Inspection on 12/02/09 for Darsdale

This inspection was carried out on 12th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Darsdale 06/09/06

Darsdale 22/11/05

Darsdale 13/06/05

Darsdale 03/03/05

Darsdale 17/08/04

Darsdale 16/03/04

Similar services:

Applegarth

Thornham Grove

Hunter`s Lodge

Conifer Lodge

Manor Court

92 Black Prince Avenue

Agnes House

The Manor House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Darsdale Chelveston Road Raunds Northants NN9 6DA     The quality rating for this care home is:   zero star poor 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: Louise Bushell     Date: 1 2 0 2 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 34 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 34 Information about the care home Name of care home: Address: Darsdale Chelveston Road Raunds Northants NN9 6DA 01933622457 01933389399 Sue@nab.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Northamptonshire Association for the Blind Name of registered manager (if applicable) Susan Henderson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 sensory impairment Additional conditions: The maximum number of service users who can be accommodated is: 30 The registered provider may provide the following categories of service only: Care home - (PC) To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Sensory Impairment (SI) Date of last inspection Brief description of the care home Darsdale is a residential care home providing personal care for 30 older people over the age of 65 years. The home is registered for service users who have a diagnosis of sensory impairment. Northamptonshire Association for the Blind is a charitable organisation that owns Darsdale Home for the Blind. The home is set in large and pleasant grounds on the outskirts of the small town of Raunds.There are bedrooms on both the ground and first floors of the building. A lift provides access to the first floor bedrooms. All Residents have accommodation provided in single rooms and twenty four of the rooms have en-suite facilities. Care Homes for Older People Page 4 of 34 care home 30 Over 65 27 3 Care Homes for Older People Page 5 of 34 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 focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting two people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Commission for Social Care Inspection. Care Homes for Older People Page 6 of 34 We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. During the visit information was gathered directly from the staff, people who use the service and relatives and or visitors to the service. The visit took place between 10.:00am and 17:00pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the registered manager. The fee range for residing at the service are from three hundred and ninety six pounds per week, with an additional fee of nineteen pounds per day for day care if required. The fee is excluding all personal items and toiletries. What the care home does well: What has improved since the last inspection? What they could do better: A number of areas have been identified as part of this Key Unannounced Inspection that require the service make considerable improvements to its running in the best interests of the people who use the service. A series of short falls were found in the management of medication. Two immediate requirements were issued at the time of the inspection regarding medication. The service complied within the allocated time scales. Numerous further requirements and recommendations have been made surrounding medication. Care Homes for Older People Page 8 of 34 Shortfalls have been identity in care planning and risk assessments. There is a need for the service to review the care planning process in place to ensure that all areas of risk are firstly identity and then actioned with the appropriate measures as required. The reviewing of the care plan does not ensure that the changing needs of the person using the service is adequate reviewed. Care plans and risk assessments were not always signed and dated, with falls risk assessments and manual handling documents often having numerous copies of the same information in a different format, leading to misinterpretation and confusion for staff. There was not adequate care plans or risk assessments in place for the management and control of infection. Environmentally, the lounge floor requires reviewing, replacing or attention as this is a trip hazard and not suitable for those who are visual impaired and walk with aids or unaided. 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 9 of 34 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 34 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. Assessments are completed however shortfalls in accuracy and detail in recording may result in the full needs of an individual not being met. Evidence: The service has developed a Statement of Purpose, which sets out the aims and objectives of the service, and includes a guide, which provides basic information about the service and the specialist care that is available. The guide details what the prospective people using the service can expect and gives an account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. The Statement of Purpose had recently been reviewed. At the time of the inspection, this information was not readily available in the foyer, however the manager stated that more copies would be added for people to view. The manager also stated that leaflets and general information would be added to the foyer for people to access as they wish. The inspection report was not on display for visitors Care Homes for Older People Page 11 of 34 Evidence: and people who use the service to access. The service has an assessment tool in place which explores and details the needs of the individuals moving to the service. Two peoples assessments were viewed as part of case tracking. The assessments had not been completed in full and there was evidence that a number of assessment areas had not been sufficiently completed, dated or signed. The assessment did not identify significant areas of risk or possible complication to consider. The manager stated that she is hopping to review the assessment process and paper work in full. The Annual Quality Assurance Assessment submitted by the service in July 2008, states that Ensure service users needs are met and supported by carrying out full pre admission assessments and 6 monthly internal reviews thereafter. One person using the service stated that I like it here, the staff are kind and caring. A relative commented that I can visit any time, there are no restrictions. We had lots of information about the home before my father moved in. I think its 10 out of 10. It was directly observed that the service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process, but shortfalls in documentation of the assessment process were identified in relation to the lack of risk assessments and care plans being implemented from information in the assessment. Individual term and conditions of residency were in place and detailed the information required in order to ensure that that rights of the person were maintained. Care Homes for Older People Page 12 of 34 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. Medication administration practices, incomplete care planning and lack of risk assessments puts the people who use the service at risk. Evidence: People have access to health care services both within the home and in the local community. The majority are able to choose their own GP and attend local dentists, opticians and other community services. People unable to access local services are supported by visits to the home by health care professionals. There was evidence available that the service actively seeks the services of out side professional such as the District Nursing Services. Health needs are monitored and action and intervention taken in most cases. The home is able to provide the aids and equipment recommended, but more attention could be given to the changing needs of residents. It was directly observed that one persons had a care plan in place for the management of Leg Ulcers and was receiving services from the District Nursing Services, however the health care plan stated Care Homes for Older People Page 13 of 34 Evidence: thatdischarged as per health plan. The health plan did not detail the date of healing and progress monitored was a little sparse. Additional information in the bathing care plan included gaining information about the removal of bandages from the leg, but no further information. A risk assessment was in place for the removal of the bandages but had not been reviewed and or closed off as not being applicable any longer from the 23rd November 2008. There is evidence in the care plan of further health care treatment and intervention. There are some gaps in information but staff are able to think in a person centred way and are able to give a verbal update. Staff encourage individuals to be independent and to take responsibility for their own personal hygiene. The views of residents are sought about the way personal care is delivered. However it was observed as part of case tracking that one individual did not have detailed preferences recorded. This was brought to the attention of the manager. One of the care plans case tracked was of a person who had recently been admitted to the service. There were a number of care plans that had not been completed and this included the nutrition care plan, life history, and preferred wishes. The person using the service has MRSA and there is no specific care plan in place or risk assessments for the safe management of infection control. In addition to this risk assessments are not in place for the use of a recliner chair, isolation, trips and falls, infection control or environmental issues due to visual impairment. There is an individual personal handling plan in place, however this is not signed or dated by the assessor. A further person case tracked had a personal manual handling assessment in place which was implemented on the 15th April 2008. This had not been reviewed any further. It was observed through accident and incident records that the individual had a total of thirteen falls. It was also noted that there were several types of forms being used for the recording and management of falls and the person had been identified as being High Risk, however neither of these forms had been fully completed and it was difficult to establish which form was active and current. The review section of the care planning process only allows for the staff member to date and sign. It does not encourage the reviewer to add additional information and or sign post the reader to the amended care plan. This was brought to the attention of the manager. It was observed that a number of risk assessments were not signed and or dated. It was also identified that risk assessments did not explore control measures in order to minimise the risk but still empower the individual to take reasonable risks. Risk Care Homes for Older People Page 14 of 34 Evidence: assessments were lacking in a number of areas, and where a possible risk had been identified in the care plan this was not then completed on a risk assessment. Of the two care plans case tracked there was no evidence of family, friend or advocate involvement. One relative commented that I dont know about his care plan but I am completely satisfied. The home has a medication policy which is accessible to staff. Medication records are not up to date; there are gaps in recording and information. The current practice and lack of adequate recording puts people who use the service at risk. On several occasion a stock balance check was conducted, however due to the lack of recording the amount of medication received, when it was started and how many tablets may have been brought forward an accurate stock check could not occur. Boxs and or creams did not have a date of opening on them, which made it difficult to establish whether the shelf live of the medication had expired following opening. There is a lack of staff training and understanding of the safe handling of medication. Temperatures of the fridge were being recorded and were within the suitable ranges for the safe storage of medication. It was observed that the room temperature was not being recorded and on the day of the inspection the room was very warm. A high number of gaps were noted on the Medication Administration Records (MAR) and on several occasions it was difficult to establish whether the individuals being case tracked were in receipt of their full medication. Instructions on the MAR detailed on occasion as required. This was discussed with the deputy manager of the service and explained how this leaves the administration to interpretation of the dosage. There were not additional guidelines in place for the administrator in order to make an accurate decision about the dosage required for the individual. Several medicines had been destroyed due to the individuals refusing them. At the time of the inspection there was not accurate record of the disposal of medication as the deputy manager stated that the destroyed records are at the chemist. Hand written entries were seen on the MAR. These were not double signed by two staff members. There has been failure to respond to unsafe practice that places people at risk. The wishes of individuals about terminal care and arrangements after death are not always recorded. Care Homes for Older People Page 15 of 34 Evidence: A relative commented that Theres not one carer who is unfriendly, you never feel unwanted here. The relative added that Everything is brilliant here, the carers, the atmosphere, we think its marvellous, we know he is looked after, good food and he is always clean and tidy. A person who uses the service commented that I like it here, its very good. A further person added the staff in general are patient, kind and caring. Information received from the service and in the AQAA, states that Care plans are reviewed monthly or more frequent if needed, Care plans updated and necessary action taken to accommodate change of needs. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provided sufficient and suitable meals and activities for the people who use the service to ensure that their individual needs, choices and preference are taken into consideration at all times. Evidence: People who use the service have the opportunity to develop and maintain important personal and family relationships. On the day of the inspection a number of people who use the service were waiting for family members and or friends to visit and commented that they are able to have visitors as they wish. One relative commented that I am able to visit when ever I like. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. This was indirectly observed through the practices of the staff on duty. A number of people who use the service were seen to be very relaxed and calm within their own environment and engaging with staff in an equal manner. The people using the service had a variety of communal and or personal spaces to relax. One person commented that We do ten pin bowling, cards, drawing singing and exercise, i would Care Homes for Older People Page 17 of 34 Evidence: like more exercises as it keeps me fit and active. A further person using the service commented that we always get two choices for our meals, but i like salad and they always provide us with what we like. They do me a good salad. Part of the care planning process does identify peoples preferred activities and comments in brief about their life history. Although it was noted that this information on those people case tracked was either sparse or not completed at all. There is an area for activities and a notice board with forth coming events and important updates for the people who use the service. In this communal area, during the inspection a number of staff were indirectly observed simply sitting with a number of individuals and taking about every day life. The AQAA determines that We offer in house religious services and support to attend services of their choice in the community. The AQAA further states that The home operates a mobile shop and a weekly order to enable service users to purchase the items they require. During the inspection it was determined that seven hours of activity is provided per week for the people who use the service. On the day of the inspection an external activity person was on site supporting a small group of people to paint plates. Feedback from the people who use the service was extremely positive regarding this. The service is near completion of a large sensory garden to the rear of the property. This is an attractive area with raised beds and walk ways throughout leading to seating areas for all to enjoy. The choice of plants has been sensitive to meet the needs of people who are visually impaired. The manager stated that plants have been chosen for their scent, texture and sound. On the first floor of the building there is also a computer available for the people who use the service to use. This has talking software installed to support people with visual and hearing impairments. The AQAA also inform us that a new vehicle has recently been purchased and an activity organiser works seven hours per week. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. Menus were on display. The food provided appeared appetising and well presented. Comments received included, The food is good and there is always a choice available for lunch and tea time, we have tea at 5pm. Generally very good efforts are made with the food. The service has achieved three stars from the last food hygiene inspection. Care Homes for Older People Page 18 of 34 Evidence: The care staff are sensitive to the needs of those people who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the individual, making them feel comfortable and unhurried. Care Homes for Older People Page 19 of 34 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. The services robust management of complaints and recruitment procedures ensures that the people who use the service are protected. Evidence: The service has an open culture that allows people who use the service to express their views and concerns in a safe and understanding environment. Complaints leaflets were on display at the service, it was observed that a record of all compliments is maintained at the service and the AQAA determines that no complaints have been received in the last twelve months. People who use the service have commented that they are happy with the service provided, feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. The AQAA determines that We provide services users and relatives with information on how to make a complaint. The AQAA further adds that We respond to complaints following policy and procedure. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. The service understands the procedures for Care Homes for Older People Page 20 of 34 Evidence: safeguarding adults and would attend meetings as required. The training matrix shows that only four staff have attended training in the entire staff group in the safeguarding of adults and that no ancillary staff have attended. As part of the inspection process, we reviewed a random selection of staff files. Four staff files were audited to ensure suitable checks had been conducted. All files contained the required information to ensure that the people who use the service are protected by the services recruitment procedures. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is clean and homely however there are several areas that require attention to ensure that people are supported to make choices and protected from avoidable risks. Evidence: The people who use the service are encouraged to personalise their bedrooms. All the homes fixtures and fittings meet the needs of individuals and can be changed if their needs change. The building design supports the needs of people using the service. The dining rooms are laid out to encourage communal dining with a calm relaxed atmosphere. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The home has an infection control policy. The service is clean, well lit and it smells fresh. A number of people using the service commented that they liked living at the service. One person using the service commented that its very comfortable and warm, I am very lucky with my room. The AQAA determines that The home is specifically adapted and decorated for the visually impaired. It is an odour free environment. Laundry facilities are in accordance Care Homes for Older People Page 22 of 34 Evidence: with health and safety requirements. A person using the service commented that My room is very clean and I like all the staff and the cleaners, they are very kind and very helpful. Individuals are encouraged to see the home as their own. It is a satisfactorily maintained, and has good access to community facilities and services. The environment is fully able to meet the changing needs of people, along with their cultural and specialist care needs. It is fully accessible throughout to people with physical disabilities, adaptations and specialist equipment are designed to fit within the homely environment. It was noted that a bathroom was being used as a store room.and a further bathroom was under repair. The people who use the service can personalise their rooms. They also say they the home is clean, warm, well lit and there is usually sufficient hot water. There has been some consultation with residents about the decor, especially for their own rooms. Some en-suite facilities are available, not all bathrooms are accessible to all people in the home although they report that they can always access a bathroom that meets their needs. It was noted that the main carpet in the lounge which has been fitted quite recently is loose and has lifted in several areas, causing a trip hazard. The manager stated that they have been in contact with the carpet manufacturer and supplier. Following the improvement which was submitted by the provider, it evidenced that the carpet has now been replaced. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected by the services robust recruitment procedure however training is required to ensure all staff have up to date knowledge in order to support and protect people further. Evidence: People are generally satisfied that the care they receive to meet their needs, but there are times when they may need to wait a short time for staff support and attention. One person using the service I am very happy here and feel safe. There are enough qualified, competent and experienced staff to meet the health and welfare of people using the service. Staffing rotas take into account the needs and routines of the people using the service. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the NMS. The manager is aware that there are some gaps in the training programme and plans to deal with this. The manager supplied a current training matrix which showed that there is a need for staff to attend and complete training in Infection Control, Safeguarding of Adults and a Manual Handling refresher. A number of staff have attended a working with visually and hearing impaired people, however this was completed many years ago and a refresher Care Homes for Older People Page 24 of 34 Evidence: is required. All staff are clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. One person who uses the service commented that the staff are all so kind and caring. The service has a recruitment procedure that meets statutory requirements and the NMS. The procedure is followed in practice and there is accurate recording at all stages of the process. There is acceptable use of any agency or temporary staff which doesnt adversely affect the quality of the individual care and support that residents receive. The AQAA determines that we encourage staff to undertake NVQ and offer a wage increment upon completion. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the service has the skills and enthusiasm, however there is a need for this to be cascaded to all staff to ensure that the service is managed effectively and that people are in safe hands at all times. Evidence: The manager has the required qualifications and experience and is competent to run the service. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve services. The service provides an adequate quality of life for the people who use the service. There is also a focus on person centred thinking, with people who use the service shaping service delivery. There is a strong ethos of being open and transparent in all Care Homes for Older People Page 26 of 34 Evidence: areas of running of the service. The manager leads and supports a strong staff team who have been recruited as required. The manager is aware of current developments both nationally and by CSCI and plans the service accordingly. The manger shows willing to develop the service and is aware of the current shortfalls identified during the inspection process. The AQAA contains clear, relevant information, however there is opportunity for this to be further developed. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The managers practice, skills, and knowledge, is based on continuous development, gained through enthusiasm for the role. There is however a need for this to be cascaded to the documentary evidence of the service to ensure that the care plans, risk assessments and the management of medication is robust and in line with the National Minimum Standards. The service has sound policies and procedures, which the manager effectively reviews and updates, in line with current thinking and practice. The manager ensures staff follow the policies and procedures of the service. The service works to a clear health and safety policy. All staff are fully aware of the policy and are trained to put theory into practice. Regular random checks take place to ensure they are working to it. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. It has been identity however that there is a need for safeguarding training to occur at the service for all staff. The home has a consistent record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. Records are of a good standard and are routinely completed. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 34 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 Care plans must reflect involvement by the person who uses the service and or their representatives. To ensure that the rights and preferences of the individual are adhered to. 15/05/2009 2 7 13 Falls risk assessments must be in place with suitable control measures in place for a named person (RS). This requirement was issued as an Immediate Requirement on the day of the inspection. Compliance date of the 13th February was set and achieved. To ensure the health safety and well being of the person is maintained at all times. 27/03/2009 3 7 15 Care plans must be reviewed 24/04/2009 accurately and changes in need identified and appropriate actions taken. Care Homes for Older People Page 29 of 34 To ensure the health safety and well being of the person is maintained at all times. 4 7 17 Records of the review of a 24/04/2009 persons care plan must reflect any actions taken and appropriate ammendements made to the care plan and risk assessments as required. To ensure the health safety and well being of the person is maintained at all times. 5 7 15 Care plans for the management of MRSA and infection control risks must be in place. To ensure the health safety and well being of the person is maintained at all times. 6 7 15 Each person using the 23/04/2009 service must have a detailed plan of care in place covering all areas of needs. To ensure the health safety and well being of the person is maintained at all times. 7 8 12 All medication must be received, recorded, stored administered and disposed of as required. To ensure that the management of medication is effective and completed in the best interest of the people who use the service. 23/04/2009 24/04/2009 Care Homes for Older People Page 30 of 34 8 8 13 An audit and or consultation must occur with the GP to ensure that all medication held at the service is prescribed. This requirement was issued as an Immediate Requirement on the day of the inspection. Compliance date of the 14th February was set and achieved. To ensure the health safety and well being of the person is maintained at all times. 27/03/2009 9 9 16 An audit system must be introduced and records accurately reflective of the stock available at any one time. To ensure that accurate and effective records are maintained of peoples medication. 30/04/2009 10 9 13 Instructions of the Medication Administration Record must be clear and accurate. Where as required is recorded additional information must be available to the administrator to ensure accurate administration in the best interest of the person using the service. To ensure that the health, safety and well being of the person using the service is maintained at all times. 30/04/2009 Care Homes for Older People Page 31 of 34 11 9 13 Room temperatures must be 09/04/2009 recorded where medication is stored. To ensure that medication is being stored in line with the manufactures guidelines. 12 9 12 Accurate records must be maintained for all medication returned to the pharmacy or disposed of. To ensure that accurate records are maintained in the best intrests of the people using the service. 16/04/2009 13 9 13 All people who use the service must receive their prescribed medication as required. An audit must occur to ensure that all medication is being administered as per the prescription by the GP. This requirement was issued as an Immediate Requirement on the day of the inspection. Compliance date of the 14th February was set and achieved. To ensure the health safety and well being of the person is maintained at all times. 27/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose, Service Users Guide and Page 32 of 34 Care Homes for Older People Inspection Reports should be made available to all people who use the service. 2 3 A review of the assessment format should be considered to ensure that the service is able to complete detailed, accurate assessments exploring all areas of need for the individual. Care plans and risk assessments should be signed and dated to ensure that they are active and current at all times. Preferences of the people who use the service should be explored and expanded upon to ensure that their individual rights are empowered and dignified. A review of the care plan reviewing system should occur to ensure that the documents details information in order to establish the changes in need of an individual using the service. A review of the documentation used to manage falls and manual handling risks should occur, to ensure that there is not unnecessary duplication and that the risk of misinterpreting the actions required does not occur due to a number of documents being in place causing possible confusion. The service should obtain a copy of The Royal Pharmaceutical Guidelines for Care Homes. Bottles and boxed medication should be dated once open to ensure effective management of expiry dates. 3 7 4 7 5 7 6 7 7 8 9 9 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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