Inspection on 04/11/08 for Firs Hall

This inspection was carried out on 4th November 2008.

CSCI found this care home to be providing an Poor 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

Firs Hall 07/11/07

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Firs Hall Firs Avenue Failsworth Manchester M35 0BL The quality rating for this care home is: poor 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 assessment of the service. We call this full assessment a ‘key’ inspection. Lead inspector: Fiona Bryan Date: 0 4 1 1 2 0 0 8 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. They reflect the things that people have said are important to them: 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 Page 2 of 27 Care Homes for Older People Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Firs Hall Firs Avenue Failsworth Manchester M35 0BL Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): Dementia Old age, not falling within any other category Number of places (if applicable): Under 65 12 0 Over 65 0 31 Firs Hall Care Home Limited Mrs Deborah Beswick Care Home 31 01616835154 01616887324 Additional conditions: The registered person may provide the following categories of service only. Care home only - code PC, to people 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. Dementia - Code DE (maximum number of places: 12). The maximum number of people who can be accommodated is: 31 Date of last inspection: Brief description of the care home: Firs Hall is a large, detached, residential care home accommodating up to 31 older Care Homes for Older People Page 4 of 27 D D M M Y Y Y Y people. The home is located on the Oldham/Manchester border and is accessible for local amenities and bus routes. Accommodation comprises 21 single rooms, 12 with en-suite toilets, and five double bedrooms, one with an en-suite toilet. Other facilities include two lounge/dining areas. The home has recently come under new management and is now owned by a limited company, Firs Hall Care Home Limited. The responsible individual is Mr J Heifetz and there is no registered manager at the present time. The weekly fees range from 334.00 to 351.00 pounds, which does not include the following: hairdressing; newspapers; toiletries; dry cleaning; prescription fees; transport/taxi fares; private health care services; clothing; continence products; trips out; private telephone and satellite TV installations and rentals and the tuck shop. A service user guide and statement of purpose are available on request and are displayed in the reception area of the home. Care Homes for Older People Page 5 of 27 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: Choice of Home poor Health & Personal Care Daily Life & Social Activities Complaints & Protection Environment Staffing Management & Administration Poor How we did our inspection: This key unannounced inspection, which included a visit to the home, took place on Tuesday 4th November 2008. The staff at the home did not know that this visit was going to take place. All the key standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with residents, the manager and other members of the staff team. Key standards refers to those standards we feel are particularly important in ensuring the health, safety, welfare and quality of life of people living at the home. The care and services provided to three residents were looked at in detail, looking at their experience of the home from their admission to the present day. A selection of staff and care records was examined, including residents care files, training records and staff duty rotas. Concerns had recently been raised with us about how medicines were being managed at the home so a pharmacy inspector took part in this inspection. Adequate Good Excellent Care Homes for Older People Page 6 of 27 Before the inspection, we asked for surveys to be sent out to residents and staff asking what they thought about care at the home. Nine residents and three staff returned their surveys. Feedback from these questionnaires is included in the report. Since the last inspection a new manager has been appointed who has registered with us. We asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what she felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager completed the form well and was very honest about the problems she had met with when she began working at the home. She was able to tell us how she was addressing these and showed that she had plans for future improvements. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Staff need to put more detail in residents care plans, as there was not enough information to show clearly what help each person needed and how their care would be monitored. Care Homes for Older People Page 8 of 27 Staff training records need to be dated so the manager can see when refresher training is due and can ensure that it is delivered in a timely way. Important training for staff in areas such as medicines management must be arranged. Although residents said they felt well cared for and staff seemed to have a good knowledge of their needs, the poor practices we saw in relation to how medicines were handled has lowered the overall quality rating for this home. Overall we found that poor practice when administering and recording medicines was placing the health and welfare of residents at unnecessary risk. Some residents had been given too much medicine and other residents had not been given enough. There were serious shortfalls in the storage and recording of controlled drugs (medicines that can be misused). This led to a risk that residents could be given incorrect doses, which could have a serious effect on their health. We found that medicines were badly managed even though we had previously told the manager that concerns had been raised with us and asked her to look at them. The manager had not investigated the concerns thoroughly enough to identify the problems we saw. The manager did not do regular checks (audits) on medicines. Checks on medicines handling are important because they help ensure medicines are administered as prescribed and help make sure that staff are competent. 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 enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were assessed before coming into the home to make sure staff were able to deliver the right care for them. Evidence: Information about the home in the form of a service user guide and statement of purpose was displayed in the reception area of the home and also provided in each residents bedroom. The information had been updated and appeared to be an accurate reflection of the services the home provided. One resident told us she had been to look round the home before she made the decision to come and live there and staff had been very helpful in answering her questions and making her feel welcome. The information she had received had proved to be accurate, in that, her expectations of what it would be like living at the home had been met. Nine residents returned surveys to us and they all told us they had received enough information about the home before they decided to live there. The care for three residents was looked at in detail. Each person had been assessed before they came into the home. One resident said staff had asked them about what they could do for themselves and what they needed help with when they first came to live at the home and this resident said he felt staff knew and understood his needs well. Care Homes for Older People Page 11 of 27 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 the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff met residents personal care needs well but the systems for the management of medicines were poor and did not protect residents from the risk of errors being made that would affect their health and welfare. Evidence: The care for three residents was looked at in detail. Daily living and needs assessments were provided in each care file and the manager said these were used as care plans. However, they did not contain enough information to tell staff exactly what care they needed to give, what the aims of the care they were delivering were and how they would monitor if the care was effective. One of the residents had another type of care plan as well, that covered most aspects of care such as the residents personal care and needs in relation to dressing, communication, mobility, safety, mental health, diet, hearing, sight, foot care, religious needs and pressure areas. However, the information for each area was minimal, often only a sentence or a few words. This did not show the resident as an individual or give specific details about particular issues that needed special consideration. For example, the resident was registered as blind but the care plan gave no indication of this and did not address the more diverse needs that their disability may create. Despite this, it was clear that staff were aware of the residents needs, for example, describing to them what their meal was at lunchtime. Risk assessments had been undertaken for each resident for pressure areas, moving and handling, nutrition and falls. Risk assessments were not, in the main, reviewed monthly but the risk to each resident had usually been assessed as low and their conditions appeared stable. Care Homes for Older People Page 12 of 27 However, staff need to be aware of some instances where risk assessments may need to be reviewed more regularly to ensure that any deterioration in a residents condition is identified quickly and appropriate action taken. For example, one resident was assessed at high risk of pressure ulcers when they were admitted to the home in February 2008 but their risk assessment was not reviewed again until May. Although residents told us they had seen their GPs, dentists and opticians, there were few records of these visits in their care files. The manager said details of visits by health care professionals were recorded in the office diary. However, any visits should be recorded in individual care files so there is an up to date record of treatment and advice obtained. A pharmacist inspector looked to see if medicines were being handled safely. Overall, we found that poor practice when administering and recording medicines was placing the health and welfare of residents at unnecessary risk. We looked at how medicines were given. We saw that if residents were in their bedrooms, their medicines were taken to them in little pots. We saw that several pots were taken at the same time and the residents names were put with the tablets on scraps of paper. If medicines are given in this way, there is a significant risk of people being given the wrong medication and this could have a serious effect on their health. We compared a sample of medicines records and stock and found a large number of gaps and mistakes in the record keeping that could place people at risk of medication errors. We found that one resident was prescribed an anti-coagulant (a medicine used to thin the blood). It is very important to give the right dose of this medicine, but we found that the resident had been given too much of the medicine. We also saw that records sometimes wrongly showed medicines had been given when they had not. This was particularly evident when a resident was prescribed a liquid medicine. For example, one resident was prescribed a liquid to be taken twice a day. In the last month the records indicated that the medicine was given 55 times, however the stock showed that less than half of the medicine was actually given. No giving medication as prescribed, whether giving too much or too little could seriously affect a persons health and wellbeing. We looked at how controlled drugs (medicines that can be misused) were managed. A special register was used for record keeping but we found lots of mistakes in these records. The cupboard used to store the controlled drugs also did not comply with current legislation. We found that three pain-relieving patches had been put into a box labelled with a lower strength. This is very dangerous, if the wrong patch had been used on the resident, they would have had twice the dose the doctor prescribed and this could have had a serious effect on their health. We looked at how residents were supported when they looked after their own medicines. People are able to take their own medication if they wish to and this promotes their independence. However, there were no accurate and up to date records to show what help people need. Having clear written plans helps make sure that people get their medicines when they need them. The manager said that she was waiting for places to become available to provide medicines handling training to staff members. Given the serious errors found during this inspection, this should be seen as a priority. Care Homes for Older People Page 13 of 27 The manager did not do regular checks (audits) on medicines. Checks on medicines handling are important because they help ensure medicines are administered as prescribed and help make sure that staff are competent. During our visit residents looked clean and tidy, their teeth and fingernails were clean and their hair was brushed. Male residents had been helped to shave. Residents said staff were kind and treated them well. One resident said, staff are very nice and helpful. If youre not well you can stay in bed and staff will get the GP for you. We overhead staff talking with residents in their rooms and they were friendly and patient. Eight of the nine residents that returned surveys said that staff listened and acted on what they said and they always received the medical support they needed. Care Homes for Older People Page 14 of 27 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Better staff understanding of the importance of meeting residents social needs has led to an improvement in the opportunities provided to them, which has been to the benefit of residents. Evidence: Since the last inspection the provision of activities and opportunities for social stimulation has greatly improved. The manager is committed to developing this area of the service and has worked hard with staff to identify and meet residents wishes. A member of staff has been designated to work an extra two afternoons per week as Activities Organiser and has been trying different things to see what the residents are interested in and enjoy doing. She was enthusiastic and could see the benefits to residents. We discussed arranging further training for her in providing activities for older people and for people with dementia with the manager; this type of training is useful as it offers ideas for other recreational pursuits that may be used as part of an activities programme. Residents told us that they had taken part in gardening, arts and crafts sessions (making greetings cards), card games and skittles. All residents we spoke to knew who the member of staff was that organised activities so they were able to request pastimes they would enjoy. Residents said that the previous week two groups had gone on trips to Blackpool to see the illuminations and have a fish and chip supper. They had celebrated Halloween and the night after our visit (Bonfire night) they were looking forward to a potato pie supper and firework display. One resident said, I dont get time to be bored because there is always something special going on every day. Its lovely, I really like it here”. Of nine residents that returned surveys, six said there Care Homes for Older People Page 15 of 27 was always or usually activities provided that they could take part in. Residents said routines were flexible in the home and they were able to get up and go to bed when they wanted. They could sit in any of the communal areas or spend time in their own room if they wished. One resident said that when she went out with her family, the cook made a separate portion of the main meal for her so she could eat it later in the day when she got back from her day out. Residents said they liked the food served at the home. One resident said the food was good and staff knew what he liked, for example, he did not like sandwiches very much so usually had pate or cheese on toast for tea. We saw menu boards in the two dining areas telling residents what the days meals were and the residents told us the cook also came round each morning and asked them to choose from the menu. While we were chatting with residents during the morning, we saw the cook discussing the days meals with them. One resident was observed requesting an alternative to the options on the menu and the cook wrote the request down and said it was no problem. Residents said they had plenty to eat and were offered regular hot drinks and biscuits throughout the day. One resident said she got up early out of choice and was always given a cup of tea by the night staff while she waited for breakfast. On the day of our visit lunch was served at 12.15pm and was the main meal of the day. The two main options were braising steak and onions or cheese and onion pie, with a choice of mashed or roast potatoes or chips and vegetables. Dessert was egg custard. The menu for tea showed a choice of sandwiches and soup or jacket potatoes with fillings or salad. Dessert was yoghurt, fruit or cheese and crackers. Residents all said they enjoyed their lunch and we tried the cheese and onion pie which was homemade and delicious! Most residents sat at dining tables, which as noted at our last inspection, could have been more attractively set; cloths and cutlery were laid but the use of napkins, condiments and other table dressings would improve the presentation and overall dining experience for residents. Residents in one dining area had to ask for the salt and pepper pots, which were still in the sideboard and no other sauces or relishes were offered. It was noted that since the last inspection larger plates had been provided, which was an improvement, as residents were not struggling to keep the food on their plates, but the meals for residents needing soft diets could have been better presented as they were served in soup bowls; one resident was struggling to get the food out of the bowl with their spoon and it would have been easier for them to use adapted crockery. Staff were seen asking residents if they wanted help to cut up their food and one member of staff explained to a resident with poor eyesight what their meal was. Of nine residents that returned surveys, eight said they always or usually liked the meals at the home. Care Homes for Older People Page 16 of 27 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were confident that any concerns would be listened to and acted upon but the manager had not always identified areas for concern when issues were raised with her. Evidence: The service user guide contained a copy of the homes complaints procedure. Seven of the nine residents that returned surveys said they knew how to make a complaint and several spoken to on the day of the inspection said they would speak to the manager if they had any concerns and were confident she would deal with it. The three staff that returned surveys all said they were aware of the complaints procedure. Since the last inspection two incidents, which concerned residents with challenging behaviour that was potentially putting other residents at risk of harm, had been reported to the Oldham safeguarding adults team. This showed that the manager had been proactive in taking steps to safeguard residents living at the home. We had also recently received two complaints, which we referred to the manager to investigate. These related to alleged poor medicines management and the unprofessional behaviour of some staff. We were satisfied with the response from the manager about most parts of the complaints but found that although she informed us that medicines were being managed properly in the home, when we visited they were not and we do not feel she investigated this thoroughly enough. In the AQAA the manager said that she intended to ensure all staff attended training run by Oldham Council on safeguarding adults. A policy was available for staff to read at the home but this was a generic document that needed additional information adding to it, such as contact numbers for staff to easily access if they needed to report concerns. Care Homes for Older People Page 17 of 27 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, comfortable and pleasant environment for people to live in. Evidence: A partial tour of the home was undertaken. This included the two lounge and dining areas and a selection of residents bedrooms. Visitors to the home walk in to an impressive reception area with a sweeping staircase and period features. The decor here was in keeping with the building, creating a homely and individual feel with old artefacts, such as a gramophone and coal scuttle, on display. Armchairs were provided for residents who may wish to sit and chat with visitors coming in and out of the home and magazines were left out for them to read. Residents rooms had been personalised, with ornaments, pictures and photographs. Everywhere was clean, tidy and smelled fresh. All of the nine residents that returned surveys said the home was always fresh and clean. Two residents told us they really liked their bedrooms and staff helped to keep them tidy. One resident, when asked what the best thing was about the home, said, I always have a nice clean bed, thats the best thing, its changed every week. There was evidence of ongoing maintenance and refurbishment. Since the last inspection, it was reported that nine rooms had been redecorated and a new carpet had been laid in one bedroom. New washing and drying machines had been bought, a shower chair had been replaced and a standaid hoist had been ordered. New bed linen, towels, flannels, cutlery and crockery had been purchased. Ongoing refurbishment does need to continue, as a number of residents rooms would still benefit from redecoration. The manager said that Partnership Caring have a maintenance person who works between homes within the group. Care Homes for Older People Page 18 of 27 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were confident in the staffs ability to care for them but lack of recent training in important areas meant that practices put residents at risk. Evidence: Staff spoken to during the inspection generally thought that there were enough staff to provide proper care to the residents. Of the three staff that returned surveys, one said there were usually enough staff on duty; one said there sometimes was; and one said there never was. Of the eight residents returning surveys that answered the question, six said there were always or usually staff available when they were needed; two said there sometimes were. At the time of our visit there were 26 residents living at the home. Staff duty rotas for the weeks beginning 27th October and 3rd November 2008 were looked at. This showed that from 8am to 10pm there was usually one senior carer and two carers on duty. During the night two carers were on duty. The manager usually worked from 8am to 4pm Monday to Friday and, in addition, there were full-time kitchen staff and part-time laundry, domestic and administrative staff. Three staff personnel files were examined. All contained the documents and evidence needed to ensure that the people recruited were suitable to work in a care home. The AQAA said that 62.5 of the care staff employed at the home had achieved NVQ level 2 or above. The manager said that all staff needed updated training in mandatory topics, which she was arranging though the Oldham training partnership. We looked at a training matrix, which showed that some staff had undertaken training in first aid, food hygiene, moving and handling, fire safety, safeguarding adults, dementia care and medicines management. However, the matrix did not include the dates for when staff had done the training so it was not clear how recent and up to date it was. Some staff had not had any recent training in the safe management of medicines and this was apparent in Care Homes for Older People Page 19 of 27 the poor practices we saw during our visit. Care Homes for Older People Page 20 of 27 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements had been made in seeking and acting on residents views but management systems were not rigorous enough to ensure that policies and procedures for the protection and promotion of residents health and welfare were established and adhered to. Evidence: Since the last inspection a new manager has been appointed who has registered with us. Residents were positive about the changes the manager had made and said she was approachable and understanding. One resident said the manager was very kind. Staff also said the manager was supportive, although the manager was frank in the AQAA that she returned, about problems she had encountered regarding staff attitudes and work practices at the home. She had been dealing with this but this had caused some friction. However, the manager was hopeful that staff were beginning to understand why she had made certain changes and demonstrated to us that she was working to improve the quality of life for residents, uphold their rights and ensure that the service was operating in the best interests of residents. We felt that the information the manager provided in the AQAA gave us a good picture of the current situation within the service. Care Homes for Older People Page 21 of 27 The manager was well supported by the owner of the home and could contact other personnel in the company for advice or help at any time. Residents said there had been some residents meeting since our last inspection. Minutes of these meetings showed that residents had been able to make a number of suggestions and offer ideas about how the home was running. The manager had sent out some satisfaction surveys to residents, relatives and other health care professionals that visit the home in October 2008. The feedback from these was mainly positive and the manager said she had followed up specific comments and less positive comments with individuals to see how issues could be improved; however, there was no record of how she had done this or the outcome, which would be useful or the manager as part of the quality monitoring process. The manager had produced two newsletters, the latest of which was on display in the reception area, telling people about some of the changes she had made and keeping them up to date with future plans. The manager needs to develop the quality monitoring system she has put in place by improving and strengthening the checks she makes on key areas of the service such as record keeping and medicines management. There were shortfalls in these areas that may have been identified sooner if she had a system of checks. The manager needs to make sure that staff are aware of and consistently following the homes policies and procedures and a system of audit would inform her of how staff were performing. Systems in place for dealing with residents money were satisfactory. The manager told us in the AQAA and on the day of our visit that regular checks of the building and equipment were made in respect of health and safety. We did not look at the records of these checks on this occasion. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes No X 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 27 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 9 13 A legally compliant controlled 04/02/09 drugs cupboard must be available to store controlled drugs. This will help to prevent mishandling and misuse. 2 9 13 There must be an effective system in place to ensure staff are competent in handling medication. This will help to ensure that staff have the skills to handle medicines safely. 05/01/09 3 9 13 Medicines must be given to people correctly. Receiving medicines at the wrong dose, the wrong time or not at all can seriously affect a person’s health and wellbeing. 04/12/08 4 9 13 Records of medicines received into, administered and leaving the home must be clearly and accurately maintained. 04/12/08 Care Homes for Older People Page 24 of 27 This will help to ensure that medicines are safely handled. 5 16 22 The manager must fully investigate any complaint that is raised under the complaints procedure. This will ensure that any shortfalls in practice are identified and addressed. 6 30 18 Staff must receive refresher 30/01/09 training in key topics such as medicines management and other health and safety topics. This will ensure that staff are competent to handle medicines and will minimise the risk of errors being made that will adversely affect residents. 19/12/08 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 Care plans should be written that clearly describe the abilities of residents, what staff need to provide and how the care that is delivered will be monitored to ensure it remains effective. Visits from other health care professionals should be recorded in each resident’s individual care file so there is a clear record of any treatment they have received. Staff should consider on an individual basis the appropriate time interval that is needed to review risk assessments and care plans to ensure that residents at high risk are reviewed regularly. The manager should consider accessing training for the Activities Organiser in providing activities for older people and people with dementia, to help her develop her role. The manager should ensure that the safeguarding adults policy in the home contains specific information for anyone wishing to report a concern, such as contact telephone Page 25 of 27 2 8 3 8 4 12 5 18 Care Homes for Older People numbers and addresses. 6 30 An accurate record of staff training should be maintained that includes the dates when staff attended so the manager can identify when refresher training is due and can ensure that staff receive training that is appropriate to the work they have to perform. The manager should put a system of checks in place to ensure that staff are following the correct policies and procedures and to identify any shortfalls in the service so they can be addressed. 7 33 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. ©This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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