Inspection on 14/07/09 for Fairfields House

This inspection was carried out on 14th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fairfields House 24/07/07

Fairfields House 15/05/06

Fairfields House 01/12/05

Fairfields House 21/07/05

Fairfields House 11/11/04

Fairfields House 03/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

Key inspection report Care homes for older people Name: Address: Fairfields House 21 Tuddenham Road Ipswich Suffolk IP4 2SN     The quality rating for this care home is:   one star adequate 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: Claire Hutton     Date: 1 4 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Fairfields House 21 Tuddenham Road Ipswich Suffolk IP4 2SN 01473213988 01473785062 ffch@talktalk.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Fairfields House Ltd care home 23 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 Fairfield House is a care home providing personal care and accommodation to up to 23 older people. It is a privately run home and is situated in a quiet area of Ipswich, not far from the town centre. The home is a two-storey building with bedrooms on the ground and first floor. The home has a shaft lift and stair lift. Twenty-one bedrooms are single and twelve provide en-suite toilet and wash hand basin. There is also one double en-suite bedroom. There are car-parking facilities at the front of the building and the rear provides an enclosed garden, which is well maintained and sheltered. The fees for accommodation range between £362.00 and £465.00. They do not cover the cost of hairdressing, toiletries, chiropody and newspapers. 0 Over 65 23 Care Homes for Older People Page 4 of 29 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: This was a key inspection, which focused on the core standards relating to care homes for older people. The inspection was unannounced on a weekday, which lasted 8 hours. This report has been written using accumulated evidence gathered before and during the inspection, including information obtained from 7 Have Your Say surveys. Comments from these surveys are used in this report. The Annual Quality Assurance Assessment (AQAA), issued by the Care Quality Commission (CQC) was returned 2 weeks after the inspection and was completed by the new manager. This selfassessment gives providers the opportunity to inform the CQC about their service and how well they are performing. We (CQC) also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and Care Homes for Older People Page 5 of 29 safety. Time was spent talking with people who live in the home, 5 members of staff, 2 relatives, a visiting District Nurse and a visiting pharmacist. Their comments are included in this report. The newly appointed manager had been in post for 3 weeks and was present on the day and was helpful and co operative with the inspection process. The owners of the home were also present for the feedback at the end of the day. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: During the inspection we gave feedback to the newly appointed manager and the owners. Both of which have given an assurance to develop the key areas that have been highlighted in this report. We found that care plans in place were in a variety of formats. It was evident from what we had observed and what we were told that care plans were not always working as well as they should be. During this inspection we looked at the information relating to health care and communication within the home and found that the systems in place were not adequate to ensure consistent action and planning relating to health care Care Homes for Older People Page 7 of 29 needs. Whilst recording had improved around medication such as controlled drugs we did find poor recording for 2 peoples medication and therefore we were unable to audit their medication to confidently say they were receiving medication as prescribed. We do not know of any safeguarding matters relating to this home, but an area of development has to be in relation to obtaining the up to date local policy and procedure on safeguarding adults from abuse and ensuring all staff have training in this. Lastly, the lack of a consistent manager has been a problem for this service and the inconsistencies in care planning are as a direct result of these many changes. The quality of consistent care directed by a long term manager is affecting the service offered by this home. We need to see an application to register this new manager soon to determine that they are suitable. We are aware that this new manager has only been at the home a matter of weeks and therefore the time in which they have been able to effect change is limited, but see promise in what is being said. 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 8 of 29 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 9 of 29 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. There is information available about this service, people are encouraged to visit and prospective residents can expect their needs to be assessed before they move in to determine that Fairfields can meet their needs. Evidence: The self assessment completed by the new manager told us that information packs are available to new residents and this includes a residents guide and a statement of terms and conditions. The owners also shared with us their desire to keep fees low compared to other similar care services. Fees start at £363.00 per week in order that people of low finances would not be discriminated against. When we last visited this service in September 2008 we looked at the assessment process carried out for a new resident and found that documentation had not been completed and there was a misunderstanding about seeking medical care for the individual who had quickly left the home. At the time we said that Fairfields could not Care Homes for Older People Page 10 of 29 Evidence: determine or assure a person and their family that they can fully meet an individuals needs without completing an assessment before a person moved into the home. Therefore at this visit we looked at assessment and information relating to 2 new arrivals at the home. In relation to one individual we found that the manager from another service had visited a prospective resident to complete an assessment. This assessment information was completed and additional information had been sought from relatives and discharge information from the hospital was informative. All this information was then able to be used to develop a plan of care for staff to follow. The second individual had information and assessments available. The individual had been visited in hospital where the assessment had been completed. Additional information from hospital had been obtained, but this contained information about mental health issues that were not throughly explored and developed into the care plan for staff to be aware of. Therefore please see comment in the next section of the report on this matter. The second individual did visit the home before moving in to determine if it was suitable. On the day of our inspection someone telephoned and arranged to look around the home to determine if it was suitable for them. Care Homes for Older People Page 11 of 29 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. Staff at this home are attentive and kind to residents, but current recording in care planning and accessing and recording health care issues may put residents at risk. Medication practices around recording are not as robust as they could be. Evidence: We spent time observing care and support being given to residents and spoke with 3 residents about their care. We also spoke with 3 care support staff. We then examined supporting documentation in 5 different care plans that related to what we had observed and what we had been told. We found that care plans in place were in a variety of formats. It was evident from what we had observed and what we were told that care plans were not always working as well as they should be. Examples included: A recent resident who had been admitted had an identified need in her assessment around specific mental health support. Indeed a health specialist was visiting that day. However key information about the individuals recent mental health was not part of Care Homes for Older People Page 12 of 29 Evidence: the care plan. Staff should have been aware of the potential signs and symptoms this person may present if they were becoming mentally unwell. There should be in place a plan of what to do to support the person should the need arise. This was pointed out during the inspection and the new manager was able to seek this information. This was known as a potential need from the assessment, relevant information had been requested by the home but had not been supplied and the individual had been at the home for some weeks. Another example was that we observed that a resident had a skin lesion to their head. Upon exploring this through documentation and speaking to staff we found that this issue had been identified 4 months previously as that was the time a date to see a skin specialist had been made(09/03/09). However, the appointment was missed and had not been followed up. The care plan for this individual had been rewritten in May 2009 at the request of an acting manager. It was extremely long and contained information that was not relevant, but this key issue around skin had not been highlighted. Another example was that we observed staff lifting a resident from wheelchair to a seat. One staff member was seen to use the under arm lift - this is both potentially dangerous to the resident and the staff member. We looked at the assessment and plan in place for this individual around manual handling and found that it had been written in December 2008 , but clearly needs had changed since that time and documentation giving staff instruction had not been reviewed or updated. This matter was discussed with the manager who said the staff member had received training but on this occasion did not follow that training. The new manager was keen to point out an example of a care plan that she had reviewed. The format was straight forward. We agreed with the new manager instead of reviewing care plans alphabetically, those with the greatest need would be completed first. A similar format would be used in an individualised way and involve the residents. At the time of writing this report the service has updated us about the current position with care planning and has assured us that 50 of care plans have now been revised with the remainder soon to follow. We were also concerned about access to health care based upon the non follow through of the appointment with a skin specialist, but also feedback from the District Nursing services currently visiting the home, who expressed a need for communication within the home to improve as they found messages were not always delivered or actioned. Therefore during this inspection we looked at the information relating to health care and communication within the home. We tracked on individual resident Care Homes for Older People Page 13 of 29 Evidence: who had an infection and looked at how this was handled and communicated within the home. We observed that staff gave a very detailed handover at the end of each shift, which is good practice. However in order to see how information was recorded and then action was more difficult to track as it became evident form the differing formats in care planning that staff were confused by the different systems in operation and therefore had set up systems to compensate - making additional recording necessary. We found communication about the individuals infection in the handover book diary, the staff message book, in the care plan under District Nurses visits, but not in the day to day care notes that all staff access. There were also other types of communication in the format of night logs and key worker record sheets. In talking to staff they said one message was likely to be put in 3 different places in order that it was not missed. In discussions with the new manager she agreed to review systems in place and around care plans and notes kept to ensure that these were effective in communication, but also conformed to data protection. We asked people about their care and all spoken to were satisfied saying that staff were very caring and kind. Observations were that staff were attentive to individuals and ensured their modesty and privacy as maintained. One relative wrote the day to day care my mother receives is excellent. The staff are sensitive and caring and seem to have a good relationship with her. My mother always has good things to say about them. At this inspection we examined the procedures around medication. At our inspection in September 2008 we had concerns around the recording of higher risk medication such as controlled drugs and the correct recording of these. We looked at the records and stocks of controlled drugs and found that these were now good. Another higher risk medication is warfrin and we examined the recording and administration of this drug within the home. We found that for one person there had been a recent change therefore this is being monitored and reviewed and action - which is good practice. We found that an error had been made in the writing up of this medication, but had been identified quickly and corrected and no one had been put at risk. However we were concerned about one persons medication as they were on high levels of pain relief. We were unable to audit this satisfactorily as the codeine phosphate could have been administered 1 or 2 tablets at a time, but records were unclear. Also another residents medication recording was of concern as they had been at the home over 2 weeks and upon the point of arrival the medication records had been handwritten by care staff, but no record of medication received was recorded, so Care Homes for Older People Page 14 of 29 Evidence: we were unable to audit the medication to determine if the resident was getting that that was prescribed. Also we would expect the care staff to immediately contact the pharmacy and get printed medication records for staff to follow in line with the homes policy. During our visit the manager had an appointment with the supplying pharmacist to work through better strategies in managing the medication. Several points were agreed including adding photographs of residents to medication records, adding allergies to the charts and developing protocols around returning creams. In addition staff medication training was booked for 27th July 2009. Care Homes for Older People Page 15 of 29 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 living in Fairfields have opportunities to participate in activities and they are supported to maintain relationships. People are offered a varied and nutritious diet. Evidence: In relation to daily life and social activities this home is very relaxed and when we arrived at 10.30 some residents were still having their breakfast as there is no set routine in getting up in the morning. Residents said they get up when they want to. There are plenty of visitors to the home and some residents were independent enough to make their own arrangement to go out and some were going out with relatives for lunch. We spoke to a couple of visitors and they said they are made very welcome. The hairdresser was visiting in the morning and had done the hair of 10 residents. We spoke to one person and they said they were very happy with it and it made them look and feel good. We asked residents what sort of activities were on offer to them and they said they frequently did quizzes and played bingo. In the afternoon we heard the piano being played. On person said they would like to go out more. We spoke to the owner about this and he informed us that he had recently bought a people carrier and Fairfields were able to use this once or twice a week. The home had realised that the use of this for the residents needed to be more planned as spur of the moment Care Homes for Older People Page 16 of 29 Evidence: trips were not always responded to. Before we visited we had a survey returned by a resident who had said my appetite is poor, but more could be done as I find the food a little bland. We met the new cook who has been employed and this ensures that a cook is available 7 days a week. She explained that each day she visits residents to ask them what they would like from the planned menu for their main meal, but also a choice was available including a cooked breakfast for some and choice for evening meal. At lunchtime we saw that 13 people chose to eat in the dining room and lunch was Turkey casserole, cabbage and mash or a cheese salad. Most people chose the hot meal, but some had salad. This was followed by peach flan and cream or orange jelly. When we asked how was lunch? residents told us very good. We also looked at what was for tea - this was a selection of sandwiches (main choice being bacon, lettuce and tomato) or bubble and squeak. There was also a selection of cakes including a homemade chocolate cake made that day. We saw the quantity of food was good. The menus in place showed a variety of foods available that would lead to a balanced diet being offered. The manager has also set up a meeting with a nutritionist who is coming from the local hospital and she is coming specifically to talk about diabetic diets - the home currently has 6 people who are diabetics and therefore this is a positive move by the new manager. Care Homes for Older People Page 17 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who used this service are listened to and any concerns are taken seriously. Residents would be more protected if all staff had knowledge and training were developed in safeguarding vulnerable adults. Evidence: Information from relatives and residents is that they are aware of how to make a formal complaint should they need to. We spoke to staff and they were aware of the complaints procedure saying that each resident had this information available to them in their rooms. Staff said if anyone had a concern they would try and resolve matters, but if this was not possible they would report the matter to the manager. We are confident that this service will listen to concerns raised and act upon them as this has been our experience in the past. In relation to safeguarding matters when we spoke with staff they were keen to point out that they would ensure any concern of this nature would be reported to the manager or owner, but also 2 staff said that they had not received specific training on identifying types of abuse and all 3 staff did not know the local policy and procedure on reporting suspected abuse. We did however find another staff member had a certificate in safeguarding adults from abuse. (We were subsequently told 17 staff had attended training on 5th June 2009) We noted that the service has not got the up to date (2008) policy and procedure in place for staff to use but had the out of date information from 2004. We are not aware of any safeguarding matters relating to this Care Homes for Older People Page 18 of 29 Evidence: home. Care Homes for Older People Page 19 of 29 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. Fairfields is a comfortable and clean place to live. Evidence: There have been ongoing environmental developments within Fairfields including the refurbishment of the kitchen and overhauling the shaft lift. General maintenance has also taken place such as replacement of dining furniture, curtains and the installation of secondary double glazing in the bedrooms with older style windows. But the main development to come is the extension that has been agreed and due to commence in August 2009. This lounge extension will bring about more communal space for residents which is needed. Also whist looking around the home we saw a new stand aid that had been purchased to meet the needs of one resident. The resident was particularly pleased and found the equipment comfortable. The home was clean through out and no odours found. We met and spoke with the cleaner who was busy on our visit making the place look good. She confirmed that all her equipment was working and adequate for the tasks in hand. A relative said how his relative enjoyed sitting outside where a gazebo had been erected. Care Homes for Older People Page 20 of 29 Evidence: We looked at the bathrooms and the equipment available for residents to bath in comfort. The self assessment confirms that all hoist equipment has been regularly serviced, but we found that hot water supplied to the downstairs bath and shower was not hot enough at 30 degrees. We tested hot water for a bath upstairs and found that this was hot enough at 41.8 degrees Celsius. We discussed this with the manager and owner. It was believed that the hot water may have been used by the hairdresser as so many hairs were washed. However, the service must have hot water available at all times in case a resident needs to be bathed. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Fairfields are supported by sufficient staff who are well recruited and satisfactorily trained. Evidence: During our visit to the service we spoke with 4 staff and looked at the records relating to 2 of these staff. We observed staff supporting residents and found that they were kind and attentive to residents. Residents and relatives spoken with said that they found the staff to be patient and kind - they have made me welcome. We looked at the rosters in place and even though the new manager was challenged by annual leave and some staff sickness the roster showed that 3 staff were maintained during the day and at night there were 2 staff awake. During the day there was a cleaner and a cook and a handy man who was available 2/3 days a week. We looked at the recruitment records for 2 new staff and found that the records were satisfactory and checks to protect residents such as references and criminal records bureau checks had been completed before staff started work. These 2 new staff had also undertaken an induction training - records were seen. One person spoken with said this covered fire safety, manual handling as well as working some shadow shifts in order to get to know the home and residents individually. Care Homes for Older People Page 22 of 29 Evidence: We asked other staff about their training as we knew that over 50 of staff had achieved NVQ in care. Staff told us that they had received training in 1st aid, medication, fire, food hygiene and health and safety. One person said they were doing a dementia care course with a local college, another person said they wished to develop their knowledge on dementia. We have previous commented in this report on the need for staff to receive training in safeguarding adults from abuse. We fed back to the new manager that there needs to be a development in staff meetings and staff supervision as we found little evidence of this happening currently. Care Homes for Older People Page 23 of 29 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 quality and consistency of management of this service cannot be assured as the service has lacked consistent management. Systems are in place that generally ensure the health and safety of residents, however these are not currently robust. Evidence: Since our last visit to the home in September 2008 when we found a new manager in place. The manager has changed again. This service has not had consistent management in the form of a registered manager who stays for a length of time. The lack of consistent manager that stays long enough to become registered has been a problem for this service and the inconsistencies in care planning are as a direct result of these many changes. Care planning currently within the home is following several different formats introduced by different managers. The quality of consistent care directed by a long term manager is affecting the service offered by this home, therefore we would like to see an application for registration made by this new manager. We need to determine that the manager is suitable to be registered and in Care Homes for Older People Page 24 of 29 Evidence: charge of this service. We are aware that this new manager has only been at the home a matter of weeks and therefore the time in which they have been able to effect change is limited, but see promise in what is being said. The self-assessment was returned 2 weeks after our inspection. This gave some good information, but we believe it reads how the service would like to be performing rather than what has been happening and does not necessarily set out the challenges clearly. Therefore will use the self-assessment more as a bench mark at our next inspection of the service. In relation to quality assurance matters we were told that people who use the service are surveyed regularly with the last survey being completed 6 months ago. However the service may wish to look at ways it can audit the quality assurance systems in place to look at ways it could have identified the failings we have found in this report before we pick them up and require action. In relation to health and safety matters the self assessment completed by the manager confirms all regular servicing of equipment is in place. In relation to fire we are aware that the Suffolk Fire Protection Service has visited this home and that the home has satisfactorily made good any requirements that they made. The home has purchased a sledge to evacuate residents who are not mobile should the needs arise however individual evacuation plans should be developed and staff trained accordingly with these plans and the equipment provided. Staff should also be monitored and reminded of their responsibility to follow manual handling training they have been given. With regard residents money the service does not control the finances of any resident. There are systems in place to hold personal monies for individuals and this is held individually in a safe with records kept. Care Homes for Older People Page 25 of 29 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 29 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 plan of care for 20/11/2009 each resident must be prepared and set out for staff to follow and say how residents needs in respect of welfare and health are to be met. This must be kept under review. This will ensure that all aspects of health, personal and social care needs will be met. 2 8 13 The registered person must ensure access to health services to meet assessed needs. Residents must have their health promoted and maintained to enable them to stay as healthy as possible. 20/11/2009 Care Homes for Older People Page 27 of 29 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 3 9 13 Medication practices relating 20/11/2009 to recording of medication must be accurately maintained in line with legislation. This will ensure the safety of residents and to protect staff. 4 18 13 All staff must receive 20/11/2009 training on how to safeguard people from abuse. This must include access and knowledge of the local policy and procedure. This will offer a greater degree of protection to residents. 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 38 Staff should be monitored and reminded of their responsibility to follow manual handling training that they have been given in order that residents are further protected. Care Homes for Older People Page 28 of 29 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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