Inspection on 13/07/09 for Cross Lane House

This inspection was carried out on 13th July 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cross Lane House 29/09/08

Cross Lane House 19/10/06

Cross Lane House 04/01/06

Cross Lane House 21/08/05

Cross Lane House 12/01/05

Cross Lane House 24/08/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Cross Lane House Cross Lane Ticehurst Wadhurst East Sussex TN5 7HQ     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: Sally Gill     Date: 1 3 0 7 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 30 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 30 Information about the care home Name of care home: Address: Cross Lane House Cross Lane Ticehurst Wadhurst East Sussex TN5 7HQ 01580200747 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: VNew490814@aol.com Mrs Amanda Patricia Newport,Mr Vincent John Newport care home 18 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: 18 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Cross Lane House is registered to provide accommodation for up to 18 older people. Mrs Amanda Newport, one of the owners is also the registered manager and is in dayto-day control of the home. The premise is a large detached converted country house. The property is set in approximately two acres of mature gardens with level walkways and seating areas. Accommodation is on three floors. There are fourteen single and two double bedrooms. The homes current policy is to offer the large double bedrooms as singles unless a Care Homes for Older People Page 4 of 30 Over 65 18 0 2 9 0 9 2 0 0 8 Brief description of the care home married couple wish to share. This means that numbers of residents does not usually go above 16. Twelve rooms have ensuite and all others have a wash hand basin. People have the use of three bathrooms, which includes one assisted bath. The home has a lounge, dining room and very large hallway with seating. The home has a passenger lift. The home has parking for several cars and is situated down a quiet road just off the main road. A bus stop is at the end of the road and train station three miles away. The village of Ticehurst is five minutes walk with its general shops, chemist, cafe, church and pubs. The staff compliment consists of a manager, care assistants, cook and kitchen assistants. Care staff work a rota that includes a minimum of three staff on duty during the morning, two in the afternoon and two at night (one of which is a sleep in). The range of fees at the time of the inspection were £450.00 to £650.00 per week. Additional charges are made for telephone, toiletries, newspapers, hairdressing and chiropody. The last inspection report can be obtained from the home or down loaded from www.cqc.gov.uk Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out over a period of time and concluded with an unannounced visit to the home between 09.15am and 4.15pm. The owner/manager and staff assisted during the visit. People that live in the home and staff were spoken with. Observations were made throughout the day. Fifteen people were living at the home on the day of the visit. Surveys were taken to the home on the day of the visit and distributed by the owner to residents, staff, a professional visiting and relatives. Three were returned from services users, five from staff, one from a relative and one from a professional all of which were very positive about the care and support received. The care of four people was tracked to help gain evidence as to what its like to live at Cross Lane House. Various records were viewed during the inspection and a part tour of the home undertaken. Care Homes for Older People Page 6 of 30 The home sent their annual quality assurance assessment (AQAA) to the Commission outside the required timescale. The AQAA is a self-assessment picture of how the owner thinks they are doing against the national minimum standards. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: It is not acceptable that not all requirements made at the previous inspection have been fully met as this leaves people at risk. This is in relation to recruitment and care planning. There must be an effective management structure in place which can meet legislative requirements and keep people safe. Medication must be further strengthened to protect people. Management must have quality assurance and quality monitoring systems to ensure the home runs effectively meeting National Minimum Standards and people have opportunities to voice their views. Care Homes for Older People Page 8 of 30 Other areas for improvement are mentioned in the text of this report. 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 30 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 30 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 and their representatives have the information they need in order to make an informed decision as to whether this home is right for them and can meet their assessed needs. Evidence: People have sufficient information in order to make an informed decision about moving into this home. The home is now using its combined statement of purpose, service user guide and contract. The owner advised parts of this are sent out when receiving a telephone enquiry and a copy of the whole document is left for people in their rooms when they move in. People surveyed confirmed they had enough information to help them decide if this home was right for them. A relative also confirmed they get enough information about the service to help them make decisions. People are protected by written contracts of terms and conditions. Two people Care Homes for Older People Page 11 of 30 Evidence: surveyed confirmed they had written terms and conditions. One indicated they did not know if these were in place. Peoples needs are assessed. The owner advised she undertakes a pre-admission assessment for all people thinking of moving in, which is recorded. Copies of these assessments were seen on file. The last admission was discussed. This persons care is funded by the local authority and the owner advised she had not obtained a copy of their professional assessment. This is required under the regulations. For people referred through the local authority the home must obtain a copy of the care management summery assessment and/or care plan prior to admission. This must inform their judgement that they are able to fully meet a persons needs. People have the opportunity to visit the home before they move in. People spoken with confirm they had been able to visit the home, they knew of the home before moving in or their families had visited for them. One person said the home was recommended. Another said they had visited and spent the weekend here before moving in. Intermediate care is not provided. Respite care can be provided vacancies allowing. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs continue not always to be identified within their care plan. There are not clear procedures to manage some health care needs leaving people at possible risk. Medication systems need strengthening to fully protect people. The principles of respect, dignity and privacy are generally put into practice. Evidence: People cannot be confident that all their health, personal and social care needs are set out in their care plan. People spoken with were happy with the support they receive. People surveyed indicated that they always receive the care and support they need and staff are always available when they need them and they are kept informed about important issues. A relative surveyed felt the care meets the needs of their relative and the home gives the care they expect. A requirement was made at the last visit that each person must have a written care plan in place which reflects all the individuals health, personal and social care needs. Care plans must contain clear guidance to staff on the management of care and health needs. The plan must be kept up to date and regularly reviewed. This requirement has not been met and is still outstanding. Four care plans were examined. The physical assessment and care plans Care Homes for Older People Page 13 of 30 Evidence: viewed showed no evidence of updating information or reviews prior to the last visit. There continues to be no information to staff about the management of needs such as catheter care or diabetes which was specifically discussed at the previous visit and could put people at risk. Although staff surveyed indicated they are always given up to date information about the needs of people. There is no evidence of peoples involvement in their care plans or any reviews. Charts used to monitor personal care and bowel management again lacked entries. One person who had moved in at the beginning of May 2009 did not have a care plan in place and staff were working from the pre-admission assessment information. Some care plans lacked risk assessments and not all risks associated with care had been assessed for others. Medication details were not an accurate reflection of all medications prescribed. For example antibiotics and eye drops prescribed were not recorded. The owner acknowledged this work had not been completed. She advised staff have received training in care planning and a new format for care planning has been purchased but nothing has been implemented. This is unacceptable management. Although outcomes for people are good, recording, documentation and specialist care training are not evidenced as in place and this leave people at risk of potential harm and must be addressed by management. Peoples health could be put at risk. The lack of information in care plans means there is no clear procedures for staff to follow for the management of health related needs. Care plans must reflect a clear safe procedure staff should follow to ensure consistency and people are not placed at risk. One person advised that the chiropodist visits every six weeks. People spoken with confirmed that a doctor is called when needed. People surveyed indicated the home always makes sure they get the medical care they need. Records evidence people attending outpatients appointments. Staff have received training in continence care no training in other conditions such as diabetes. Medication systems must be improved to protect people. Since the last visit the home has purchased a medication trolley and new controlled drugs cupboard for safer storage. Medication is logged into the home and out although medication waiting to be returned is not logged which would enable a clear audit trail and be good practice. Medication details contained within the care plan are not always accurate and some short term medication is not recorded. All of the the Medication Administration Record (MAR) charts were examined. The current charts had been in place for five days and reflected that in 18 instances there was no signature or code recorded against medication that should have been administered. Where medication was prescribed for one or two tablets the amount administered had not been entered so it was unclear what amount had been given. One medication that was prescribed three times daily had only been given twice each day. The owner advised that staff that administer Care Homes for Older People Page 14 of 30 Evidence: medication have received training and are currently undertaking a 12 week distance learning course. It is evident that any training is not followed through into practice and this must be addressed. A requirement is made. People feel they are treated with respect and their right to privacy upheld. People spoken with feel their dignity is maintained when receiving assistance from staff for personal care and they have privacy. Observations confirmed staff adopt a kind and caring approach with people. However on several occasions everyone including the inspector were called by a questionable endearing term. This practice should be reviewed to ensure people are addressed how they wish to be which is then respected. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their life style. Social and recreational activities only sometimes meet individuals expectations. People enjoy a variety of meals. Evidence: People have limited opportunities for activities. An activities programme is in place, which is displayed. This includes bingo, coordinated games, reminiscence, cross words, exercise to music, cards, scrabble and old films. Chair basketball was held on the day of the inspection. Outside entertainers come in to sing and play music. The owner advised that recently six people attended an open garden of a relative. She also plans at the request of people to organise a trip out. Religious services are held each month. Several people have newspapers or magazines delivered. Most people spoken with felt there wasnt a lot going on or what was going on they werent able to or didnt want to participate in. Most said they read their papers, walk round and chatted to others, had visitors or went out with relatives. Activities records showed very limited numbers of activities are happening. People surveyed were mixed about the activities two people felt there were always activities to take part in and one felt there was only sometimes activities. One professional said staff take time out to sit and talk to the service users. One staff member felt activities was an area which could Care Homes for Older People Page 16 of 30 Evidence: be better more entertainment (outside trips etc) for the residents. The owner said activities are offered but refused although this is not recorded. This is an area where the home should make improvements. If activities are refused perhaps the type of activities should be discussed and reviewed. People are able to maintain contact with family and friends. People spoken with say they have family and friends visit and also go out with friends and family. On the day of the inspection several people were visiting. Each bedroom has a telephone point and people have activated this service to stay in contact with people. People choose how to spend their time and make day-to-day decisions about their lives. People said they are able to get up and go to bed when they wish. People were asked if they wanted to join the activity. People confirmed they had brought in their own possessions or had chosen not to. A relative and professional surveyed felt people are able to live the life they choose. People confirmed the food is good and they enjoy their meals. People spoken with felt the food was alright, very good and very nice. One said I cant eat onions and they do take notice. People surveyed indicated they always or usually like the meals. There is a four-week rotating menu in place. Most people said they take breakfast on trays in their bedroom. Breakfast is fruit juice, cereals or porridge and toast. Lunch is the main meal and everyone is encouraged to the dining room to make it a social event. The main meal is not a choice menu but people confirmed alternatives are available followed by a desert. Supper is a light meal or sandwich followed by something sweet and people are asked their choice each day. Lunch on the day of the inspection was cottage pie, carrots and cabbage followed by pear crumble and custard. Care Homes for Older People Page 17 of 30 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. People who use the service are able to express their concerns, and have access to a complaints procedure. People are protected from abuse Evidence: People feel confident any complaints would be resolved but do not have any. People confirmed who they would speak to should they have any concerns. They said they had not needed to complain but felt confident any concerns would be addressed. People surveyed indicated staff always listen and act on what they say, there is someone they can speak to informally if they are not happy and most knew how to make a complaint. A relative surveyed indicated they knew how to make a complaint and the service has responded appropriately if they have raised concerns. There is a complaints procedure displayed within the front porch. The AQAA stated that there have been no complaints made to the home since the last inspection. The Commission has received no complaints. There is a complaints/suggestions book situated in the front porch of the home. People are protected from abuse. The home has policies and procedures in place regarding safeguarding adults and whistle blowing. Further safeguarding training has taken place with most staff now trained. Care Homes for Older People Page 18 of 30 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. People live in a light, airy, clean, pleasant and comfortable home. Evidence: People live in a homely and comfortable environment. The majority of the home has been refurbished in the last five years. This has been done to a good standard resulting in a very pleasant home which is well maintained. Since the last visit additional bedrooms have been redecorated, had new carpets and an ensuite added. See comments under management regarding fire safety tests. People confirm they are happy with their rooms. People spoken with all said they like their rooms. One said its a lovely room and Ive a lovely view out to the garden. One had been in another room but said they much preferred the new room which opened onto the garden. People confirmed they had been able to bring in their own furniture. Bedrooms are personalised with items of furniture, knick knacks and other possessions. People are able to enjoy light and airy communal accommodation. The home is set in large grounds with pathways for walks, which are enjoyed by people living at Cross Lane House. People not spending time in their rooms tend to sit in the hallway which is the hub of the home. Care Homes for Older People Page 19 of 30 Evidence: The home was clean, tidy and hygienic throughout. People spoken with confirmed their rooms are cleaned regularly and are always clean and tidy. People surveyed indicated the home is always clean and fresh. Care Homes for Older People Page 20 of 30 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. People receive care and support from a staff team which is sufficient in numbers, qualified and trained. People are not fully protected by robust recruitment processes. Evidence: Peoples needs are met by the numbers and skill mix of staff. The manager advised that there are four staff on duty 7am to 11am, three 11am to 2pm, two staff 2pm to 7pm and three 7pm to 8pm. This is an increase since the last visit between 7am to 11am and 7pm to 8pm. There is one member of staff on duty at night and another sleeps in for emergencies. This is in addition to the owner/manager and other ancillary staff such as cook, kitchen assistant and domestic. All comments about the staff were all positive. One said the staff are excellent, cant fault them, all very good. Others said they are very nice and do a marvelous job, all very nice cant do enough for you and very nice people, they treat you as good as you treat them. A relative and professional surveyed felt staff always or usually have the right skills and experience to look after people properly. One said staffing levels seem good. There is always someone around if you require a staff member. Most staff surveyed felt there is usually enough staff to meet individual needs. One commented there could be more staff at certain shifts (sometimes). People receive care from a qualified staff team. The AQAA stated that eight staff have obtained their National Vocational Qualification (NVQ) level 2 or above. The owner Care Homes for Older People Page 21 of 30 Evidence: advised another four are working towards this. This already meets the 50 recommended by the National Minimum Standards for good practice. People are not fully protected by the homes recruitment processes. One staff member has been recruited since the last visit so this file was examined. The homes application form has been reviewed unfortunately it is still not clear a full employment history must be submitted as required by the regulations. The application form examined evidenced gaps which had not been checked out during recruitment. This was part of a requirement made at the previous visit. A reworded requirement will now be made. References and other checks were in place prior to employment starting. However on discussion with the owner it is evident that staff are starting their induction training before employment starts and checks have been completed which leaves the home and people who live there very vulnerable. People receive support from a trained staff team. The owner advised that a Skills for Care induction programme is in place and will be completed with the newly recruited member of staff. Records confirmed staff also undertake an orientation induction to the home. Staff surveyed felt their induction very well or mostly covered what they needed to know. The owner advised of training data. Most staff are trained in mandatory subjects (fire, first aid, infection control, moving and handling and food hygiene). Further training has taken place in medication and health and safety which included fire, infection control, Containment of Substances Hazardous to Health (COSHH), infection control and risk assessment. The owner advised staff have received training in care planning and continence care since the last visit. Further training is planned in moving and handling and first aid. Staff surveyed felt they receive the training they need for their role. Staff training has improved and outcomes for people are good. However it is questionable whether the all the knowledge gained is transfered into practice given the shortfalls in recording particularly in areas of care planning and medication and management must address this. Care Homes for Older People Page 22 of 30 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. People live in a home which from their prospective is managed well day to day. This is not supported by robust and effective procedures which leaves people vulnerable. Quality assurance systems continue not to be effective in highlighted shortfalls. Peoples health, safety and welfare is not always promoted and protected. Evidence: The owner/manager advised she has completed her Registered Manager Award (RMA) and has an NVQ in care level 4. Quality assurance systems are not operating in peoples best interests. No formal quality assurance has taken place since the last visit. The owner advised that she has developed new quality assurance questionnaires for people using the service, relatives and staff. Those for relatives were sent out last week others are yet to be implemented. No resident meetings have been held as the manager advised people do not attend. Care Homes for Older People Page 23 of 30 Evidence: The AQAA was completed by the home. It was completed fully although at times contradicted what was found at the visit. For example on admission a full care plan is put into place, we review care plans on a regular basis, we have regular service user meetings and staff meetings. People do not benefit from a staff team which are appropriately supervised. Two staff meetings have taken place although there are no minutes. One member of staff was asked about the last meeting but could not remember what had been discussed. The owner advised this meeting had been to highlight shortfalls in practice to staff. Following discussions with staff and the lack of minutes it is questionable the success of the meeting. The owner advised that there has been no formal staff supervision since the last visit although she has developed a new supervision form. Staff surveyed felt the owner gives them enough support and meets with them regularly. Due to the declaration from the owner and the lack of records this must be informally. The owner advised that the home currently holds a small amount of savings for two people. These were examined and found to be in order. Peoples health, safety and welfare is not always promoted and protected. The owner advised the hoist requiring servicing at the last visit is no longer in place. Therefore the home no longer has a safe method for moving people who have fallen should they not be able help themselves up. A selection of certificates were examined. Records confirmed that most equipment had been serviced within required timescales. The owner confirmed they had not contacted the Fire Officer to discuss the frequency of testing equipment as advised previously. Therefore the fire safety log book was examined. The servicing of fire equipment was not up to date and there were no records of interim tests required by the home although the owner advised fire alarms are tested weekly. The home were advised to urgently contact their fire equipment contractor as servicing was two months overdue. The home is again advised to contact the Fire Safety Officer for advice and guidance on required testing and records. The accident book was examined. Reports should be stored securely to ensure confidentiality. Accidents records again could not all be tracked at the time of the visit which was discussed at the previous visit. It is not acceptable that compliance has not been achieved for outstanding requirements some nine months later. Effort has gone into training staff but again there is a lack of management to ensure this followed through into practice. The home must have a robust management structure and quality monitoring systems in place to ensure the home meets it legislative requirements and people remain safe. Care Homes for Older People Page 24 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 10/11/2008 have for each service user a written care plan in place which reflects all the individuals health, personal and social care needs. Care plans must contain clear guidance to staff on the management of care and health needs. The plan must be kept up to date and regualrly reviewed. Regulation 15 of the Care Home Regulations 2001. The registered person shall after consultation with the service user prepare a written plan as to how the service users needs in respect of health and welfare are to met. The registered person shall keep the service users plan under review and revise the service users plan. Care Homes for Older People Page 25 of 30 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 7 15 The registered person must 13/09/2009 have for each service user a written care plan in place which reflects all the individuals health, personal and social care needs. Care plans must contain clear guidance to staff on the management of care and health needs. The plan must be kept up to date and regularly reviewed. Regulation 15 of the Care Home Regulations 2001. The registered person shall after consultation with the service user prepare a written plan as to how the service users needs in respect of health and welfare are to met. The registered person shall keep the service users plan under review and revise the service users plan. Care Homes for Older People Page 26 of 30 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 9 13 The registered provider must ensure a safe medication procedures are in place and followed. Regulation 13(2) of the Care Home Regulations 2001. The registered person must make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 13/08/2009 3 29 19 The registered provider shall 13/08/2009 operate a robust recruitment procedure. In particular a full employment history must be obtained together with a satisfactory written explanation of any gaps in employment Regulation 19 of the Care Home Regulations 2001 requires the registered person shall not employ a person to work in the care home unless - he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2 Care Homes for Older People Page 27 of 30 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 4 31 10 The registered provider must ensure the home is managed and meets legislative requirements Regulation 10(1) of the Care Home Regulations 2001 requires the registered provider and manager shall, having regard to the size of the care home, statement of purpose, and the number and needs of the service users, carry on or manage the care home with sufficient care, competence and skill. 13/09/2009 5 33 24 The registered provider must have effective quality assurance and quality monitoring systems Regulation 24 of the Care Home Regulations 2001 requires the registered provider shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care at the care home. The system shall provide for consultation with service users and their representatives 13/09/2009 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 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. 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