Inspection on 22/04/09 for Elizabeth House Care Home

This inspection was carried out on 22nd April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elizabeth House Care Home 02/07/09

Elizabeth House Care Home 08/04/08

Elizabeth House Care Home 11/04/07

Elizabeth House Care Home 11/04/06

Elizabeth House Care Home 01/11/05

Elizabeth House Care Home 23/08/05

Elizabeth House Care Home 08/07/05

Elizabeth House Care Home 03/11/04

Elizabeth House Care Home 20/04/04

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

Key inspection report Care homes for older people Name: Address: Elizabeth House Care Home 2 Church Hill Avenue Mansfield Woodhouse Mansfield Nottinghamshire NG19 9JT     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: Lynda Dyer     Date: 2 2 0 4 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: Elizabeth House Care Home 2 Church Hill Avenue Mansfield Woodhouse Mansfield Nottinghamshire NG19 9JT 01623657368 01623631720 d.ramnarain@btinternet.com RAMNARAIN9@aol.com Mrs Vijay Ramnarain,Surendra Dev Lutchia,Mr Vivek Obheegadoo care home 16 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Elizabeth House is a care home providing personal care and accommodation for 16 older people. The home is located in Mansfield Woodhouse, in a quiet residential area and close to shops, pubs, the post office and other amenities. The home is an older style domestic property with a more recent two-floor extension. There are 14 single, and 1 double bedroom, which are located on both floors and there is a passenger lift. There are a variety of lounge areas. There is a garden that is only accessible people who have good mobility. There is limited car parking available on the homes driveway and further parking is available on the street. The manager told us on the day of the inspection that the current range of fees are between £1,420 to £1,460 per month. There are additional costs for newspapers, chiropody and taxis. 0 Over 65 16 Care Homes for Older People Page 4 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: The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last time we visited this service was April 8th 2008. We, as it appears throughout the Inspection Report refers to The Care Quality Commission. One inspector carried out an unannounced site visit to the agency, which took place over 6 hours. The Registered Manager assisted us during the site visit to the home. We have introduced a new way of working with owners and managers. We ask them to Care Homes for Older People Page 5 of 30 fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service, this is called an AQAA (Annual quality assurance assessment). We received the AQAA back from the manager in good time. The form was completed well and gave us all the information we asked for. We also sent out surveys called, have your say, to people who use the service, staff that work there and relatives. This meant we could get an idea of what people thought about the way the home was run. We had 11 completed surveys back and we have included some of the comments in this report. We have not included comments that could identify the writer as we want people to feel they can be open about the way they feel the service is run. We also reviewed all of the information we have received about the agency since we last made a visit to them and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking, which involved us choosing two people who use the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We spoke with the manager, two members of staff, four people who use the service and two visitors to help us to form an opinion about the quality of the service being provided to people. We read documents as part of this visit and looked at the environment to form an opinion about the health and safety of people who use at the service. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. 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. Peoples needs are assessed before they move into the home so that staff know how to care for them. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that all Service Users needs are assessed by social workers before they are admitted to Elizabeth House. They also said that they ensured that their needs can be met first and foremost before admission by a pre admission visit being undertaken and a pre admission assessment completed. People living in and visiting the home told us that they had received enough information before deciding to move into the home. However the information we saw in the homes service user guide had out of date information relating to the fees and how to contact the Commission. Care Homes for Older People Page 9 of 30 Evidence: One relative told us that when they had first visited the home they had been given a brochure and staff had answered questions about the home very well. We viewed two care plans and both had a full pre admission assessment and we spoke with a visitor who told us that an assessment had been carried out on their relative prior to admission. Staff said that the manager gave them details of peoples care needs before they moved into the home. The home does not offer intermediate care so this standard does not apply. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some medication procedures in the home are not safe and there is evidence that some people are not always having their choice and dignity respected. Evidence: The manager told us in the home Annual Quality Assurance Assessment that all Service users health care needs are fully met and that all service users are ensured that they are treated with respect and dignity and their privacy are upheld at all times. One survey was received from a health professional and they said, The staff constantly strive to maintain holistic care for their clients and The manager always listens to any suggestions and often initiates changes in clients care We viewed the care plans of two people who live in the home. Both had various risk assessments in place with a care plan for each risk with the action for staff to take to minimise those risks. However one care plan contained information stating that staff were monitoring this persons blood pressure and blood sugar levels but the manager said this was not happening as the district nurses were responsible for these Care Homes for Older People Page 11 of 30 Evidence: procedures. There was not any evidence in the care plan that people living in the home are involved in either the compilation or the reviews of their own care plan. We spoke with one person living in the home who was being visited by their relative and although the relative had been shown the care plan, the person living in the home had not seen their care plan. We looked at the medication systems in the home and we found evidence that some of the systems presented a risk to some people living in the home. One person should have had an item of prescribed medication administered twice a day but staff were signing the medication administration record stating that it was being given three times a day. The manager told us this would have been as a result of an instruction from the GP but there were not any records that the dosage had been increased. We were able to audit the item of medication and this gave evidence that staff had failed to administer the medication at all on some days. The issues we found led us to make a safeguarding referral and to share the information with the Commissions pharmacy inspectors. Staff were observed signing for medication before administering it to people and some hand written entries on the medication administration records were not signed or witnessed. The last inspection showed some concerns around the dignity of the people living in the home and made a requirement for staff to be given training in dignity and respect. The manager wrote and told us that this had been addressed. However on the day of the inspection we observed the lunchtime routine and we did not feel that some peoples dignity and choice was being respected. A member of staff and the manager were assisting a number of people with their meal. The member of staff was assisting people to eat from a standing position so that they could move from person to person and give assistance. The meal was egg and chip and the staff member went around mashing peoples food up altogether on the plate and gave them a spoon to eat with. This looked very unappetising and there was no evidence of specialist equipment such as plate guards or cutlery being used to try and maintain peoples Independence and dignity. These issues have been addressed by us making requirements in this outcome and also in the staffing outcome of this report. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that live in the home are given the opportunity to participate in recreational activities and maintain social contacts. People receive a nutritious diet but individual needs are not always met. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that every effort is made to respect service users wishes and that the home encourages contact with family, friends and other members in the community. They also state that all service users enjoy three well balance meals freshly prepared by two cooks and all service users have a choice. They state that there is a visiting choir group and a church warden visits the home to give communion to one lady as she is the only one wishes to receive it. People living in the home told us in completed surveys that they always had activities they could take part in and one said that they didnt but that was their own choice as they did not want to take part. We spoke with one person living in the home and they told us there were regular activities and they spoke about a trip out at Christmas and a forthcoming brass band Care Homes for Older People Page 13 of 30 Evidence: trip that was arranged. On the day of the inspection there was an activity for people to take part in during the afternoon. We viewed the menus and they showed that there was a choice at each mealtime. On the day of the inspection there was not a choice available for lunch and the cook said that everyone liked what was being cooked that day and so an alternative was not offered. One person living in the home told us that there is not a choice at lunchtime but there is a choice for the evening meal. One person had specialist needs surrounding food intake but this is not always maintained. The cook does not have written instructions regarding peoples likes, dislikes and specialist needs. A survey was received from a health professional and they said that the home always supported people to live the life they chose and responded to the individual needs of people living in the home. We observed lunch and had some concerns regarding the safety, choice and dignity of some people who needed assistance with their meals. This has been addressed in the health and personal care and staffing sections of this report. Care Homes for Older People Page 14 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 living in the home know how to make a complaint and staff know how to safeguard them from abuse. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that all service users have opportunities to tell them on a daily basis about any complaint or unsatisfactory issues and that they are dealt with as soon as possible, often straight away. They also state that there is a policy and procedure in place and that all permanent staff have attended an abuse course. We have received one complaint about the service since the last inspection and this was dealt with by speaking with the manager. The home states that it has received one complaint in the last 12 months and that it was resolved within the specified timescale. The homes complaints procedure contains out of date information of how to contact the Commission. People living in and visiting the home told us that they knew how to make a complaint. Care Homes for Older People Page 15 of 30 Evidence: The home has the current local safeguarding procedures in place and we viewed the files of two members of staff and both had training in safeguarding vulnerable people. Care Homes for Older People Page 16 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 adequate 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 that is clean and well maintained but there are some maintenance, storage and infection control issues that may affect the level of comfort. Evidence: In the Annual Quality Assurance Assessment the manager stated that they ensure the Service Users live in a safe, clean, homely and well maintained environment. They also say that they ensure the environment is always cleaned to a high standard. The home was fresh and clean on the day of the inspection. The shower room/sluice room was cluttered with pressure area equipment and the shower was out of use. The manager told us that there were plans to put the shower room back into operation. The garden is not accessible to people with mobility impairments and on the day of the inspection it was very overgrown. We were told in a completed survey that there are sometimes bags of clinical waste left on the driveway of the home, next to the clinical waste container. Two bedrooms were viewed and both were clean and personalised. One bedroom had Care Homes for Older People Page 17 of 30 Evidence: a large cupboard that contained various items belonging to the home. There was also a wardrobe for the person to use but it was difficult to access as it was behind two chairs. The bedroom was cold on the day of the inspection, despite the rest of the home being warm and the people living in the room said it was sometimes cold in the room. The large window in the room was in a poor state of repair both internally and externally which could contribute toward the temperature of the room. There was not any facility in place for people to dry their hands in the upstairs communal bathroom. Staff were observed following some infection control procedures. Care Homes for Older People Page 18 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. The home has robust recruitment and training procedures but there may not always be enough staff to meet the needs of the people living in the home and this could place them at risk. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that staff of various skills, acquired knowledge and experiences are on duty and that all staff recruited undergo checks before starting work in the home. We looked at the recruitment files of two members of staff and both contained evidence that the required checks are made on staff before they commenced employment in the home. We also looked at their training records and saw evidence of staff attending training courses in areas of health and safety and some areas of care delivery. Staff told us that they received training that was relevant to their role and helped them to keep up to date with new ways of working. One member of staff told us in a survey, We have courses very regularly which include mandatory courses and the offer of other courses to help us with our job. One visitor told us in a survey, Excellent day to day care, with all that it entails. Care Homes for Older People Page 19 of 30 Evidence: Another told us, Staff are cheerful and helpful. A health professional told us in a survey, I feel the staff treat the clients as individuals, show lots of empathy and understanding. We received views from people involved in the home and it was apparent that some people did not feel there was always enough staff on duty to meet the needs of the people living in the home. One staff member said, At busy times of the day we could do with a third person to enable us to deliver a better service to service users. We looked at the staff rota and there are usually two members of staff on duty with the manager including her hours as a third member of the care team. The manager usually works from lunch time to the evening which means that in the morning there are only two care workers on duty. There were fifteen people living in the home at the time of the inspection, five of whom required two care workers to help them with any care they needed. This means that if a person requiring the help of two carers is receiving personal care, there are no further care workers on duty during the morning to support the other fourteen people living in the home. We observed lunch and there were several people living in the home that needed assistance with their food. One member of staff was administering medication and the remaining care worker and the manager were left to assist these people and to see to any needs of the other people living in the home. The care worker had to walk around the people needing assistance instead of being able to sit and give the time that was needed. At breakfast, the needs of all fifteen people are met by two care staff who also have the medication to administer. One person we casetracked was at risk of choking and needed supervision with meals. However we did not see any staff in the area to ensure this person was safe during lunch as the staff on duty were all busy assisting other people with their meal, in a connecting dining area. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of a quality assurance system means that people using the service are not supported to have their say about the way the home is run. Evidence: The manager told us in the homes Annual Quality Assurance Assessment (AQAA) that the service is run by a person who is compassionate and ensures that all service users welfare are her number one concern. The manager also states that she is responsible for service users day to day expenses and that she liaises closely with families to ensure all their financial needs are met and that the service users and staff health, safety and welfare are promoted and protected at all times. We received two completed surveys from staff and they said that the manager often or regularly met with them to give support and discuss how they were working. A health professional told us in a survey, The care home manager is pro-active in responding to the needs of the clients. They also said, The manager is extremely Care Homes for Older People Page 21 of 30 Evidence: knowledgeable and knows her clients very well. We viewed records in the home and these gave evidence that there are effective health and safety systems in place that are maintained regularly. However we found that one person living in the home who required a hoist for moving around was being transferred in a sling that was not big enough to ensure the transfer was safe. We spoke with the manager and she said she would purchase a larger sling immediately. The home does not have an effective system in place that gives people using the service a way of having their views on how well the home is running listened to or acted on. We looked at the spending money kept for two people living in the home and these were being managed appropriately. Care Homes for Older People Page 22 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 23 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 1 5 The homes service user guide must be up to date with regard to the current fees and how to contact the Commission. To ensure people have up to date information. 01/07/2009 2 7 15 People living in the home and their representative, if appropriate, must be involved in the reviews of their care plan and signatures obtained to give evidence of this. This will ensure people have their care delivered the way they want. 01/09/2009 3 9 13 If a change is made to the Medication Administration Record (MAR chart)then the reason for the change must be recorded, dated and signed. 01/06/2009 Care Homes for Older People Page 24 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 This will ensure people receive their medication as prescribed. 4 9 13 Prescribed medicines, including inhalers must be administered as prescribed by their GP. To ensure peoples healthcare needs are met. 5 9 13 A Controlled Drugs register, with bound, numbered pages, must be provided for the secure recording of any Controlled Drugs. This will ensure any controlled medicines used by the home will be managed safely. 6 9 13 Staff must not sign the MAR until the medication has been administered to the person for which it is prescribed. This will ensure people receive their medicines safely. 7 9 13 The home must have in 01/09/2009 place a metal storage facility for controlled drugs, which meets the requirements of the misuse of drugs regulations 1973. 01/06/2009 01/09/2009 01/06/2009 Care Homes for Older People Page 25 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 This will safeguard the health and welfare of people living in the home. 8 10 12 People living in the home 01/07/2009 must not be given meals that are mashed or liquidised unless this has been advised by their GP or a dietitian and is recorded in their care plan. This will help to maintain peoples dignity and choice. 9 16 22 The homes complaints procedure must have up to date details of how to contact the Commission. This will ensure people know how to contact the Commission. 10 19 23 The large window in the bedroom already identified must be assessed and repairs made if identified. The ensure it is of sound construction. 11 27 18 The manager must supply the commission with a detailed risk assessment of how they have determined the amount of staff that needs to be on duty at any time. 01/07/2009 01/08/2009 18/06/2009 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 This will show how the home intends to meet the needs of people living in the home. 12 27 18 There must be sufficient 01/07/2009 suitable and competent staff on duty at all times to meet the needs of people living in the home. This will ensure the assessed needs of the people living in the home will be met. 13 30 18 Staff must be given training in respecting peoples choice and dignity, particularly around nutrition. This will help to ensure people living in the home have their choice and dignity respected. 14 33 24 The home must have in 01/09/2009 place a system for reviewing and improving the quality of care provided, which includes the views of people using the service. This will ensure that the home includes the views of people who use the service and can measure how well it is being run. 01/09/2009 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 15 38 13 A sling must be available for staff to use that is the correct size for the service user it is intended. To ensure the health and safety of that person is maintained. 01/06/2009 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 7 The information in the identified care plan regarding blood testing and blood pressure monitoring should be changed to reflect the current practice. Handwritten entries on the medication administration records must be signed and dated by staff and witnessed with a further signature. Change the policy on what action to take if a medication error occurs to reflect the current contact details of the Commission. Specialist cutlery and plate guards should be available for people who require them. If people are assessed by a GP or dietician as needing their food chopped or liquidised then this should be done separately and not all together so that the food still looks attractive and appetising. If people living in the home are assessed by a GP or dietitian as not being able to eat food without it being chopped or liquidised then this must be fully documented in their care plan and a reason given for this. If people living in the home are assessed by a dietitian or GP as needing to eat all of their meals with a spoon instead of a fork then this must be fully documented in their care plan and a reason given for the decision. 2 9 3 9 4 5 10 10 6 10 7 10 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 8 9 10 15 15 15 A choice of meal should be offered to people living in the home every day. If a person has specialist needs with regard to diet, such as diabetes, then these needs must be provided for. Peoples likes, dislikes, allergies and special requirements with regard to food should be recorded and kept in the kitchen for the cook to refer to. Items belonging to the home must not be stored in the bedrooms of people unless those items are specifically for their use. Address the issue of the cold temperature in the identified bedroom. Assess the position of the wardrobe in the identified bedroom and address any problems arising from the positioning of it with the people living in the bedroom. Remove the items belonging to the home from the itentified bedroom to give more storage space to the people living in the bedroom. Remove the items of clutter from the downstairs shower room. All communal bathrooms should have facilities in place for people to dry their hands. Ensure all clinical waste is placed directly into the clinical waste container in the designated bags. People living in the home should be supported to have regular meetings and these meetings should have minutes taken and issues raised should be acted on. 11 19 12 13 19 19 14 26 15 16 17 18 26 26 26 33 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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