on the northern side of Milton Keynes in Newport Pagnell. The town centre is a short walking distance from the home where there are a range of local and high street shops, restaurants and other facilities. The local buses give access to many other areas Care Homes for Older People Page 4 of 29 Over 65 0 79 79 0 Brief description of the care home in Milton Keynes and the centre of Milton Keynes is only a short bus ride away. Excelcare Holdings Ltd owns the home. It provides personal and nursing care for up to seventy-nine people. It is separated into three units. Each unit has its own sitting, dining and kitchenette area. Bedrooms are single occupancy with en-suite facilities. There are also a number of therapy rooms such as, hairdressing, computer with internet access, a sensory and prayer room. The home has been adapted to meet the needs of people with disabilities There is an enclosed garden, which is secure to provide a safe environment for service users. The staff team consists of qualified nurses, carers, housekeeping, catering, laundry, administrative and maintenance staff. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was conducted over four days and included a review of the information we hold about the service and two days spent in the home, the first of which was unannounced. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment which was completed in full and returned on time. Surveys were sent to the home for distribution to residents, families and staff. A member of staff helped eight residents to complete the surveys. Eleven members of staff and four health care professionals returned their surveys. Residents and visiting families were spoken to on the day of the unannounced visit. Discussions took place with the manager, nursing, care and ancillary staff. Care practice was observed and the care of a number of residents was followed through in detail. A tour of the building and examination of records was also Care Homes for Older People Page 6 of 29 undertaken. The homes approach to equality and diversity was considered throughout. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The management of medication must be improved to ensure everyone receives their medication as prescribed. There must be clear information in the care plans or on the prn protocols as to when medication which is prescribed on an as needed basis should be given and what constitutes as needed for individual service users. The risk of people becoming malnourished and losing weight must be assessed accurately and residents care plans should be clear about how that risk is to be Care Homes for Older People Page 8 of 29 managed and the steps to be taken to prevent people losing weight, as far as is possible. All staff should be reassured that they can and should raise concerns with the management team if they have concerns about residents care. The environment in the dementia care unit should be enhanced to provide greater stimulus and opportunity for people with dementia to engage with every day activities and objects. Staffing levels in the dementia care unit should be monitored carefully and adjusted if necessary, particularly when staff are supporting residents on another unit and when the dependency of those in the dementia care unit is high. Verbal information about prospective staff members suitability to work with vulnerable people should be recorded in the recruitment files to protect residents from unsuitable staff. 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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available and the opportunity to visit the home to help people decide whether they wish to move to the home. Peoples health and social care needs are assessed before they move to the home, to ensure they can be met. The home can meet a diverse range of faith and cultural needs. Evidence: There is information available to prospective residents in the form of a statement of purpose, which describes the services provided by the home and a home brochure. Prospective residents and their families are welcome to visit the home at any time before deciding whether the home is for them. The care files of four residents who have moved to the home since the last inspection were checked. The manager or deputy manager had met with them to assess their needs and wishes for care. The assessment documentation prompted staff to take note of peoples faith and cultural wishes as well as their health and social care needs. Care Homes for Older People Page 11 of 29 Evidence: The home does not provide intermediate care for those requiring intensive rehabilitation. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are generally met, with evidence that they see the general practitioner and other members of the health care team on a regular basis to promote their wellbeing. There is a need to ensure that peoples risk of becoming malnourished and losing weight is accurately assessed and that their individual care plans describe how this is to be addressed. There is also need to ensure medication is managed consistently throughout the home to minimise the risk of harm to service users. Evidence: The care of three people on each unit was followed through. All had comprehensive care plans which gave carers guidance on the support people needed and wanted. They had been reviewed monthly and some had been signed by the service users or their family to show that they had been involved in drawing them up. Service users are registered with a local General Practice and records showed that they were seen by the general practitioner and other members of the primary healthcare team on a regular basis. People on the ground floor nursing unit who Care Homes for Older People Page 13 of 29 Evidence: needed nursing care had a named nurse who was responsible for overseeing their care. One family member spoken to said that they knew the named nurse and she had been very supportive. There were some people on the first floor who needed nursing care. Their care was overseen by the nurses from the top floor dementia care unit. There was information in their care plans to show that they had been seen by different nurses regularly but it was not clear whether any one had overall responsibility for coordinating individuals care. The operations manager has since told us that they are implementing a named nurse system on all floors to promote continuity of care. Peoples risk of developing pressure damage had been assessed and if at risk they had appropriate care plans and support mattresses. Two of the people whose care was followed through had developed pressure damage during a stay in hospital. They had seen the community nurse specialist and their damage was healing since the move to the home. Peoples risk of falling was assessed, care plans were in place and records were kept of falls. Carers said that if someone fell they would be monitored and the General Practioner would be told. There were records to show that peoples medication had been reviewed following falls. Peoples risk of becoming malnourished was assessed using a recognised assessment tool. This was not completed in full in all cases and it was not clear that staff fully understood its use. Two of the people whose care was followed through had gained weight over the preceeding ten months whilst three had lost weight, ranging from four to ten kilograms. Two had been referred to a dietician. The dietician had recommended that their food be fortified with additional calories although how this was to be done was not recorded in the care plan. The chef said that he always used high calorie foods including full fat yoghurts and milk. He was not aware however of residents who were losing weight. There is a need to ensure that peoples risk of becoming malnourished is assessed accurately and that a clear individual care plan is developed to show how the additional calories that some people require to prevent them losing weight, is to be incorporated in their meals. There are medication policies and procedures in place and the staff spoken to were aware of these. The storage facilities were satisfactory. Records are kept of medication delivered and disposed of by the home. Residents individual medication administration records were completed in full and appropriate steps were taken to ensure that supplies were received regularly. Procedures were in place to deal with variable dose medication such as blood thinning medication although these were not consistent on all three floors. On one floor a fax seen from the general practice did not Care Homes for Older People Page 14 of 29 Evidence: state the dose or frequency of the medication that should be given following the latest blood test. This had not been challenged by the staff although a similar fax on the first floor had been challenged and the correct dosage and frequency were recorded. The operations manager has told us that since the inspection they have devised a form for these faxed messages, which they had asked the general practice to implement. There was some inconsistency as to how medication which should be given when needed, but not regularly, was managed. This were handwritten entries on the medication administration record and it was not clear whether two people had checked the prescription and signed the record to show that they had done so. In some cases the reason for giving the medication was recorded on a protocol which was kept with the medication administration chart, but not in all. These were not always correct. One protocol said that a medication should be given for agitation whereas the general practitioner had prescribed it to prevent seizures. There were also inconsistencies between the prescription and the medication administration record provided by the dispensing chemist. One prescription stated that a medication should be given when needed but the medication administration record stated it should be given regularly twice a day which the staff had done. Although there was no indication that anyone had come to harm there is an urgent need to ensure consistency in medication administration on all floors in the home, particularly the way in which medication that is to be given when needed is recorded and administered and when and why individuals may require it. There is also a need to ensure that the medication administration record reflects all the current medication accurately. If care staff copy medication to the medication administration record two people should sign to verify that it is a correct copy of the prescription. There is information available from the Royal Pharmaceutical Society on their website www.rpsgb.org.uk and from our website www.cqc.org.uk. None of the residents managed their own medication at the moment although there are policies and procedures in place to support this if residents wish. The staff spoken to said that medication was never given covertly. If a resident did not want to take their medication, this would be recorded. If the medication was essential and the resident lacked capacity, the doctor and family would be told and a way forward agreed. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can choose how they spend their day and are supported to take part in activities in the home if they wish. The standard of food is good meeting residents social and nutritional needs. The way in which people who have dementia are supported to participate in everyday living and to engage with their surroundings should be developed to provide a more meaningful day for residents in the dementia unit. Evidence: Residents spoken to said that they had a choice as to how they spend their day. There are two activities coordinators in post who arrange a programme of activities and 1:1 sessions with residents. Most people, although not all, said that there were activities on offer and that they had a choice as to whether they joined in. One resident said they have helped me great deal. I now have an electric wheelchair and can get out to the shops. It has turned my life around. The activities are posted on a notice board on each floor and range from outings, shopping, in house entertainers, quizzes and bingo. There was an entertainer in one lounge on the day of the unannounced visit which residents from all floors were enjoying. The manager said that they are trying to make the dementia care unit more homely. Some residents families had personalised their rooms and some rooms had memory boxes by the door to remind people of times in Care Homes for Older People Page 16 of 29 Evidence: their life. Many rooms however were very tidy with little in the way of items which might remind people of events in their life. The manager said that the activities coordinator also ran reminiscence sessions. Residents were not seen to be helping with everyday tasks, such as laying tables or drying up cups and saucers. There was also a lack of items with which residents could engage and which might stimulate memories. The way in which people are supported to participate in everyday living and to engage with their surroundings should be developed to provide a more meaningful day for residents on the dementia unit. A number of family members were spoken to and all said that they could visit at any time and were made to feel welcome. They said that they were kept up to date with their relatives needs and were told of any untoward event. The chef is knowledgeable about residents likes and dislikes and said that he could provide menus to meet residents cultural wishes. There is a varied menu and a choice at main meals. Some residents eat in the dining rooms, which were laid with tablecloths, cutlery and beakers. Carers were observed to be supporting residents, who could not eat unaided, discretely. People spoken to said they enjoyed their meals and they were not hungry. The chef was knowledgeable as to whether residents needed special menus on health grounds and provided soft and pureed food for those who had difficulty swallowing. He provides a fruit booster drink in the mornings and also uses full fat products, cakes and finger foods to increase the calories for people who only eat small amounts. He had a list of people who needed a special diet but did not know who was losing weight. This should be considered and included in the special diet category. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are complaints policies and procedures in place and in most cases peoples concerns were listened to and addressed in a timely way. The safeguarding procedures in place should protect people from harm. Staff need to be reassured that they can and should raise concerns which affect the wellbeing of residents with the homes management team, the organisations head office or with the local authority as a safeguarding issue if they feel unable to raise the issue in the home, to ensure residents are protected from harm. Evidence: There is a copy of the complaints procedure displayed in the home and it is described in the Service Users Guide. Everyone who was helped to complete the surveys said that they knew who to speak to informally if they had a concern and that they knew how to make a formal complaint. Records are kept of complaints. These showed that most are responded to promptly and that action is taken to address the concerns. We are aware of one complaint which was made in June 2009 and has not yet been fully resolved at the time of the unannounced visit. The complaint was made by the family of a resident who lived on the dementia care unit, and who expressed concerns about the care that their family member had received. The concerns were about the overall standard of care, that she lost a considerable amount of weight and that some of her clothes were missing as were her false teeth. The issues were investigated and limited apologies were given. Care Homes for Older People Page 18 of 29 Evidence: The home has a copy of the local multi agency policies and procedures to safeguard people living at the home. The manager stated in the annual quality assurance assessment (AQAA) that she had made five safeguarding referrals. Records showed that these had been dealt with appropriately. The training records showed that staff have had training in safeguarding vulnerable people either during their initial induction programme or during the last year, using an e-learning computer programme. There are whistle blowing policies and procedures in place and the staff spoken to on the day said they would have no hesitation in reporting concerns. Some staff however expressed concerns about the privacy and dignity of residents and some staff members using inappropriate language in the staff surveys, sent out as part of this inspection, which they had not previously raised with the management team. This was raised with the manager. There are opportunities for staff to raise concerns with team leaders and the head of care as well as the manager. The manager also said in the AQAA that a freephone telephone number was available at the organisations head office for staff to raise concerns. The home should ensure that all staff know how to raise a concern and that they should contact the organisations head office or make a safeguarding referral themselves if they have concerns about peoples wellbeing and do not feel able to raise them in the home. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and provides a safe clean environment for people to live in. There is a need to create a more therapeutic environment for people with dementia to give them more stimulus and to promote the memories and skills that they have. Evidence: The home is a modern purpose built three storey building a short distance from the centre of Newport Pagnell. The communal areas are warm and carpeted. There are a number of places where residents can choose to sit, on their own or with company. There is a safe garden area at the back of the home although staff said residents rarely went out on their own. People with dementia live on the second floor and can only go into the garden with a carer. All bedrooms have ensuite facilities. Residents are able to personalise their rooms and some had chosen to do so. The home had been decorated for Christmas. There are infection control policies and procedures in place and residents rooms have soap and hand towels for the use of carers and visiting health care professionals. Residents have their own hoist slings and bed sliding sheets if they need them. Staff were observed to wash their hands and to wear gloves appropriately. The laundry is separate from the kitchen area and the washing machines have suitable disinfection programmes to wash soiled laundry. The home was clean and tidy on the day of the unannounced visit and there were no offensive odours. Care Homes for Older People Page 20 of 29 Evidence: Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care from kind, well trained staff who can meet their diverse health and care needs in a timely way, although staffing levels particularly on the dementia care unit must be monitored carefully to ensure that staff have the time to meet peoples complex needs effectively. Recruitment procedures are in the main thorough, protecting residents from unsuitable carers. More attention should be given to recording the outcome when verbal checks are made on gaps in work history or adverse references to ensure people are fully protected. Evidence: The manager has agreed staffing levels to which she works. There is one registered nurse and four carers caring for twenty four residents in the nursing unit throughout the day and one registered nurse and two carers at night. There is a senior team leader and three carers supporting thirty residents on the first floor residential unit, with two at night and one registered nurse and three or four carers supporting twenty four residents on the dementia care unit, with two at night, depending on the needs of the residents. The nurse from the dementia care unit also supervises the care of people with nursing needs who are cared for on the first floor. In the surveys staff told us that they usually had enough staff although two said they never had enough staff. One commented that some times care staff are so busy they do not have time to talk to residents who do not need extra care (those who are confined to bed or need feeding). Care staff on the dementia care unit were observed to be busy throughout Care Homes for Older People Page 22 of 29 Evidence: the day. They were seen to be patient and to manage unpredictable behaviour well but not to have time to talk with residents. Interaction with residents was mostly when a care task had to be completed. The homes own dependency analysis for October showed that all but two of the residents on the dementia care unit had high dependency needs. The staffing levels on the dementia care unit and the residential unit should be monitored carefully particularly when people with nursing needs who are cared for on the residential unit are supervised by staff from the dementia care unit, depleting their staffing levels. Residents spoken to on the residential and nursing unit said that staff were kind and helpful and that they came when they rang the bell. There is an ongoing training programme. Training records were in good order and showed that staff have had training in safe working practices, with regular updates. There is a programme of specialist training which some staff have completed including dementia care, an introduction to Parkinsons disease and care of people who have suffered a stroke. The home should consider offering staff training in falls prevention, wound care and continence promotion. Fifty- four per cent of care staff hold the National Vocational Qualifications (NVQ) in care at level 2. The recruitment files of two members of staff who had started at the home since the last inspection were checked. Both had the required documents. Criminal Records Bureau disclosures had been sought before the staff member started work. The application form showed the staff members work history and interview records were kept. One member of staff had had a break in employment and the reasons for this were not recorded in the interview records although the manager was aware of the reasons. Two references had been sought for each prospective staff member. For one the reference held some concerns about the prospective staff members eligibility to work. The manager said that she rang the referee for clarification although this was not recorded. This issue is now resolved. Verbal checks made as part of the recruitment process should be recorded. There was evidence that staff had had an induction programme. Ten members of staff returned the surveys, six said that they always had the support they needed to meet residents diverse needs, five that they usually had the support and one that they sometimes had support. Staff told us that they were given the opportunity to attend training and one said that there was a family atmosphere amongst staff and residents. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well organised and managed in the interest of the residents. The quality assurance programme should be strengthened to ensure that deficiencies in medication administration are identified and action is taken to ensure residents safety. Evidence: The home is managed by an experienced manager who has registered with us. She holds the Registered Managers Award. There is a Head of Care who is a qualified nurse and oversees the nursing care in the home. The manager said they were considering appointing team leaders in each of the units to further strengthen the team and improve the service for residents. There is a quality assurance programme in place. There are regular resident, family and staff meetings. The manager said that she had an open door policy. This was confirmed by one family member spoken to on the day. Another said that it had been difficult to see the manager although the Head of Care had been very helpful in resolving her mothers concerns. The company has a regular audit programme in place and monthly returns of untoward events are made enabling trends to be identified. The home does not manage residents financial Care Homes for Older People Page 24 of 29 Evidence: affairs. Residents have locked storage in their rooms and are supported to manage their own personal expenditure if they wish. If a resident cannot manage their own expenditure families are invoiced for any expenditure incurred. There are health and safety policies and procedures in place. Maintenance records were up to date and there was evidence that essential safety checks of services and equipment are undertaken. Water temperatures are tested regularly and there are window restrictors to upper floors to reduce the risk to residents of falling. The fire risk assessment had been updated and fire safety checks were made. The last Fire Safety Officers visit was in September 2009 when all matters were considered satisfactory. The last Environmental Health Officers visit showed that food hygiene standards were good. The training records showed and staff confirmed that they had had training in safe working practices, including moving and handling, fire safety and infection control. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 Peoples risk of becoming malnourished and losing weight must be assessed accurately and a care plan must be developed and implemented to prevent them losing weight, where possible. To support people who are at risk to maintain their weight and strength. 26/02/2010 2 9 13 All medication must be administered as directed by the prescriber. Verbal messages for changes or transcriptions to teh medication administration records must be signed by two people. To ensure people receive their medicines correctly. 29/01/2010 3 9 13 Care plans or prn protocols must include detailed, accurate information and instructions for staff about 29/01/2010 Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action when and why medication which is prescribed on an as needed basis for an individual should be given. To ensure that service users receive their medication safely and when they need it. 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 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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