Inspection on 11/01/10 for Chestnut Lodge

This inspection was carried out on 11th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chestnut Lodge 19/03/10

Chestnut Lodge 20/11/08

Chestnut Lodge 21/05/08

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Chestnut Lodge 43 Glenwood Road West Moors Ferndown Dorset BH22 0EN     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: John Hurley     Date: 1 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Chestnut Lodge 43 Glenwood Road West Moors Ferndown Dorset BH22 0EN 01202892116 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: janetravers@chestnutlodgecare.com Mrs Jane Travers care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 10. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Chestnut Lodge is situated in a residential area of West Moors, local shops, churches, pubs and a library are available close by following a level walk. It is a detached property with a pleasant front garden and summerhouse. It is registered to provide residential care only for up to 10 male and female residents over the age of 65yrs.There are 5 bedrooms on the ground floor rooms all of which are single occupancy and most with en suites. On the first floor there are a further 5 bedrooms, 2 of which are double size and communal bathroom facilities.It is privately owned by Mrs Jane Travers, who is also the Registered Manager and manages the home on a day-toCare Homes for Older People Page 4 of 31 Over 65 10 0 Brief description of the care home day basis, together with her son, who is deputy manager. The service aims to provide individualised care to people in a friendly, family atmosphere and tries to encourage residents to continue with the lifestyle and interests they had prior to moving into the home.At the time of this inspection, fees ranged from £450- £600. Additional charges are made for hairdressing, chiropody, newspapers and personal shopping. See the following website for further guidance on fees and contracts www.oft.gov.uk Value for Money and Fair Terms in Contracts. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was undertaken over the course of two separate days at the end of November and the beginning of December in 2009 by two separate inspectors. The reason for the second inspector was to check compliance with the immediate requirements that were made following the first day of the inspection. The focus of the inspection was to look at relevant key standards under the Commission for Social Care Inspection (now the Care Quality Commission) Inspecting for Better Lives 2 Framework. This focuses on outcomes for residents and measures the quality of the service under four headings; these are excellent, good adequate and poor. The judgment descriptors for the seven sections are given in the individual outcome groups and these are collated to give an overall rating for the quality of the service provided. We looked at two selected care files in detail, the staff files, undertook a tour of the building and looked at all the documentation relevant to the running of a care home. We also spoke with visiting relatives. The registered manager elected that her trainee Care Homes for Older People Page 6 of 31 manager assist with the inspection and recieve feedback at the end. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 31 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service User Guide give a good account of the services on offer but describes an assessment process that is not adhered to. The assessment documentation needs to provide sufficient and robust information to staff to ensure that individuals needs are met in the way that has been agreed with the recipient of the care. Evidence: The Statement of Purpose and Service User Guide was not veiwed at the time of the inspection. These key documents were sent to via email following the inspection. When these documents were sampled we found that the requirement to update these documents had been met. We looked at the documentation of a person who had recently moved into the home. The recording evidenced that an assessment of need had not been fully made prior to Care Homes for Older People Page 11 of 31 Evidence: the person entering the home. Whilst there were tools to complete the assessment a number of areas where needs should have been recorded were found to be blank for example, the care needs assessment was blank as was the current medication record. The persons daily routine was also found to be blank and so the staff would not have sufficient information to ensure that the person maintained as much individuality as possible and that their individual routines were respected. We spoke with the person who the documents referred to who informed us they were happy with the process. We also spoke with their visiting relatives who again confirmed that they had felt they had been included in the process. At the time of the inspection we were informed that intermediate care is not a service offered by the home. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and subsequent reviews do not give an accurate picture of the person at the centre of the care, which may mean they have unmet needs The administration of medication may put people at risk. Not all people are treated with dignity and respect. Evidence: We looked at the care records of 2 people who lived at the home and sampled several others. The records we saw were inconsistent in the accurate recording of peoples needs and did not demonstrate how the home is meeting the needs of those who live there. In one file it was noted that the person had developed needs that required input from other professionals. These needs had put the person and others at risk. The home had responded well by carrying out and documenting a risk assessment, monitoring and recording behaviors and contacting other professionals. However this good practice was not evident in all of the files for example in one Care Homes for Older People Page 13 of 31 Evidence: persons file it stated that they needed the help of one staff for assistance with bathing yet in another part of the same file it stated that they needed two people. Further more in the initial assessment it stated that they did not require help with personal care. The file did not give a clear audit trail through reviewing systems that would establish how this persons mobility or independence had deteriorated. However there was evidence of a period of falls but there was no evidence of these falls being evaluated to establish there cause or to prevent further falls. Another file evidenced that the person had an erratic diet and at times ate very little yet no food or fluid charts had been considered or any other monitoring systems put into place. Whilst the person had had their weight recorded when they first entered the home this had not been regularly carried out so systems to evaluate the persons possible risk of malnutrition or weight loss had not been established. Another example of their needs not being met was evidenced in respect of the person becoming physically sick following a visit home yet no staff member had considered calling a doctor and the managemnet had put the sickness down to a psychological reason. The file further evidenced that they had demonstrated a degree of challenging behaviour and some possible underlying mental health issues. The care plans lacked direction to staff with regards to how to deal with this behaviour and there was no documented evidence that the input of other professionals had been considered. The risk assessments that were available did not mention the challenging behaviour. A number of further ambiguities and omissions in the documentation were noted in the files sampled for example a person had come into the home with a broken foot but the care records did not evidence this as an issue, a person who uses a leg brace had no mention of this aid in their care files and falls were not evaluated and did not influence or change the care plans of the individual involved. Although it states in the Service User Guide that all people will have their needs reviewed when required or at a minimum monthly, there was no evidence available to suggest that this is being consistently achieved. We looked at the medication records and found that some people self medicate. The individuals files of people who self medicate did not contain any risk assessments in relation to this. These risk assessments should be made on entry to the home and reviewed on a monthly basis to ensure the safety of those who live at the home. We looked at the storage arrangements made for one of the people who is responsible their own medication. This was found to be inadequate as it was in a pouch that was in a drawer that was not lockable. A return compliance visit made on the 1/12/09 Care Homes for Older People Page 14 of 31 Evidence: found that the storage arrangements had improved. Further more a risk assessment had been made in relation to the person self administrating but this was found to require improvement to meet the standards required. Advice was given to the trainee manager at the time of this visit with regards to the improvements required. We sampled the Medication Administration Records (MAR) relating to medication and found that the home keeps a photograph of the individual who is to be administered the medication. This helps ensure that people get what is prescribed to them. With regards to those who self medicate we noted that the home receives medication on the persons behalf and gives it to the individual concerned. They do not record or sign what has been handed over or the quantity given and so an audit trial does not exist. This may put people at risk as the home has no way of knowing exactly how much of any preparation is on the premises or how much medication each individual has. It was noted that in one case the medication administered on a Per required needs basis was for pain but the care plans did not include a plan for pain control. Whilst assessing compliance with the immediate requirement it was noted that the home regularly breaks tablets in half to be able to give the required dose ie if the person needs 1/2 a milligram of a tablet the staff may break a one milligram tablet in half. This is poor practice as the dose cannot be assured and the preparation is at risk of contamination from the person who breaks the tablet in half. The trainee manager was advised to contact the doctor and pharmacist to ensure that medication is available to the home to administer in the dose required. We spoke to a number of individuals about the approach of staff particularly about whether they felt treated with respect. All individuals said they felt staff did so and that all were very friendly, staff are helpful and kind. This was also reflected to us by visiting relatives who considered that staff are respectful. Whilst this appeared to reflect the current practice for those individuals who could articulate themselves it was observed at both inspections that those with enduring mental health problems were spoken about as if they were not there for example a individual was introduced as this lady has dementia whilst standing with their (staff) back to the individual. We also noted a persons documentation that they have a pacemaker fitted but this was not referenced in the section of the care plan relating to death and dying. As a funeral director needs to be made aware of this important information the persons file needs to be updated to reflect this so that at the time of their death they can be assured that they will be treated with dignity. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Visitors are welcomed and individuals are assisted with maintaining contact with relatives and friends. There appears to be well balanced diet that offers a degree of choice to those who live at the home. Evidence: People who use the service were observed in a number of different locations. They choose when to get up and when to retire. They have free access to their bedroom and communal facilities. Those who use the service are able to meet privately with visitors either in their rooms or in a designated lounge. Those who were spoken with indicated that they were happy with their life in the home and confirmed that the staff support them in following their preferred lifestyle The people who live at the home informed us that there are things to do and the pace of life suits them. Care Homes for Older People Page 16 of 31 Evidence: Visitors were observed entering or leaving the home. All visitors were warmly welcomed. The inspector spoke with one relative who spoke highly of the home. Peoples records and the visitors book in the entrance hall demonstrate contact with family and friends as well as visits by professionals. We were informed by those who use the service that the food was always good and that choices were available. People told us that the staff knew peoples likes and dislikes and as such were able to cater for their needs. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service felt confident that any complaints or concerns would be listened to and taken seriously. All staff should receive training with regards to the Protection of Vulnerable adults. Evidence: The people who we spoke with informed them that they felt able to complain and said they would have no concerns complaining to any staff member should they have need to. They felt that the manager and staff are very approachable and will deal with any issues no matter how minor there and then if they could. The home keeps a record of any complaints made. There has been one issue recorded at the home which had been addressed with the assistance of the Local Authority. The homes published process had been followed. We looked at the staff training records and found that not all staff had received training with regards to Safeguarding Vulnerable adults, the trainee manager agreed with our observations. This was also a requirement of the last inspection. Without the underpinning knowledge provided by Safeguarding training people may be put at risk of harm. Care Homes for Older People Page 18 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More needs to be done to ensure the safety of those who live at the home. People who use the service can personalise their private space and contribute to the decor. Infection control procedures need to be improved upon in order to protect those who live at the home. Evidence: People informed us that they are able to bring personal possessions with them into the home. We looked at a sample of the bedrooms used by people who use the service and found that they had been personalised with pictures, furniture and photographs to reflect the individuals taste. The rooms were tidy and clean and the individuals clothes had been put away in the wardrobes available. It was evident from walking around the home that there was a good standard of decoration and maintenance. Individuals we spoke with said the home was always clean and well kept. On the day of our visit the home was clean and free of offensive odours. It was noted that a range of aids and adaptations had been made to assist the Care Homes for Older People Page 19 of 31 Evidence: people who live there retain as much independence as possible of to help make their lives easier. We looked around the premises accompanied by the manager and the trainee manager at different times throughout the day. We noted that many rooms did not have the window openings restricted or radiators covered in order to prevent scolding. We asked for risk assessments relating to these issues but no environmental risk assessments were available. We also noted that in one of the communal bathrooms the hot water temperature exceeded 50 degrees centigrade which is a high risk of scolding, again no risk assessment was available and no management systems were in place to ensure that risks associated with the environment were effectively managed. At the last inspection a requirement was made stating that ; The registered manager to make sure that unnecessary risks to the health or safety of individuals who live in the home are identified ands far as possible eliminated. This refers to the need to undertake risk assessments where there are uncovered radiators by the 3/03/09 The home has an Infection Control policy in place but during the tour it was noted that many areas undermined this policy for example; we found fabric towels and flannels in the bathrooms. Many areas which required a waste bin did not have one with a foot operated lid and in the staff room the bin was found to have a used sanitary product unbagged in the bin. These issues put people at risk of cross infection. Due to the risks of serious harm to people who live at the home we left a Immediate Requirement in relation to the radiators and discussed our concerns with regards to the rest of the issues at some depth with the trainee manager. On the second visit it was found that these issues had been addressed. However one of the risk assessment that had been completed was not robust as it did not consider the mobility issues in relation to the person who used the area. It was further noted that at both inspections that an individual who spends extended periods in their room did not have easy access to their call bell with which to request staff help. Care Homes for Older People Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all staff have received the necessary training in order to meet the needs of those who live at the service. The management do not have a robust system in place to demonstrate what staff have worked and when. Evidence: We looked at the documentation in relation to the appointment of staff. We found that the home takes up references and carries out Criminal Records Bureau (CRB) checks as well as Protection of Vulnerable Adults (POVA) checks. Some of the staff files provided photographic evidence of the persons identification others did not. The latest person to take up employment had a recorded interview record, this is considered good practice. This persons file demonstrated that they had undergone a short induction that briefly followed the Skills for Care induction requirements. We asked to see a training matrix and staff rota in order to evidence if there was sufficient well trained staff on duty at all times. The home did not have a useable rota to demonstrate when staff had worked. What was used was a diary but this had not been kept up to date and suggested that at times no one was on duty. This record did Care Homes for Older People Page 21 of 31 Evidence: not demonstrate who was in managerial control at any one time. The training matrix was also not available and the management had not formulated a system to ensure that staff had the required statutory training to carry out their duties. When we looked at what training had been undertaken, through looking at individuals files we found that a significant amount of the training was now out of date. At the previous inspection staff training was also highlighted as an issue that required attention. The previous requirement stated that The manager must make arrangements, by training staff, or by other measures, to prevent residents being harmed, or being placed at risk of harm, or abuse. This refers to the need for all staff to undertake Safeguarding, Moving and Handling and first aid training by the 3/0309 We spoke to the management about the lack of training who informed of their plans to address this. These were to send staff on training in the early part of 2010 this is unacceptable. Care Homes for Older People Page 22 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management need to introduce systems to ensure the National Minimum Standards are established and maintained at all times. Failure to do this will put people at risk of unnecessary harm. The Health and Safety of people who live and work at the home is not protected due to the lack of action with regards risk assessments and action to minimise risks. Evidence: The manager Mrs Travers is a registered nurse and has 30 years experience of working in the care sector. Individuals we spoke with including staff all spoke of her continue to state that she is someone who we can talk to, is firm but fair, approachable. Relatives spoke of her as being very approachable and if we say anything will listen and respect what we say. Mrs Travers takes an active part in running the home in Care Homes for Older People Page 23 of 31 Evidence: that she undertakes care shifts and illustrated to the inspector a good understanding of the needs of those in her care. We were advised that quality questionnaires are given to individuals who live in the home and relatives. However there are a number of issues within this report that indicates the systems required for the smooth and efficient running of the home are not in place for example the lack of staff rota or their equivalent. Throughout the report it has been noted that the majority of requirements set out the previous inspection had yet to be met. This means that people who live at the home could have been put at risk of harm through the lack of compliance with the requirements made. We looked at the records relating to the management formally supervising the staff group and found that they were being kept up to date. The staff we spoke with stated that they felt supported by the manager and could take an issue to them for consultation. We looked at a range of records required by regulation and found that the home has valid Gas and Electrical safety certificate in place. The home has a fire alarm system which is regularly serviced as well as service records for a number of aids used at the home. As already discussed within the main report aspects of the Health and Safety of those who live at the home are not fully protected. The management need to introduce systems to ensure the National Minimum Standards are established and maintained at all times. Failure to do this will put people at risk of unnecessary harm. Care Homes for Older People Page 24 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 The manager must make arrangements for the recording, safe handling, safekeeping, safe administration and disposal of medicines received including: Medication prescribed s required must have the reason and frequency of dose documented. 28/02/2009 2 30 13(6) The manager must make 30/03/2009 arrangements, by training staff, or by other measures, to prevent residents being harmed, or being placed at risk of harm, or abuse. This refers to the need for all staff to undertake Safeguarding, Moving and Handling and first aid training. 3 38 13 4 The registered manager to 30/03/2009 make sure that unnecessary risks to the health or safety of individuals who live in the home are identified and as far as possible eliminated. This refers to the need to undertake risk assessments where there are uncovered radiators. Care Homes for Older People Page 25 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered manager 11/01/2010 must ensure that the receiving, administration, recording of and returning of medication is carried out in accordance with the National Pharmaceutical requirements. So as not to put people at risk of harm. The registered manager 11/01/2010 must take action to ensure that people are not at risk of harm of scolding by having unguarded radiators. To protect those who use the service 2 25 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 15 The registered manager must ensure that all care needs assessments are robustly completed so as to ensure that the staff can meet the assessed need. So as to ensure the home can meet the needs of the prospective resident. 25/01/2010 Care Homes for Older People Page 27 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 2 7 15 The registered manager 29/01/2010 must ensure that all care plans and reviews accurately reflect the needs of the person and give enough detail to guide and inform staff as to how to met the agreed needs. So that people do not have unmet needs 3 10 12 The registered manager must ensure that all staff treat people with respect and dignity regardless of their ability to engage with them. To ensure people are treated with respect and dignity 29/01/2010 4 18 18 The registered manager must ensure that all staff undertake Safeguarding Adult training To ensure that staff have the knowledge to respond to safeguarding concerns and thus protect those who live at the home. 26/02/2010 5 21 13 The registered manager must ensure that the hot water temperature does not pose a significant risk of injury. 25/01/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To protect those who use the service 6 25 13 The registered manager 25/01/2010 must ensure that the window openings are either restricted or a comprehensive risk assessment is undertaken that demonstrates how people will be kept safe from harm. To protect those who use the servise 7 26 13 The registered manager must ensure that infection control policies are adhered to so as to promote the well being of those at the home To promote the well being of those at the home 8 30 18 The manager must ensure that all staff have undertaken the statutory training required. to ensure people are not placed at risk of poor practice caused by untrained staff. 9 37 17 The registered manager must ensure that they develop a system which illustrates who and when staff have been on duty. 25/01/2010 29/01/2010 25/01/2010 Care Homes for Older People Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that the home can demonstrate that sufficient staff are on duty. 10 38 13 The registered manager 29/01/2010 must ensure that all risk assessments demonstrate how the safety of the people who use the service or work at the home is being maintained. So as to protect those who live and work at 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 1 11 The registered manager must make sure that the persons documentation ensures that the undertakers have clear and accurate information as to any risks that may be associated with the deceased so that at the time of death they will be treated with respect and dignity. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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