Inspection on 12/01/09 for Elms, The

This inspection was carried out on 12th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elms, The 15/01/08

Elms, The 27/03/07

Elms, The 28/02/06

Elms, The 15/09/05

Elms, The 15/03/05

Elms, The 17/11/04

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 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elms, The 147, Barry Road London SE22 0JR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Maria Kinson     Date: 1 4 0 1 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 31 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 31 Information about the care home Name of care home: Address: Elms, The 147, Barry Road London SE22 0JR 02086934622 02086939403 care.manager@virgin.net 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) : South East London Baptist Homes care home 25 Number of places (if applicable): Under 65 Over 65 0 25 dementia old age, not falling within any other category Additional conditions: 25 0 The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 25) Dementia - Code DE (maximum number of places: 25) Date of last inspection Brief description of the care home The Elms care home is registered to provide care and accommodation for up to 25 older people. The home has been managed by South East London Baptist Homes since it first opened in 1953. The premises is a large detached house with a single storey extension to the rear. Bedrooms are single occupancy. Communal space includes two lounges, a conservatory and a dining room. The home has a large, well-maintained garden to the rear and off street parking is available. Care Homes for Older People Page 4 of 31 Brief description of the care home The home is located in a residential road in East Dulwich and is within walking distance of local amenities such as a library, shops and several bus routes. The work of the home is based on Christian principles and it is stated in the homes Statement of Purpose that Christians from any denomination may apply. The aim of the home is stated as: To provide a secure, comfortable and caring home for residents, so they can spend the rest of their days in peace and security. We provide comfort and support in a Christian atmosphere where mutual help and friendship are encouraged. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection on this service was completed on 15th and 16th January 2008. This inspection was carried out over two days in January 2009 and was unannounced. We reviewed all of the information that we had received from, and about the service in the period since the last inspection. This included notifications, the previous inspection report and the annual quality assurance assessment form that homes complete and return to the commission once a year. This information was used to determine the focus of our inspection. We spoke with three members of staff, four residents, two sets of visitors and five professionals during the inspection. We gave out four surveys, two of which were Care Homes for Older People Page 6 of 31 returned to the commission. The written and verbal comments that we received from residents, relatives, staff and care professionals helped us to form a judgement about the home. Some of their comments are included in this report. During the site visit we examined some of the records that were kept in the home and assessed the management of medicines. We observed staff supporting residents to move around the home, undertake activities and eat and drink. We visited all of the communal areas and viewed a selection of bedrooms on each floor. There were twenty three people living in the home and two empty beds at the time of this inspection. The fees charged by the home range from £560 to £620 per week. The fees do not include hairdressing, toiletries, activities in the community or newspapers. What the care home does well: What has improved since the last inspection? The home had introduced new care records. The package includes a pre admission assessment form that covers all areas of need. Alternative accommodation was secured for some of the residents, whilst the planned work programme was taking place. The new accommodation was close to the home which meant residents could continue to see their friends and take part in activities. Care Homes for Older People Page 8 of 31 New chairs were purchased for the lounge and two of the televisions were replaced. The number of senior carers had increased. This will provide better supervision for junior staff. Robust checks were carried out before people started to work in the home. A fire safety risk assessment was completed and work was in progress to address the findings. 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 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 31 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 31 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. This home provides a peaceful and supportive environment for older Christian people. People that were not familiar with the home could visit and spend time in the home before they moved in. Staff obtained information about peoples care needs but did not always record this information. There is a risk that important information could be missed, if it is only passed by word of mouth. Evidence: The Service User Guide provides information for people that live in the home and their relatives about the service. The copy that we saw of this document did not include some of the information that is required such as a summary of the complaints procedure and the terms and conditions of occupancy. See recommendation 1. Care Homes for Older People Page 11 of 31 Evidence: We looked to see what information the home obtained and recorded about peoples care needs, before the person moved into the home. There was some variation in the information that was recorded but it was clear that staff knew about residents needs and preferences. Two out of the three files that we looked at included a pre admission assessment form. The assessment form provided information about different areas of need such as mobility, continence and nutrition. The staff member that completed the assessment ticked the description under each area of need that most closely described the residents strengths and needs and provided additional comments, where necessary. The assessment forms also included information about peoples personal interests and preferences such as the time that the prospective resident liked to go to bed and details about known risks such a history of falls. There was no written information about one of the residents care needs. It was apparent during conversations with the manager that some of the people that were admitted to the home were already known by staff through their attendance at church services and events. Although some of the staff may already know prospective residents, it is essential that information about the persons care needs is recorded. This will help to ensure that all of the staff regardless of any prior association with the resident know what help and support the person requires. See recommendation 2. People that expressed an interest in the service could visit the home to view the facilities or to see if they liked the home. Some of the residents that we spoke with said they already knew the home and some of the staff and some people said their relatives chose the home for them. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provided guidance for staff about the action they should take to meet residents needs but some information was out of date or was not included in the plan. Training was planned to address this issue. Staff worked in partnership with other professionals to maintain and monitor residents health needs. The medication procedure did not provide adequate guidance for staff about the safe management of medicines and some records were not consistently maintained. Staff had a good understanding of residents needs and treated people with respect. Evidence: The home had introduced new records in the period since the last inspection. We looked at three sets of care records for people that had moved into the home in the previous six months. One file did not include a care plan. Staff said they used Care Homes for Older People Page 13 of 31 Evidence: information that they obtained during the assessment to support the resident. The assessment record provides information about the support that people require, but does not state what action staff should take to meet the persons needs. See requirement 1. The care plans for the other two residents were mostly satisfactory but some information was not updated when when peoples needs changed or was not referred to in the plan. For instance the care plan for one resident stated staff were monitoring their fluid intake. Staff that we spoke to said the resident was now drinking well so the fluid chart was discontinued. No one had updated the care plan to reflect this change. Another resident was assessed to be at risk of falls but there was no information in the plan to show what action staff planned to take to minimise this risk. The manager told us that care planning training was arranged for staff but had to be cancelled as the trainer was unwell. The manager took immediate action to rearrange the training and provided us with written confirmation about the session. The home must ensure that they have effective systems in place to monitor and improve the care records that are kept in the home. See recommendation 3. We spoke to four health and social care professionals that visited the home during the inspection. They told us that staff made appropriate referrals and requested advice or support from their team, if necessary. All of the professionals that we spoke with commented about staff, who they described as caring, responsive and organised. We looked at four medicine charts. Records of receipt of medicines were poor. We could not establish how many tablets the home received for two residents. See requirement 4. The home kept a small supply of homely remedy medicines. These medicines can be purchased without a prescription and are usually only administered for short periods. There were no records to show when these medicines were received in the home. One homely remedy medicine was kept in a compliance device. The label that was attached to the box stated there were five different types of medicines in the box. The box was named but we were told that the resident no longer lived in the home. See requirement 2. Records of administration were good and all of the medicines that we saw were in stock. Information that was recorded on medication charts was usually completed by the pharmacist but some of the instructions on two of the medication charts that we Care Homes for Older People Page 14 of 31 Evidence: looked at were hand written by staff. The staff member that completed the entries did not sign the record or get another member of staff to check and countersign the chart. See recommendation 5. The medication trolley was stored in the dining area which felt warm. We could not establish the exact temperature as there was no thermometer or monitoring records. The deputy manager was advised to monitor the temperature for a period and and consider relocating the trolley to a cooler area, if necessary. The medication refrigerator was not in use at the time of the inspection. Some medicines were kept in a special cupboard which was located inside another cupboard. The regulations about the storage of controlled drugs recently changed and now include residential homes. The home must ensure that the cupboard used to store controlled drugs complies with the regulations in respect of the locking device and is fixed to a solid wall. See requirement 3. The homes medication procedure was reviewed and updated in July 2008. The procedure provides guidance for staff about the management of medicines but did not state what records staff should maintain about the receipt of medicines or include information about the management of homely remedy medicines. The medication procedure must be reviewed and updated. See requirement 2 and 3. Senior staff completed a distance learning medication training package and were due to attend a session about the safe administration of medicines at Dulwich hospital in January 2009. There was no evidence that staff were assessed to check that they were competent to administer medicines. See recommendation 4. We observed staff interacting and supporting residents throughout the day. Staff ensured that peoples privacy and dignity was maintained and respected peoples views and choices. Relatives told us that staff were consistently helpful and caring and warm and friendly. One resident said staff always opened her mail as she has arthritic fingers, she said that although she asked staff to do this they always left her bank statements unopened to maintain her privacy. Care Homes for Older People Page 15 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lived alongside people that shared their beliefs and values. This meant that there was a sense of community amongst the people that lived and worked in the home. People received a wholesome diet that was presented in an attractive way. Evidence: The home is managed and run on Christian principles and aims to provide both physical and spiritual care for older people. There were regular church services in the lounge which most of the residents and staff attend. The home used a Christian radio station to recruit staff. The staff team had a good understanding of the homes ethos and often share the same religious beliefs as the residents. This helps staff to understand and support residents. People told us they liked the home because it was friendly and peaceful and was as near to home as you can get. Activities focused on meeting peoples spiritual and social needs. There were regular opportunities for residents to worship during the two services that were held in the home each week and some residents were also supported to attend local church services and events. Residents were encouraged to play an active role in the home. Care Homes for Older People Page 16 of 31 Evidence: One resident played the organ during a service that was held in the home and another resident was asked to lead the communal prayer that was said prior to lunch. There was a weekly exercise class which was funded by the home and a weekly art and craft session. Some of the artwork produced by residents was displayed in the dining room. The home organised outings to local places of interest such as Kew Gardens during the summer months. The home hosted various social events throughout the year such as a Wimbledon style strawberry tea, a Thanksgiving service and an open day. Residents told us that they were able to make decisions about where they spent their time, what they ate and who they sat with during the lunch period. Some residents liked to see in the lounge that overlooked the garden, other people liked to be spend time in the quiet room or the main lounge. One resident said they liked to stay up late because they found it uncomfortable lying down and said one of their friends was the complete opposite choosing to go to bed early and never got up until after 9am. Staff were seen asking people if they wanted to attend the communal service and respected residents decisions. One relative told us that the home does run some activities for residents- but doesnt make them do stuff they dont want. We spoke to two visitors during the inspection and received written feedback about the home from two relatives. People said they could visit their friend or family member at anytime and were made welcome by staff. One person told us that I nearly always get given a cup of tea and most of the staff address me by my name. Relatives said they were invited to attend social events and to support their family member during outings. The menu was displayed on a board in the dining room. Some of the residents made a point of looking at the menu and discussed the planned meal with their friends and staff. It was clear that residents looked forward to their meals and some of the people that we spoke to praised the cook. There were two sittings at mealtimes. Most of the residents knew which sitting they should attend and others were prompted by staff to get ready for lunch. Staff knew what types of food residents liked and disliked and about their preferred portion size. One resident was given her meal without any gravy because she didnt like gravy. The meal smelt and looked appetising and we were told by residents that the food served in the home is always good and well cooked. The atmosphere in the dining room was relaxed and people were given adequate time and support to eat. Care Homes for Older People Page 17 of 31 Care Homes for Older People Page 18 of 31 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 home had procedures in place for managing complaints and allegations and residents knew who to speak to if they had concerns. Evidence: The homes complaints procedure was reviewed and updated in 2008. Residents and relatives said they would approach the manager or a member of staff if they had concerns and were confident their views would be listened to. The people that we spoke with had never made a complaint but one person that had raised a concern about missing laundry said staff did respond appropriately. The home had answered one ongoing complaint that was referred to in the previous report and had received one new complaint in the period since our last visit. Staff told us they would report concerns or allegations to the manager but were not always clear about the procedure they should follow if the manager was off duty. See recommendation 6. Most of the staff that we spoke with had attended a recent safeguarding training session or covered safeguarding procedures as part of their NVQ course work. Care Homes for Older People Page 19 of 31 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. Work was in progress to improve the visual appearance of the home and provide better facilities for residents and staff. Evidence: The home was about to undergo a major refurbishment programme. The planned programme of work will start in April 2009 and is likely to take several months to complete. The work includes installation of a bigger passenger lift and six new bedrooms bedrooms with en suite facilities on the upper floor. The company had rented a building at the rear of the property for some of the residents to live in whilst the work was in progress. We visited the property with a colleague from the registration team who was assessing the suitability of the building. The company had carried out a significant amount of work prior to our visit to ensure the building complied with health and safety standards and was suitable for the client group. The building was furnished and arranged like a family home and looked comfortable. An assisted bath was fitted and some other adaptations were made to meet residents needs. When we returned to the home on 14/01/09 the top floor of the home was empty and five of the residents had moved into the annex at the rear of the property. We spoke Care Homes for Older People Page 20 of 31 Evidence: to two residents about the move. One person said they were very happy in their new home and liked their new bedroom, the other person that we spoke to knew all about the move but was not aware that it had taken place. Staff said all of the residents that had moved over to the annex building had settled well and one resident said they were sleeping better. Residents that moved to the annex spent most of their day in the main building with their friends. The main building was clean and warm but looked dated and tired in parts. The communal areas and residents bedrooms looked homely and welcoming but the paintwork and facilities in some of the other areas looked old and worn. The planned work programme should address these issues. We have not made any requirements about the environment as the current work programme should address these issues. All but one of the toilets had a call bell to summon assistance. This issue was discussed with the staff member that accompanied us on our tour of the home. See recommendation 7. The home was clean and fresh and clinical waste was stored appropriately. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users were supported by a stable team of competent and caring staff. Pre employment checks had improved. This provides better protection for people that use the service. Staff were supported to update their skills and knowledge and to achieve recognised qualifications. Evidence: The manager, deputy manager and five care staff were on duty when we arrived in the home. Care staff were supported by a team of ancillary staff. This includes kitchen, domestic, laundry, administration and maintenance staff. The home had a team of bank staff to cover staff absence and sickness. The home had not used any agency staff in the period leading up to this inspection. The off duty roster provides information about the people that work in the home and the hours they work. Staff carried out regular checks in the lounges and responded promptly to requests for assistance. Additional staff were provided to support residents that had recently moved into the annex at the rear of the building. The manager told us in her Annual Quality Assurance Assessment that all of the care staff had a NVQ qualification in care at level two or above. This exceeds the standard set by the Department of Health. Relatives and health care professionals said that most of the staff that worked in the home had the right skills and experience to look after people properly. Care Homes for Older People Page 22 of 31 Evidence: We looked at three staff files to see if the home was carrying out adequate pre employment checks. All of the files included an application form and copies of important documents such as proof of the persons identity, a recent photograph, two written references, a statement about the applicants physical and mental health, a pova first check and a criminal record disclosure. There was no written information to explain why there were gaps on one applicants employment history. The home purchased training from various sources and provides some in house training sessions for staff. Training certificates were kept in staff files. It was difficult to establish from these records when the staff member last completed some mandatory training courses. The manager should consider maintaining a training matrix this will ensure that information is all in one place and can be used to develop the annual training programme. Some of the staff attended food hygiene, fire safety, moving and handling, medication, infection control, mental capacity, health and safety, dementia care, record keeping and COSHH training sessions during the past year. Staff were satisfied with the training they received and said I get all the training I need. A newly appointed senior carer commented that staff were well trained and know what they are doing. Care Homes for Older People Page 23 of 31 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. Residents enjoy living in a home where their views and beliefs are respected and understood. The home was well managed overall but does not have adequate monitoring systems in place to identify concerns. Evidence: The registered manager had worked in the home for over twenty years but only became the manager of the service in recent years. The manager was assessed by the commission to be a suitable person to manage a care home for older people. Staff and residents said the manager was always around and was easy to talk to. It was evident during discussions with residents that they were kept informed about significant issues and changes. A regular newsletter was prepared to provide news about the home and church events. The home obtained feedback from residents and relatives via anonymous surveys but Care Homes for Older People Page 24 of 31 Evidence: there was no formal system in place to check that staff were following procedures and good practice guidelines. The home must establish a system for reviewing and improving the quality of care provided in the home. See requirement 5. The board of trustees carried out regular visits to assess the conduct of the home and prepared a report about their findings. Some residents were able to look after their own money and some of the bedrooms had lockable facilities for the storage of valuable items. The secretary was responsible for storing personal money and valuable items for people that were not able to manage their own money. We checked the personal money records for two residents. Individual records were kept about money that was handed to staff for safekeeping and about purchases such as toiletries that were made for residents. The records also provided information about money that was handed back to residents. Receipts were kept for items that were purchased for residents and for services such as hairdressing. Records were kept about valuable items and they were stored securely. The secretary was advised to provide more detail or take a photograph of items such as jewellery. Staff could attend regular group supervision sessions that were facilitated by an independent person. The sessions provide an opportunity for staff to raise concerns and issues in confidence. Staff said that they could also ask to speak to the manager or Pastor if they wanted to discuss their work or had concerns about the service. Regular checks and service visits were carried out to ensure that the fire alarm system and equipment were working properly. The home had arranged for a fire safety risk assessment to be completed and work was planned to address some of the issues that were identified in the assessment. Fire drills were taking place, but were infrequent. The manager told us that the last drill occurred in March 2008 and involved all of the residents. The manager should obtain advice from the local fire authority about the recommended frequency of fire drills and whether it is necessary to evacuate the building during drills. See recommendation 8. Hot water temperatures were monitored but it was not clear if any action was taken when the temperature was outside the recommended range. See requirement 6. The home had a dedicated maintenance person. The maintenance person carried out regular health and safety checks and routine repairs within the home and grounds. Health and safety records were sampled. All of the records seen were up to date and corresponded with the information that was provided by the manager in the Annual Quality Assurance Assessment report. Care Homes for Older People Page 25 of 31 Care Homes for Older People Page 26 of 31 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 27 of 31 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 A written care plan must be 17/08/2009 prepared for each resident. The plan must show what action staff will take to meet the persons needs. To ensure people receive the care they need. 2 9 13 A clear procedure about the management of homely remedy medicines must be developed and followed. This will help to protect residents by ensuring that homely remedy medicines are safely managed. 17/08/2009 3 9 13 Controlled drugs must be stored in an appropriate cupboard that is fixed to a solid wall. To comply with the Misuse of Drugs Act. 17/08/2009 4 9 13 The medication procedure must be updated to include guidance for staff about the action they should take 17/08/2009 Care Homes for Older People Page 28 of 31 when medicines are received in the home. The procedure must be followed by staff. This will help staff to account for all medicines and will protect residents. 5 33 13 The home must establish a 17/08/2009 system for reviewing and improving the quality of care provided in the home. This will enable the home to identify and address concerns promptly. 6 38 13 Hot water temperatures must not exceed 44oC, in areas that are accessible to residents. High water temperatures create a scalding risk to vulnerable people. 24/07/2009 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 Service User Guide should include all of the information listed in regulation 5 and standard 1.2 of the national minimum standards for older people. Staff should carry out a care needs assessment and record their findings, before people move into the home. Regular audits should be carried out to effectively identify and address the concerns identified in this report about care planning. A competency assesssment should be carried out to ensure that staff understand the homes medication procedure and are competent to administer medicines. The assessment should be repeated at regular intervals. 2 3 3 7 4 9 Care Homes for Older People Page 29 of 31 5 9 Hand written entries on medication charts should be checked and countersigned by a second member of staff. This will reduce the risk of errors. Staff should have a clear understanding of the procedure for reporting concerns and allegations outside office hours or when the senior management team are off duty. There should be a call bell with an alarm facility in every room. The manager should seek advice from the fire authority about the recommended frequency of fire drills and the need to evacuate the building during drills. 6 18 7 8 22 38 Care Homes for Older People Page 30 of 31 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). 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. 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