Inspection on 17/04/09 for Court Nursing Home

This inspection was carried out on 17th April 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Court Nursing Home 03/05/07

Court Nursing Home 06/09/06

Court Nursing Home 20/02/06

Court Nursing Home 19/07/05

Court Nursing Home 04/03/05

Court Nursing Home 04/05/04

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Court Nursing Home 644 New Chester Road Rock Ferry Birkenhead Wirral CH42 1QB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michael Perry     Date: 1 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Court Nursing Home 644 New Chester Road Rock Ferry Birkenhead Wirral CH42 1QB 01516431162 F/P01516431162 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Helmreal Limited care home 31 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 31 31 The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Dementia Code DE, Mental disorder, excluding learning disability or dementia - Code MD. The maximum number of service users who can be accommodated is: 31. Date of last inspection Brief description of the care home The Court Care Home is situated in a residential community and is close to all local amenities and is on a public transport route with easy reach to Birkenhead town centre. Accommodation for service users is provided on three floors. Communal space is situated on the ground floor and includes a lounge with access to the dining room. There is a serving hatch from the kitchen to the dining room. The dining room is accessed through the lounge. There is single and shared bedrooms on three floors. A passenger lift is available to service the first and second floor. Care Homes for Older People Page 4 of 32 Brief description of the care home The home is owned by Helmreal Ltd and the Responsible Person is Mr Paul ODonoghue. The Registered Manager is Carol Lynn Owens. The current fees for the service are 509 pounds weekly. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: Before we visited the home the manager filled out a form (Annual Quality Self Assessment, or AQAA) we sent and returned this. It had a lot of information about the home and how the people are supported to live their lives. We also sent for and received some feedback from surveys we sent to staff who work in the home. We spoke to health and social care professionals prior to the inspection who have knowledge of the home. We visited the home without telling the staff we were coming so that we could see how Care Homes for Older People Page 6 of 32 things work normally. We spoke with the people who live there and watched how they spend their day and how the staff support them. We also spoke with visitors. We received some comments from relatives who also completed surveys and some of these comments are used in the report. We looked at the records kept on people who live in the home and other records to do with how the home is run. We looked around the home to see if it was clean and a nice place to live. We saw all of the day areas and some of the bedrooms. What the care home does well: The home complete detailed assessments prior to people being admitted to the home so that the home are sure that any care needs can be met. Each of the people living in the home have a care plan which details the needs and care that is provided. Overall the documentation we reviewed was able to give a good outline so that the care could be followed and communicated to staff. We spoke to relatives who said that staff are very good at looking after physical and health care needs. The care files included information on when and how people accessed health care and support external to the home. These include GP and other health professionals. People who need psychiatric review are facilitated in this. This ensures that peoples rights to health care are met. We spoke with a health care professional prior to the inspection who said: The home take very challenging people and improve them. Always plenty of staff. Very proactive in their approach. One person we spoke with was very complimentary about the staffs efforts to encourage mobility; I couldnt walk when I came in here but now I can get around on a zimmer. The staff are very good. other comments were generally very favorable: There are a number of people with various disabilities in the home and they seem well cared for. The care home provides the residents with a way to live their lives the best they can. They let them have their Independence, provide activities and provide smoking times. We looked at how the home respects peoples privacy and dignity through the personal care offered. We saw evidence of good practice such as the way staff assist people to feed and also assist people to the toilet. Overall the comments we received were very positive with all people spoken with saying that staff are very caring. Staff have completed training in recognizing abuse and how to safeguard people in the home. Staff spoken with were aware of the principals involved and were able to identify different types of abuse and how this may occur. This helps to ensure that people in the home are kept safe. Staff are trained appropriately. Training records seen indicate that staff have attended mandatory training courses and most staff have either achieved or are undertaking NVQ qualifications. The induction program is well devised and staff spoken with have benefited from this and have been able to feel supported in their role. This ensures Care Homes for Older People Page 8 of 32 that staff are equipped to undertake their duties. What has improved since the last inspection? What they could do better: The assessment documentation is good but we would recommend that all documentation should be signed and dated to ensure that they can be clearly identified. We would strongly recommend that residents who can, and relatives, are involved in the ongoing care planning and evaluation process. This will assist people to be more involved in the care. The manager should evaluate the homes approach to self medication for residents and help facilitate any person who can assist themselves to any degree. This will help some people to be more independent. We would recommend more individualized activities for people especially those with dementia. This will help to focus more on some individuals needs. We have made some requirements and recommendations around the upgrading of the facilities in the home. These are around the upkeep and disabled accessibility of the garden and the provision of toilet and bathroom facilities on the ground floor. This is to ensure that the general environment is maintained for people to live comfortably. We found the home to be clean on the inspection but we were concerned at the current lack of systems in place to manage infection and the lack of overall policy, training and awareness. We have made requirements for the manager to address this. We looked at staff records and found that some checks required to ensure staff are fit to work in the home have not been made consistently. This is important so people living in the home can be assured of the suitability of staff. We discussed some health and safety issues and made some recommendations around management of accident records and training of staff responsible for assessing general environmental risk. We found many areas of good practice but were concerned that some key areas of the homes management, such as infection control and staff recruitment checks, have not been addressed consistently. This also includes not fully addressing requirements made on the last inspection. It is important that the home should evidence continued development and that there are management systems in place to ensure consistent standards, so that the home can continue to be run in the best interests of people living there. Care Homes for Older People Page 9 of 32 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 set out 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 10 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed and admitted to the home appropriately so that care needs can be effectively planned. Evidence: The pre inspection self assessment completed by the manager [AQAA] tells us that the home complete detailed assessments prior to people being admitted to the home so that the home are sure that any care needs can be met. We saw some assessments carried out on two people admitted and these were thorough in assessment detail but were not signed or dated. The assessments were also on loose leaf paper which was not fixed together so that there is a risk of documentation becoming detached and not identifiable. The homes assessments were supported by further information and assessments from professionals such as social workers and health care professionals so that a full picture Care Homes for Older People Page 12 of 32 Evidence: of the person could be built up. From this information a care plan can be drawn up. We spoke with a relative of a current person in the home. They felt that staff gave good information as they were being admitted and that the written information [Service user Guide] was available. This helps people to orientate and settle into the home. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs are managed well so that peoples privacy and dignity is respected. Evidence: Each of the people living in the home have a care plan which details the needs and care that is provided. The care plans are supported by other documentation that detail events for each person. Overall the documentation we reviewed was able to give a good outline so that the care could be followed and communicated to staff. Staff reported that the communication process in the home include a number of briefings during the day and all staff contribute to these and shared information about each resident. We spoke to relatives who said that staff are very good at looking after physical and health care needs. All of those spoken with had had little input, however, into the care planning process which is generally staff led. We would recommend that relatives and residents who can be involved are consulted. The care plans are reviewed regularly Care Homes for Older People Page 14 of 32 Evidence: and perhaps this would be an opportunity to formally introduce this. The care files included information on when and how people accessed health care and support external to the home. These include GP and other health professionals. People who need psychiatric review are facilitated in this. This ensures that peoples rights to health care are met. We spoke with a health care professional prior to the inspection who said: The home take very challenging people and improve them. Always plenty of staff. Very proactive in their approach. One person we spoke with was very complimentary about the staffs efforts to encourage mobility; I couldnt walk when I came in here but now I can get around on a zimmer. The staff are very good. other comments were generally very favorable: There are a number of people with various disabilities in the home and they seem well cared for. The care home provides the residents with a way to live their lives the best they can. They let them have their Independence, provide activities and provide smoking times. Another person reviewed who has no mobility and is recorded as chair bound is cared for long periods in bed although gets up for periods and has access to a reclining chair in the day room. During the inspection we observed that another resident also uses this chair and we were informed that there are no more suitable chairs available. We discussed this with the manager and would recommend that a suitable chair be provided so that care needs, in this case, can be met effectively. We looked at how the home respects peoples privacy and dignity through the personal care offered. We saw evidence of good practice such as the way staff assist people to feed and also assist people to the toilet. We spoke to one person who was being allowed to use another persons room to sit in for periods. This was discussed with the manager and is a concern as this practice infringes on the rights and privacy of the original occupant. The manager has since stopped this practice. Overall the comments we received were very positive with all people spoken with saying that staff are very caring. Care Homes for Older People Page 15 of 32 Evidence: We looked at the way peoples medication is managed and found safe practice. Medication records were clear and the manager carries out routine audits and stock checks. People spoken with said that they receive their medication on time. There are no people self medicating to any degree and this was discussed. There is a good risk assessment tool available and we would encourage and recommend that the manager and staff assess individuals for possible self medication as this would encourage more autonomy in this area. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social life for people living in the home continues to be developed but there is a need to review meal time arrangements so that the quality of life for people can be further improved. Evidence: We looked at the care records and saw a list of activities on file for each resident. There is an activities organiser employed to ensure that people in the home have regular input and stimulation. We spoke to people in the home who where able to express an opinion and they were settled and found the general atmosphere to be relaxed and sociable. A relative spoken with reported that their relative was well supported and that they enjoy the atmosphere. Also that I am always made welcome and I can come any time I want to. Staff reported that there is time in the afternoon for staff to accompany people out of the home and that this is a regular occurrence. We did find that some activities records for people were a bit unrealistic and needed reviewing. For example one person discussed was very confused and physically unwell but was recorded as enjoying bingo and watching DVDs. We would recommend a review of this and more appropriate activities involving one to one attention and touch Care Homes for Older People Page 17 of 32 Evidence: etc which may be more appropriate. The care plan for this particular person described behavior such as shouting for periods but the care interventions recorded relied on isolation and medication rather than any attempt at distraction or other more social forms of intervention. There was reference on this care plan to communicating with the confused person using eye contact and verbal cues which we would encourage to be further developed. This will help ensure a more diverse and individualized approach to the care for those people with dementia. Staff we spoke with clearly understood people as individuals and felt fully informed about their care needs because of the high level of daily communication or briefings. A requirement had been made on the last report in May 2007 for the manager and staff to review the dining arrangements in the home and to improve the meal time experience for people. We observed little improvement although the manager reported that various options had been tried. We saw that tables were still not laid however and spoons were used rather that knives and forks. We spoke at length how this can be improved and the requirement remains. This is important as the social cues surrounding meal times can assist people with dementia to orientate themselves as well as improving overall quality of the mealtime experience. We spoke with the cook who is currently reviewing the menus in the home to try and provide more choice during the main meal period. There is good choice at breakfast with a cooked option on offer and this was commented on by some residents. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures and staff are trained so that peoples concerns are listened to and reported and they are protected Evidence: Since the last inspection there has been one safeguarding incident in the home. This involved an alleged assault by a male resident on a female resident. The incident was reported through to the local safeguarding team but this was not before the manager was involved in commencing the investigation. This was discussed on the inspection as any delay in reporting such incidents can result in any evidence being jeopardized. The manager is clear that this was an error and is now fully conversant with the safeguarding procedures. Staff have completed training in recognizing abuse and how to safeguard people in the home. Staff spoken with were aware of the principals involved and were able to identify different types of abuse and how this may occur. This helps to ensure that people in the home are kept safe. The home have a complaints procedure and this is accessible through the information in the homes written guides. There was one recorded complaint from a relative regarding issues around confidentiality of information. The manager has responded appropriately to this. As part of the homes response they did involve the residents Care Homes for Older People Page 19 of 32 Evidence: social worker which shows good practice in this area. Residents were seen to be relaxed in the presence of staff indicating that they feel safe in the home. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider and manager need to upgrade some areas of the home such as toilet and bathroom facilities and ensure safe practice around the control of infection in the home so that people are fully protected. Evidence: We toured the home and visited all day areas and facilities and some bedrooms. There has been some upgrading of bedrooms since the last inspection and there is an ongoing program of decoration for these. Bedrooms seen were clean and personalized to varying degrees which reflect the individual personalities of the people in the home. We observed some shared rooms. Some had movable screens in place but at least one room did not have any screens in place. Screening is important in shared rooms to help ensure some privacy for people. Movable screens are cumbersome to use for staff and do not offer any choice for elderly people who may not be able to maneuver them at all. We would strongly recommend some curtain screening which will offer choice for people who can use them without staff help if needed. We were advised of the routine safety checks undertaken and observed that windows and wardrobes, for example, were safely secured to reduce the risk of accidents. There is also and ongoing program for covering radiators to protect people from burns and Care Homes for Older People Page 21 of 32 Evidence: this should continue and be completed within the time limits described [over the next six months]. The previous requirement to ensure adequate bathroom and toilet facilities has only been partially met. The bath room and toilets above ground floor have been upgraded but the toilets on the ground floor are in need of upgrading. These were observed to be very basic and bare in appearance. One toilet was lacking in any ventilation and there was a strong maloudour. There was also a lack of appropriate liquid soap and paper towels in all communal bathroom and toilet areas which puts people at risk from cross infection. These areas must be upgraded. We spoke to the manager about controls for infection in the home. We observed references in care files to residents who had diarrhea in the past and were advised that on one occasion this amounted to 3 - 4 people at once. This was not reported appropriately at the time as a possible infectious outbreak which may have put people at risk as appropriate advise was not sought. The current policy does not contain information on the reporting of such incidents and the manager was unaware of who to contact. We spoke with staff who reported some training as part of induction [the induction training recorded was seen] but there has been little or no updates around infection control otherwise since 2003 and none of the care staff have food hygiene training although a number of people require support with feeding. We visited the laundry which was tidy and the home employ a person for specific laundry duties. But again there was no hand-wash facilities as there was no liquid soap or paper towels. We were advised that staff involved themselves in hand sluicing of soiled linen which must cease as germs can be displaced in the air and settle on clothing which may present as an infection risk. In the event of managing soiled and infected linen there is a lack of suitable equipment such as alginate bags [to ensure reduced contact] and adequate laundry policy to support good practice. We were advised that disposable aprons and gloves are not kept in the laundry. The flooring in the laundry is split and therefore difficult to clean although we were assured by the provider that all the flooring on the ground floor is to be renewed. This area of managment needs to be reviewed urgently and adequate policy and resources put in place to ensure basic standards are met and the risk of infection is minimised. There were comments in the previous report around the garden facility at the rear of the building. This remains uninviting to people living in the home as it is poorly maintained. For example we observed discarded cigarette butts, grass not cut and garden pots with dead flowers.There is also poor disability access to the garden at present and with some residents having mobility needs this needs to be reviewed so that residents with disability can be enabled to enjoy the garden more regularly. Care Homes for Older People Page 22 of 32 Evidence: Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient and well trained staff so that care needs can be met effectively but the manager needs to ensure recruitment checks are made on all new staff so that residents are protected. Evidence: For 24 residents there was a trained nurse and four care staff on duty on the day of the inspection. Normally there would also be an activities organiser in addition. There are also good levels of ancillary staff cover so that care staff can concentrate on spending time with the people in the home. We spoke with staff and also looked at the duty rota which confirmed consistent staff numbers. Staff are trained appropriately. Training records seen indicate that staff have attended mandatory training courses and most staff have either achieved or are undertaking NVQ qualifications. The induction program is well devised and staff spoken with have benefited from this and have been able to feel supported in their role. This ensures that staff are equipped to undertake their duties. We would recommend some in house training around dementia care and mental health issues as these subjects have not been a regular feature of the training program. Also, as discussed earlier, staff are not conversant with infection control issues. Care Homes for Older People Page 24 of 32 Evidence: We looked at staff files to see how staff are recruited. Of three staff reviewed one had been working in the home for 5 months on work experience but there was no record of any of the required checks having been taken place. We were informed by the manager that the agency who sent the member of staff concerned had completed checks but there is a requirement that the home have records that can be referenced. Two other files seen were complete apart from the availability of two written references [only one reference on each file]. These checks are important to ensure suitable people are employed to work in the home and assist in protecting vulnerable adults. We require that these checks are carried out prior to employing all staff in the home. People in the home and visitors spoken with all felt that staff were very caring and felt supported by them. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider and manager need to review some aspects of the running of the home so that all systems are consistently monitored and maintained and the home is run in the best interests of the residents. Evidence: The registered manager for the Home has been in post for 9 years and is well experienced. She displayed a positive attitude and caring approach and was open to discussion and comment. Staff spoken with felt she was approachable and supportive. The manager is supported by a full time administrator who takes on a large amount of responsibility within the home and contributed to the overall management. There are clear lines of accountability. The managers undertake many routine audits within the home including some health and safety audits and other systems audits. The home also employs an external quality audit which looks at staffing issues [Investors in People Award].The Provider Care Homes for Older People Page 26 of 32 Evidence: [owner] of the home also visits regularly and we were informed that he carries out audits as well. We were unable to be provided with routine monthly quality audits [Regulation 26 reports] however and would require that these are carried out so that further feedback about standards in the home can be given to the manager. We were concerned that since the last inspection there has been a lack of consistency in maintaining standards of some key areas of management in the home. For example the lack of adequate infection control measures and standards of staff recruitment checks. The managers have also not fully addressed two requirements made on the last inspection [two years ago] around upgrading toilet facilities and improving dining arrangements. The Provider and manager must ensure that such requirements are met in a timely manner. The pre inspection information [AQAA] informed us that standard safety certificates were all up to date and we spot checked some of these on the inspection. Generally health and safety issues are well managed [Infection control not withstanding] and we saw regular risk assessments of the environment which were completed to a good standard.The staff carrying out both health and safety checks and fire checks have received basic training in these areas and we would recommend more in depth training to increase knowledge further. This helps ensure that people in the home are kept safe. We looked at accident records and although accidents are recorded the standard practice of filing records confidentially and completing reference details in the accident book were not being carried out. This means that accident records are not maintained confidentially. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 15 12 and 16 The dining room needs to be 31/07/2007 improved to ensure that meal times are taken in a more comfortable and pleasant surroundings. 2 19 23 Improvements must be 30/09/2007 made to the bathroom areas to ensure a more comfortable and homely environment is provided. Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The garden area must be maintained adequately and the access for people with disability must be further assessed. This will ensure that people living in the home can experience this facility. 03/08/2009 2 26 13 The policies and procedures and standard practices in the home regarding the control of infection must be reviewed and updated with reference to comments in this report and relevant good practice guidance put in place. This will ensure there are adequate systems in place to control the spread of infection and reduce any risk for people living in the home. 01/06/2009 Care Homes for Older People Page 29 of 32 3 33 26 The Provider must complete 01/06/2009 a monthly report [Regulation 26 report] on standards within the home and provide this to the manager. This is so that the manager can benefit from feedback concerning standards in the home and the home can be run in the bes interests of the people living there. 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 2 3 7 All assessments should be signed and dated to ensure that they can be clearly identified. We would strongly recomend that residents who can and relatives are involved in the ongoing care planning and evaluauton process. The manager should evaluate the homes approach to self medication for residents and help facilitate any person who can assist themselves to any degree. We would recommend that a suitable comfortable chair is provided to support the person discussed who has no mobility. We would recommend more individualized activities for people especially those with dementia. There should be adequate screening provided in all shared rooms to ensure privacy and we would recommend fixed curtain type screening so that elderly people can have more choice and be enabled to to use them independently. The prgramme of covering radiators should be completed as agreed All staff should receive updates and training around infection control. Care staff should be included in the training of safe food handling. 3 9 4 10 5 6 12 24 7 8 25 26 Care Homes for Older People Page 30 of 32 All communal toilet and bathroom facilities should have liquid soap and paper towels in place. 9 37 The management of accident records should be reviewed and meet standards around storage / confidentiality. 10 38 We would recommend that staff undertaking health and safety and fire checks complete more in depth training. 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