Inspection on 28/09/09 for Chatham House

This inspection was carried out on 28th September 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chatham House 08/10/08

Chatham House 29/01/08

Chatham House 31/07/07

Chatham House 13/09/06

Chatham House 15/12/05

Chatham House 24/06/05

Chatham House 01/02/05

Chatham House 06/07/04

Chatham House 11/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Chatham House Chatham House 44/46 Wembdon Rise Bridgwater Somerset TA6 7QZ     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: Alison Philpott     Date: 2 8 0 9 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: Chatham House Chatham House 44/46 Wembdon Rise Bridgwater Somerset TA6 7QZ 01278427758 01278427758 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Jessie Joan Pope care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Chatham House is registered with the Care Quality Commission to provide personal care for up to 26 people aged 65 years and over. The home is not registered to provide nursing care nor is it registered to provide dementia care or any other specialist care. The registered provider/manager is Mrs Pope. Chatham House is situated in the residential area of Wembdon, 2 miles from Bridgwater town centre. Two large Victorian houses are linked by a modern annexe. There is car parking at the front of the house. To the rear there are extensive gardens with wheelchair access and handrails with a pleasant patio area. Accommodation is on two floors, comprising of 22 single bedrooms and 2 double rooms. There are 19 rooms with en-suite WC facilities, some have a bath/shower facility. TV points are available in each room. There is a passenger lift and two sets of stairs to the first floor, one with stair lifts. The communal rooms comprise of a very Care Homes for Older People Page 4 of 29 Over 65 26 0 0 8 1 0 2 0 0 8 Brief description of the care home large lounge with three distinct seating areas, a smaller lounge and an adequately sized dining room. There are three payphones in different locations in the home, plus the use of a mobile phone for incoming calls. There is a call system fitted to all areas of the home. 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 unannounced key inspection was conducted over one day (9.25 hours) by one inspector. On the day of the inspection, 20 people were living at the home. Mrs Pope, Registered Manager was available throughout the inspection. We were given unrestricted access to all parts of the home and all records requested for this inspection, were made available to us. We were able to meet with people using the service and staff. The home completed its Annual Quality Assurance Assessment (AQAA) and this was received by the Commission within agreed timescales. The AQAA is a self assessment which focuses on how well outcomes are being met for people using the service. It also provides us with some numerical information. Care Homes for Older People Page 6 of 29 We received completed surveys as follows; eight from people who live at the home; nine from staff who work at the home; and three from social and health care professionals. Extracts have been included in this report where appropriate. The term we, used throughout this report, refers to we the Commission. We would like to thank all involved for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. 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: It is strongly recommended that a pre-admission assessment is always carried out before people move to the home to ensure that the home can fully meet the persons need. Care Homes for Older People Page 8 of 29 The home should introduce guidance relating to the use of food and fluid intake charts for staff so that they know what to look for and when to take action. The home must ensure that they consistently seek prompt assessment and advice from health professionals when there is a deterioration in an individuals physical or mental health needs. A requirement relating to seeking advice from health care professionals was made at the previous inspection. The home should ensure that creams are consistently dated on opening and discarded appropriately so that they are used when at their best. It is recommended that the home consistently records when one identified medicine is received into the controlled drugs cupboard so that there is a clear audit trail. The home has procedures in place to reduce the risk of harm or abuse to the people living there. We found that the registered provider/manager and staff did not have a satisfactory knowledge of procedures to be followed in the event of an allegation of abuse being made. At the last inspection, it was strongly recommended that the registered person ensures that they, and all staff are aware of the local procedures for safeguarding adults. Further to additional safeguarding incidents, this recommendation has not been met. It is recommended that the reasons for any gaps in an applicants employment history are documented. This recommendation was made at a previous inspection. The home should ensure that a photograph is kept on each staff file for identification purposes. The registered person must ensure that regulation 37 reports are sent to the Commission in a timely manner. This is so that we know what is happening at the home. 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. People receive sufficient information so that they can make an informed decision about the home. The home usually ensures that people are assessed before they offer them a place to ensure that their needs can be met appropriately. Evidence: People who live at the home and completed surveys told us they received enough information so that they could decide that the home was the right place for them. We looked at the care plan of a person who had recently moved to the home. The home had carried out the pre-admission assessment on the day the person moved into the home. We discussed this with the manager who told us that the person had visited the home recently to have a look around. The home did not complete a preadmission assessment at this time. The manager had not obtained a copy of the Care Homes for Older People Page 11 of 29 Evidence: assessment carried out by the local authority. It is strongly recommended that a preadmission assessment is carried out before people move to the home to ensure that the home can fully meet the persons need. Other care plans we looked at contained completed pre-admission assessments and assessments from the local authority. A relative commented telephone contact during the first week was exceptional, nothing is too much trouble. The home provides a one month trial period when people move into the home. 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. Care plans contain a good level of detail. People receive personal and healthcare support using a person centred approach. People have access to a range of health professionals. On some occasions when there are concerns about individuals, assessment and advice could be sought more promptly. Medication and records relating to medicines are generally well managed and protect people who live at the home. Staff treat people who live at the home with respect. Evidence: We looked at four care plans. These were person centred, contained a good level of detail about what the person could do independently and support needed, and included peoples preferences. They also contain a social history so that staff know more about the person and their interests. There was evidence that people and their Care Homes for Older People Page 13 of 29 Evidence: relatives are involved in the care planning process. Care plans are reviewed every month. People who live at the home and completed surveys told us they always receive the care and support they need. Comments from people who live at the home and relatives include they look after me very well, everything we have asked for has been done quickly and efficiently. One person who lives at the home has presented some challenging behaviour. Incidents have been recorded in a log so that they can be monitored. The care plan dated 17/09/08 states can be very aggressive towards staff and clients. There have been a number of incidents since this date. One incident was recorded in the daily records on 30/08/09 verbally and physically challenging towards staff, wandering around building until 4am. This had not been transferred into the care plan or incidents. The home should ensure that information in daily records is transferred into the care plan. The last recorded incident was on 15/09/09. The manager advised that the Community Psychiatric Nurse has recently reviewed the person. The home is awaiting the report. We asked the home whether the funding authority had carried out a review regarding the suitability of the placement. The manager told us that they are currently planning a review. The home must ensure that a review takes place to assess whether the placement continues to be appropriate. The person also has continence needs. The manager confirmed that the person has not received a continence assessment carried out by a health professional. We discussed this with the manager. The home should ensure that a continence assessment is carried out to determine whether the persons needs can be met more appropriately. We looked at food and fluid intake charts. Staff complete these on a daily basis. The manager advised that she checks these regularly and will take action as required. There was no guidance for staff to follow if the manager was not available for any reason. The home should introduce guidance for staff so that they know what to look for and when to take action. When asked what does the home do well?, health professionals comments included always happy to discuss individual needs and to seek to promote individual solutions for each resident, extremely person centred and provides excellent care, care staff will report any concerns and caring prompt attention and notification of medical needs to surgery. Care Homes for Older People Page 14 of 29 Evidence: When asked what could the home do better?, one health professional commented the record keeping doesnt always reflect the very good work done with residents. Another health professional commented brief staff when they have called the doctor to make sure relevant concerns passed over in handover if doctor arrives after initial team finish shift. We looked at risk assessments relating to falls. We spoke with one person who lives at the home who had recently had a fall. They told us how the staff had moved the furniture around in their bedroom so that the risk of them falling again would be reduced. We looked at medicines and records. Medicines are stored securely. The home uses a monitored dosage system. We looked at Medication Administration Record (MAR) Sheets. These were fully completed. Where people had been prescribed medicines with a variable dose, the actual dose given had been recorded. Where MAR Sheets had been written by hand, these had been signed by two members of staff to check for accuracy. Some people who live at the home are prescribed creams. We viewed creams in peoples bedrooms. A number of these were not dated on opening. The home should ensure that creams are dated on opening and discarded appropriately so that they are used when at their best. Where medicines are taken as required, the home doesnt record the reason for administration and action that staff should take if the desired outcome is not achieved. We spoke with a member of staff who was able to explain the reasons why individuals take their as required medication. We checked the balance of two medicines stored in the controlled drugs cupboard. The balance of one was correct. The home stores Temazepam in the controlled drugs cupboard which is good practice. We checked the balance and found that there were more tablets than the amount recorded. We found that a prescription had been delivered but had not been recorded in the controlled drugs book. It is recommended that the home consistently records when this medicine is received into the controlled drugs cupboard so that there is a clear audit trail. We observed staff knocking on peoples bedroom doors before entering. People told us that the staff respect their privacy and dignity. 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. The home offers a range of activities for people who live at the home. The meals at the home are balanced and nutritious. People are very happy with the quality and choice of food available. Evidence: During the inspection, most of the people who live at the home were in the lounge area. People were observed reading, chatting, watching television and taking part in games. A weekly activity planner is displayed on the wall in the lounge. This included movement to music; ball exercise; games; movies, bingo and an outing. The home has also purchased a karaoke machine and WII. We asked people does the home arrange activities that you can take part in if you want; 7 people said always and 1 person said sometimes. The home keeps a record of activities that have taken place. This includes comments about the outcome for each individual who takes part. The home told us that internet access is available for people who live at the home. Care Homes for Older People Page 16 of 29 Evidence: This also enables people to stay in contact with friends or relatives who live in different parts of the country or the world. People told us that their visitors are made welcome. A relative who visited the home during the inspection commented theyre fantastic here. One person told us that they enjoy listening to audio books on their compact disc player. We looked at the minutes of the last meeting for people who live at the home. This included discussion about suggestions and improvements. People told us that they are very happy with the food at the home. The home has been awarded five stars for food hygiene by the environmental health department. We observed lunch being served in the dining room. The tables were laid nicely. The home has a four week menu. A menu was available on each table. Lunch consisted of oxtail soup followed by cheese pie or jacket potato with salad. A choice of desserts was offered. The home is able to offer an alternative meal if requested. Staff served a choice of drinks to people. The food looked and smelt appetising. 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 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 in place so that people can raise any concerns. The home has a range of policies in place to reduce the risk of harm or abuse to people. Management and staff are not fully aware of the local policy on safeguarding adults and procedures to be followed. Evidence: The home has a complaints procedure in place. People who live at the home knew what to do if they had any concerns. One person commented there is always somebody I can talk to. The home confirmed that they have not received any complaints since the last key inspection in October 2008. The home has a whistleblowing policy available to staff to reduce the risk of abuse to people living at the home. We found that staff recruitment files contained criminal record and protection of vulnerable adults checks. Protection of vulnerable adult checks had been obtained prior to staff commencing work in the home. The home has a copy of the Somerset Safeguarding Adults Policy. We looked at information relating to safeguarding investigations that had taken place at the home. Two safeguarding incidents took place on 6th May 2009 and 1st June 2009. The management at the home did not follow the correct reporting procedures in relation to these incidents. This was also highlighted at the last key inspection on 8th October Care Homes for Older People Page 18 of 29 Evidence: 2008 when it was strongly recommended that the registered person ensures that they, and all staff are aware of the local procedures for safeguarding adults. During the inspection, we discussed the Somerset Policy and procedures with the manager. There is a notice on the board providing a telephone number for Somerset Direct so that staff have an external contact to phone to report abuse. All staff have completed training in the Protection of Vulnerable Adults (POVA). We spoke with one member of staff who had recently completed the training but they were unable to explain what POVA is. Another member of staff told us they would go to the manager but was not aware of who they could contact outside of the home. The third member of staff we spoke to knew that they could contact Somerset Direct and that the telephone number is on the notice board. 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 clean, well maintained, and provides a comfortable environment for the people who live there. Peoples bedrooms are personalised to reflect their individual tastes and interests. Evidence: Chatham House is registered with the Commission to provide personal care for up to 26 people. The home consists of two large Victorian houses that have been linked together. On the day of the inspection we observed that the home was well maintained and homely with comfortable furnishings. There is good sized communal space which includes a large lounge area, a further lounge and spacious dining room. The accommodation is provided over two floors. Areas can be accessed by a shaft lift and stair lift. There are 22 single bedrooms and 2 double bedrooms. 19 bedrooms have en-suite toilet facilities. Some of the bedrooms have bath/shower facilities. We viewed a number of bedrooms. These were nicely personalised to reflect peoples individual interests and tastes. The home has an assisted bath in the ground floor bathroom. This room has been redecorated since the last inspection. A walk in shower room is available on the first floor. Care Homes for Older People Page 20 of 29 Evidence: There is a large, attractive garden at the rear of the home with fruit trees and raised flower beds. The home has provided ramps so that everyone is able to access the garden. Doors lead out from the lounge onto a patio area with new wooden garden furniture. The home has added a hairdressing area to the home that is used weekly by the visiting hairdresser. People who live at the home told us it is always clean and tidy. On the day of the inspection, the home was clean throughout. Most areas of the home were fresh. There was a malodour in one bedroom. This was discussed with the manager during the inspection. The laundry has been redesigned so that staff bring the washing into one side of the laundry and process clean washing out the other side. This promotes good infection control and hygiene practice. Staff were observed wearing aprons and appropriate hand washing facilities were available. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are normally sufficient staff on duty to meet the needs of people who live at the home. People who live at the home benefit from having caring, skilled and trained staff. The homes recruitment procedures are generally good and protect people from risk of harm. Evidence: We looked at the rotas. There are 4 care assistants on duty in the morning; 3 care staff in the afternoon and 2 waking staff at night. In addition to this, the home employs domestics, a handyperson, and kitchen staff. When we asked people are staff available when you need them?; 7 people said always and 1 person said usually. We spoke with people who live at the home during the inspection. Comments included they dont seem to have enough time and theres not always enough staff, theyre busy. When we asked staff if there is enough of them to meet individual needs of all the people who live at the home, one said always and 8 said Care Homes for Older People Page 22 of 29 Evidence: usually. A health professional commented care staff generally have a good rapport with residents. People who live at the home and their relatives told us about the staff. Comments included, the care and consideration given by the staff makes it feel like family and staff are extremely caring, attentive and always willing to chat and help. We looked at four staff recruitment files. These contained most of the required checks and information. Two of the files viewed did not have a photograph of the staff member. The home should ensure that a photograph is kept on each staff file for identification purposes. One person had some gaps in their employment history. The home was able to explain the reason for the gaps but this was not documented. The manager documented the reasons at the inspection. We looked at the homes training matrix. This includes the following areas; induction; manual handling; first aid; fire; health & safety; health & food hygiene; medication; dementia awareness; diabetes; and RNIB Deaf blindness. 18 of the 20 care staff employed at the home have completed an NVQ in care at level 2 or above. Staff spoken with told us they are very pleased with the training opportunities available to them. One staff member said theres been lots of courses over the last year so staff are more aware. 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. People who live at the home generally benefit from a well managed service. Knowledge and understanding of safeguarding procedures needs to be improved. Effective quality assurance systems are in place. Systems are in placed to ensure that staff are supervised and that appropriate records are kept. The homes health & safety policies and procedures protect peoples health, safety and welfare. Evidence: Mrs Pope is the registered provider and registered manager. She has owned and managed the home since 1983. Mrs Pope is supported by her daughter, who is employed as the deputy manager, and senior care assistants. Mrs Pope confirmed that she has completed the Registered Managers Award since the last inspection. Care Homes for Older People Page 24 of 29 Evidence: Staff told us that the management is approachable. One person commented the manager provides ongoing support to those studying NVQs and encourages all to gain a qualification. We looked at the minutes of the staff meeting held on 5th June 2009. Staff receive an agenda for the meeting and are encouraged to make suggestions of things they would like to discuss on slips of paper. Staff told us that they enjoy taking part in these meetings. The home sent surveys to people who live at the home and their relatives in May 2009. Surveys had also been sent to health professionals. A suggestion box is available in the hall. The home sent us their completed AQAA. The information they gave us was brief. They told us what they have improved in the last 12 months. They did not tell us very much about how they meet the National Minimum Standards or what they do to make sure their services provide good outcomes for people. The manager confirmed that the home does not manage any monies for people living at the home. The home sends peoples next of kin an invoice on a regular basis for any purchases. Records and receipts are kept. We looked at a staff supervision planner that contained the dates of six formal supervision sessions. Staff spoken with confirmed that they have regular one to one meetings with the management. We looked at a sample of staff supervision records. These were detailed and contained what was discussed during the meeting. We looked at health and safety records and checks relating to the lift, hoists, hot water temperatures, portable appliance testing, electrical installation, and gas safety. These were all found to be up to date. We looked at detailed accident audits that have been carried out to identify patterns and minimise the risk of further incidents and injury to people. We looked at a Regulation 37 report that the home had completed to notify us about the safeguarding incidents that had taken place. The report was not completed until 3 weeks after the second incident and was dated 22nd June 2009. The registered person must ensure that regulation 37 reports are sent to the Commission in a timely manner. This is so that we know what is happening at the home. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 13 The registered person must ensure that the advice and input is sought from appropriate health care professionals where there are concerns or a deterioration in an individuals mental or psychological well-being. This requirement was made at the previous inspection. The timescale of 10/11/08 has not been fully met. To ensure that peoples psychological needs are monitored and met. 30/11/2009 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 38 37 The registered person must ensure that Regulation 37 reports are sent to the Commission in a timely manner. This is so that we know what is happening at the home. 16/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 It is strongly recommended that a pre-admission assessment is carried out before people move to the home to ensure that the home can fully meet the persons need. The home should introduce guidance relating to the use of food and fluid charts for staff so that they know what to look for and when to take action. The home should ensure that a continence assessment is carried out for one identified person to determine whether their needs can be met more appropriately. It is recommended that the home consistently records when one identified medicine is received into the controlled drugs cupboard so that there is a clear audit trail. 2 8 3 8 4 9 Care Homes for Older People Page 27 of 29 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 5 9 The home should ensure that prescribed creams are consistently dated on opening and discarded appropriately so that they are used when at their best. It is strongly recommended that the registered person ensures that they,and all staff are aware of the local procedures for safeguarding adults. This recommendation was made at a previous inspection. It is recommended that the reasons for any gaps in an applicants employment history are documented. This recommendation was made at a previous inspection. The home should ensure that a photograph is kept on each staff file for identification purposes. 6 18 7 29 8 29 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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