Inspection on 17/11/09 for Eastbrook House

This inspection was carried out on 17th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Eastbrook House 08/12/08

Eastbrook House 02/08/06

Eastbrook House 18/10/05

Eastbrook House 16/05/05

Eastbrook House 15/02/05

Eastbrook House 04/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Key inspection report Care homes for older people Name: Address: Eastbrook House 16 Eastbrook Avenue London N9 8DA     The quality rating for this care home is:   two star good 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: Anne Chamberlain     Date: 1 7 1 1 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: Eastbrook House 16 Eastbrook Avenue London N9 8DA 02088056632 02088056637 Eastbrookhouse@UK2.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Roland Jenkins Beacham,Mrs Janet Beacham care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only: Care Home only-- Code PC To service users of the following gender--Both Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category-Code OP and Dementia Code DE Date of last inspection Brief description of the care home The home is owned by Mr & Mrs Roland Beacham and managed by their sons Jonathan and Richard, the former being the registered manager. The Beacham family has run Eastbrook House for over twenty years. The home is registered to provide care for forty three older people. The number of double rooms had been decreased so that there is now only one room Care Homes for Older People Page 4 of 30 Over 65 0 43 43 0 1 7 1 1 2 0 0 9 Brief description of the care home used as a double room. The communal space includes three lounges and a dining room. There is a passenger lift and the garden is to the rear of the property. The registered manager stated that the current cost of the service is #400 per week. The home displays the latest CSCI inspection report in the entrance hall of the home for the information of all. The registered manager stated that relevant information is shared with all concerned. Eastbrook House is situated in a quiet part of Edmonton at the end of a short residential road. The home is accessible by public transport and within ten minutes walking distance of the local amenities. The home aims to provide a safe and caring environment for service users. 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: two star good 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 quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. The inspection was conducted over eight hours. We spoke with residents and relatives and the manager. We also spoke with a district nurse and the community matron. We viewed key documentation and records, three service user files and two staff files. We inspected the arrangements for the administration of medication and made a tour of the environment including the garden. We would like to take this opportunity to thank all those who contributed to the inspection for their assistance and co-operation. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 7 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 8 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 using this home experience good quality outcomes in this aea. We have made this judgement using a range of evidence, including a visit to the service. The needs of prospective residents are properly assessed before they are offered a place in the home. Intermediate respite care is also offered appropriately. Evidence: The home states in their Annual Quality Assurance Assessment (AQAA) that they provide information to prospective service users and their families, verbally and in writing. The home has produced a Service User Guide, brochure and Statement of Purpose. The manager assesses the prospective service users needs and the AQAA states that placements are only offered when the manager is confident that the needs can be met. The brochure was well produced and informative. However it stated that the deputy Care Homes for Older People Page 9 of 30 Evidence: manager has had many years of experience and training with the care for the elderly and dementia care. As the deputy manager advised us he had had one day of training in dementia we felt that this was somewhat misleading. There was evidence on file of good and comprehensive needs assessment, regularly reviewed. The home does offer intermediate care in the form of respite breaks. These do not usually include intense rehabilitation. We felt that the home were able to provide these breaks within their resources, and this would not be detrimental to the welfare of the permanent residents. Care Homes for Older People Page 10 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 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 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 adequate plans of care, health care is properly addressed, medication practice is sound and privacy and dignity are upheld. Evidence: We viewed the personal files of three residents. The information is presented in the cardex system. The plans were linked to the assessments and they were comprehensive, also regularly reviewed and updated. There was evidence on files that health professionals were appropriately involved with residents. General practitioners, the community matron and district nurses all call. We spoke to the community matron who said he finds the home very supportive to his patient and helpful to him. He finds the staff follow things up and are able to carry out his instructions. Care Homes for Older People Page 11 of 30 Evidence: The district nurses manage any pressure sores and give advice regarding pressure relieving equipment. We spoke to the district nurses who told us they have had no major concerns with the home and find the manager helpful. Residents see chiropodists, opticians and dentists, a check is kept on weights and diabetic diets are provided where needed. Assistive technology had been provided in the form of alarm mats when residents are at risk of falling when they get out of bed. We felt that risk assessments were underdeveloped with an absence of an assessment for bed rails including a short bed rail, and an absence of manual handling assessments and strategies to reduce risks. Requirements have been made. We noted in the accident book, that some people were prone to falls and suggested to the manager that he make a referral to the falls clinic which is a borough resource. The home has a registration for caring for people with dementia. It has not yet admitted anyone with an existing diagnosis of dementia, but a number of residents have developed the condition whilst living at the home. Some have had a formal diagnosis of dementia. The manager is undertaking a distance learning course for dementia but the deputy manager has only undertaken a one day course. We recommend that the manager ensure that there is a good level of understanding of dementia among the staff particularly the supervisors. We also recommend that if the home feels a resident has developed dementia they organise a formal assessment for them. On a tour of the environment of the home we were concerned to meet two residents who were on an upper floor alone in their rooms. One lady was suffering confusion due to a temporary infection. She did not know how to summon assistance with her nurse call buzzer. She was however mobile and the manager said she usually uses her buzzer. Another lady was in bed with the buzzer to hand but was not aware enough to use it. The manager stated that these ladies would see a staff member at mealtimes and a.m. and p.m. drinks times. We felt that this was inadequate and recommend that staff regularly pop up to check on these residents and reassure them. We suggest every twenty minutes. Care Homes for Older People Page 12 of 30 Evidence: We viewed the arrangements for the administration of medication. The medication cabinet is kept in a locked room. We were pleased to see that the supervisor who opened the door for us had the key on her person. We did note however that the actual medication cabinet was not locked at the time of the inspection. We recommend it is kept locked at all times for security and safety. The medication folder has the medication policy at the front and a list of specimen signatures, which is good practice. The home uses mainly monitored dosage systems. The medication administration record (MAR) charts were neat and we saw not gaps in signatures. We sampled several medications to check if the correct balances were in stock. We found one discrepancy in a stock of Senna tablets as there were eighteen instead of fourteen. These tablets should have been administered two every other day. It appears that four had not been administered. We brought this to the attention of the supervisor who is responsible with her supervisor colleague for the administration of medication. She will take the matter up with the carers involved. The supervisor told us that they have started auditing the medications on a regular basis. We pointed out to her that to do this properly a brought forward figure must be entered on MAR charts for loose medication. A recommendation has been made. The medications are recorded when they come into the home and when they are disposed of and we were quite satisfied with the way this is done. We viewed the Controlled Drugs book and this had been properly used. The medication room has a refrigerator and the temperature is taken regularly to ensure that it is within a safe range. One resident had a jar of sudocrem in her room. Alongside it was a partially completed MAR chart which had other drugs on it as well as the sudocrem. We asked the manager about this. He stated that it was an attempt to record the use of the sudocrem but had not been properly kept up. We advised that if the MAR chart is to be kept with the preparation in the residents room, then it must be kept properly with other drugs crossed off so it is clear the sheet is only for the sudocrem. Also every administration must be properly recorded. When the cycle is complete the MAR chart must be placed in the medication folder with the other MAR charts for that person. The home states in its brochure that the values held are privacy, choice and independence. We observed the manager to knock on bedroom doors before entering and relatives spoken to were very positive about how staff treat residents. Care Homes for Older People Page 13 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 using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home supports social contact and indoor activities and some community contact. The choices of residents are respected and meals are varied and well cooked. Evidence: There are two ground floor lounges where most of the residents spend their days. We noted from residents personal files that they engage in a wide variety of activities which are organised in the home by the activities organiser. In addition an occasional trip is organised. The home has large and well kept gardens which residents use in the summer months. The manager said that about twelve relatives visit regularly. We spoke with visiting relatives and they said that they are always made welcome at the home. One resident is mobile and able to access the community quite independently. The home has limited staff resources for taking people out into the local area and it is also situated some distance from any shops. The manager did say however that the activities coordinator has sometimes been able to people out for short periods and a carer Care Homes for Older People Page 14 of 30 Evidence: escorted a resident to see a relative in the community. The home does organise planned events, and outings to places like Clacton. People are sometimes taken out shopping. Three people have newspapers delivered and a hairdresser calls regularly. The home has very pleasant dining rooms. It offers a range of breakfast foods, a cooked lunch with a pudding and a choice at tea time, with soup and toast usually included for those who prefer something hot. The lunchtime pudding is adapted for diabetic diets i.e. using sweetener instead of sugar in custard and rice pudding. The menu follows a four weekly cycle. Relatives spoken with stated that the food in the home is really good and enjoyed by all. Many of the residents have been at the home for some time and their food preferences are known and followed, so they are not offered things they do not like. Care Homes for Older People Page 15 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 using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home takes complaints seriously and has a procedure for dealing with them and recording them. Residents are protected from abuse. Evidence: We viewed the complaints procedure and record of complaints. The home has had no complaints this year. The manager stated that they would expect to respond to a complaint immediately or within forty eight hours, and come to a conclusion or resolution within twenty eight days, which would be communicated by letter to the complainant. We were satisfied that the home would take any complaint seriously. The home had no incidents recorded. We explained the use of an incident log where untoward events which are not accidents, complaints or safeguarding issues can be properly recorded. We noted such an incident had taken place and the only record was in a staff file. We suggested to the manager that an incident form should have been completed. There have been no safeguarding incidents since the last inspection. The home has a Care Homes for Older People Page 16 of 30 Evidence: safeguarding policy and also keeps a copy of the local authority safeguarding policy. We emphasised to the manager that the first action on having a suspicion or allegationof abuse reported to him must be to contact the local authority safeguarding officer. Care Homes for Older People Page 17 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 using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The environment is homely, comfortable and safe. The home was clean and hygienic. Evidence: We viewed the environment of the home, including two residents rooms which they gave us permission to see. The accommodtion is spread over three floors with a sitting room on the top floor and two on the ground floor. There is a lift and two sets of stairs. The bedrooms are a good size but are not en suite. The rooms we saw were comfortably furnished and all have hand basins. There are plenty of bathrooms and toilets and residents leave their rooms and use the nearest facilities. The condition, maintenance and decor of the home was generally good but there were some shortfalls. There was a radiator cover in bathroom 3 which was loose and rotten at the bottom. It needs replacing. There was a broken handle on a cleaning cupboard which presents a sharp hook and needs to be removed. An alarmed mat had been left in a corridor and presented a trip hazard. This was pointed out to the manager. There is a nurse call system and arrangements for clinical waste disposal. There is a Care Homes for Older People Page 18 of 30 Evidence: worker for laundry duties, a cleaner and identified hours for cooking. Some carers also undertake cooking duties but in hours identified separately from their caring duties. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service experience adequate quality outcomes in this aea. We have made this judgement using a range of evidence, including a visit to this service. The levels of mandatory staff training are low and need improvement to benefit residents. Staffing levels are not high and should be kept under continuous review, should the needs of residents change or more residents be admitted. Evidence: There are no residents in the home with continuous nursing needs. Intermittant nursing needs are managed by district nurses and the community matron. There are nine residents in the home with a formal diagnosis of dementia and there may be others who suffer from dementia but have not had a formal diagnosis. There are twenty-eight residents in total. There are 24 care staff employed and there are kitchen, laundry and cleaning staff, 32 in total. On the day of the inspection there were 5 caring staff for 28 residents, with mixed levels of need. The manager stated that this staffing level was supplemented with two additional carers in the morning. We viewed the training matrix which gives an up to date picture of what training the twenty five care staff have had (one care staff has recently left). The manager has Care Homes for Older People Page 20 of 30 Evidence: also developed a training plan. Most staff had had safeguarding training, but one supervisor who was booked to undertake training in January 2010 had not had safeguarding training since 2005. Another carer was booked to undertake training in January 2010 for the first time. The previous inspection report of 8th August 2008 made a requirement that all staff have refresher training in safeguarding adults by 15/05/09 and this had not been met. The manager stated that the home waits for the local authority to organise training for their staff to attend. This is not an acceptable reason for delaying staff training, which the home has a responsibility to arrange and pay for if necessary. Three carers had not had manual handling training since 2006. One carer had no record of having had first aid training. One staff member was booked to have training in January 2010 had not had the training since 2005.Two had not had training since 2006 (one was booked for training in January 2010). Seven had not had training since 2007. Care staff who had had training did not have three year certificates in first aid. Most care staff had had food hygiene training. Four carers had not had fire training since 2007. One carer had health and safety training recently, one in 2007 and one in 2006, one in 2005, four carers had no record of training in health and safety. One carer employed at the home, who apparently works on Saturdays, had no record of having, health and safety training, first aid training, manual handling training and fire training. This carer does have NVQ 2 which we do not regard as a substitute for training. Three carers had had no training in dementia, one had had training in 2004, one in 2006 and seven in 2007. As some of the staff have worked at Eastbrook for a number of years this is not a good reflection of the homes commitment to training. The previous inspection carried a requirement that the home take a systematic approach to training, ensuring that all areas of mandatory training are covered and all staff have refresher training in safeguarding. We feel the planning and recording of training is now systematic but the Care Homes for Older People Page 21 of 30 Evidence: actual levels are still quite inadequate. The home gives carers the opportunity to watch training DVDs which have tests following and also gives them handouts. We do not regard these as having the same value as training with a trainer and for training which needs a practical element for example manual handling and first aid, we believe they are not adequate. The manager stated that the DVDs had not been used for those two elements of training i.e. manual handling and first aid. Our view is that the core basic training elements are, safeguarding, manual handling, first aid, health and safety, infection control and food hygiene. We expect these core basics to be refreshed within two years. The manager stated that his understanding was three years. We feel this is too long. A requirement has been given. We viewed two staff files to check on recruitment safety. The recruitment process appeared robust with an application form, two references taken up, proof of eligibility to work in this country and a Criminal Records Burea (CRB) disclosure. We reminded the manager that staff should only start work on a Protection of Vulnerable Adults (POVA) check if there is a compelling reason and they are supervised by another member of staff. 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 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 experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is qualified and competent to run the home. Quality assurance is addressed adequately, service users monies are safeguarded and working practices are safe. Evidence: The registered manager of the home has the Registered Managers Award and substantial relevant experience. The home has good systems and structures in place for management and the records are well kept. The home takes a pro-active approach to quality assurance. We were shown a sheaf of recent surveys completed by service users, which had been analysed and had resulted in some changes being made. We also saw a business plan for the coming year. Care Homes for Older People Page 23 of 30 Evidence: The home supports residents with their finances where this is needed. The arrangements for doing this were viewed and appeared quite safe and reliable, with receipts being retained and accounts being kept. On inspection of the environment of the home it was noted that in two bathrooms doors to void spaces were unlocked. This presents a health and safety hazard as a resident could go through the door into a dangerous area. The doors must be kept locked. The level of staff training in health and safety was not totally adequate. The training matrix showed that some staff members had had training in October 2009 but three staff members had had training in the years 2005,2006 and 2007 respectively. The other four staff had no health and safety training recorded against their names. A requirement has been made in another section of this report regarding health and safety training for staff. The fire protection arrangements were sound, but the fire risk assessment was undertaken in 2007 and is therefore in need of updating. The manager stated that the home conducts a fire drill every weekend when they set off the smoke detector and staff have to check the panel to see which part of the building is involved. The building is compartmentalised with fire doors. The fire alarms are checked at the same time. Two outside contractors check the fire systems, one for the fire extinguishers and one for everything else. We saw documentary evidence of the checking of the fire extinguishers on 5/11/09 and the fire alarm on 14/10/09. The London Fire Brigade visit the home. The had given some recommendations which had been the subject of a requirement at the last inspection. These we were told have been met. The emergency lighting was checked on 30/07/09. There was a check for gas safety on 14/10/09 and electrical wiring on 3/1/08. The portable appliances had been checked in June 2009. We were told that the Control of Substances Hazardous to Health COSHH products are locked away and there is a COSHH manual in the staff room and data sheets for products used. We spoke with the manager about his duties under the recent Mental Capacity Act 2005 and the Deprivation of Liberties (DOLS) element. He said the local authority have informed him of the new legislation and he expects them to take the lead in organising training on the topic. The manager has some DOLS guidance which we Care Homes for Older People Page 24 of 30 Evidence: saw. We advised him that to comply with the act he will need to assess whether anyone living in the home would need a DOLS assessment, and if so he should contact the supervisary body to progress this. Care Homes for Older People Page 25 of 30 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 26 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 1 19 23 The broken handle on the cleaning cupboard must be removed. It presents a hazard to residents and staff. 04/12/2009 2 19 22 The corridors of the home must be kept clear of trip hazards. To promote the safety of residents and staff. 04/12/2009 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 30 Mandatory training in core 29/01/2010 basics, safeguarding, infection control, first aid, fire, food hygiene and health and safety, must be refreshed regularly. We suggest within two years as a safe interval. So that staff are able to meet residents needs. 2 7 13 Risk assessments must be undertaken on all bed rails including the short bed rail which has been put in position on a residents bed. 04/12/2009 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 To ensure they are not presenting risks to residents. 3 7 13 Risk assessments must be 04/12/2009 undertaken on any risks identified, including manual handling. Strategies must be identified to reduce the risks. To protect residents from risks. 4 8 13 MAR charts must be clear and completed properly for creams used. So that the administration of prescribed preparations is properly recorded. 5 38 13 The home must ensure that the two identified doors located in bathrooms which lead into void spaces are kept locked. To safeguard the residents from going through them. 6 38 13 The fire risk assessment for the building must be updated. To ensure the safety of residents and staff. 30/01/2010 04/12/2009 04/12/2009 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 1 2 9 9 The medication cabinet is kept in a locked room but the cabinet should be kept locked too for better security. We reccommend that the brought forward balance of loose medications be entered on the MAR charts to facilitate proper auditing. We strongly recommend that the level of training, including dementia care, across the whole staff group, including the deputy manager be improved. 3 30 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. 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