Inspection on 13/05/09 for Fleetwood Nursing Home

This inspection was carried out on 13th May 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fleetwood Nursing Home 18/05/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fleetwood Nursing Home Grange Road Fleetwood Lancashire FY7 8BH     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: Christopher Bond     Date: 1 3 0 5 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 30 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 30 Information about the care home Name of care home: Address: Fleetwood Nursing Home Grange Road Fleetwood Lancashire FY7 8BH 01253779290 01253779290 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) : NR & VGP Carehomes Ltd care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care home with Nursing - N 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 The maximum number of service users who can be accommodated is: 30 Date of last inspection Brief description of the care home This is a nursing home which is registered for a maximum of 30 residents. It is situated in a residential area of Fleetwood, Lancashire, quite close to the sea front, shops and transport routes. A doctors surgery is situated close to the home and there is a library near by. Most of the bedrooms within the home are single rooms and are quite large, and some of the bedrooms have en-suite facilities. There were double rooms but these were being used as single bedrooms at the time of the inspection. There is a lift to the first floor and there are several aids and adaptations around the home for those with disabilities. Care Homes for Older People Page 4 of 30 Brief description of the care home There are two lounges and some residents also sit in the dining area. There is a conservatory area at the back of the building, which serves as a main lounge and a smaller lounge area is available for those who like to sit in a quieter environment.. Information relating to the home is included in the welcome pack, which is given to all prospective residents. This information explains the care service that is offered, who the owner, manager and staff are, and what the resident can expect if he or she decides to live at the home. At the time of this visit, (13/05/09) the information given to the Commission showed that the fees for care at the home are from GBP 386.50 to GBP 560.50 per week, with added expenses for hairdressing and chiropody. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: As part of the main inspection we undertook a visit to the home on 13th May 2009 which lasted for six hours. We looked at the information that the service held regarding the care of its residents and we assessed how well they were being cared for. We also looked at the other records that the home had, such as information about the care staff, what training they had received and how this enabled them to do provide a better standard of care. We also looked at what arrangements were in place to help the people who use the service to voice their concerns and views, and how well they were safeguarded from harm. Safety certificates and insurance documents were also seen. We spoke to six residents, and three visitors to the service, about their experiences. Care Homes for Older People Page 6 of 30 We also spoke to care staff and the manager of the service. We also sampled the lunchtime meal and sat with the residents whilst this was being served. The chef gave us information about what meals are served and how special diets are arranged. Every year we ask the manager of the service to send us an Annual Quality Assurance Assessment that tells us about her views on how well the service is progressing. This also tells us about what changes have been made and what future changes will be needed. This document is used by us to focus out inspection activity and provides us with essential information. What the care home does well: What has improved since the last inspection? What they could do better: It would be good practice to have a planned programme of daily activities displayed within the home. Although activities were available, people should be able to see what was being planned and have a choice as to whether to attend or not. The care plans that helped guide the type of care that people were receiving were good, but these were not being reviewed properly. No information was written down after reviews took place. Information such as this is important when ensuring that all the care staff have the correct information about someones condition and that care is consistent. We also found that information that should have been in individual care plans was held elsewhere. There was a list on the office wall with records of weight and blood pressure. This is confidential information and should be held on individual plans. Care plans were also held together in one large ring binder: it would be better if they were individually bound to help ensure that information could be easily found. When we looked at the medication records some of them hadnt been signed when Care Homes for Older People Page 8 of 30 prescribed medication had been administered. It is very important that this is done so that it is known for sure that prescribed medication has been given. Information was available about this home for prospective residents. It needs to be evident that this information is recent. Some of the information that we were shown had not been reviewed for some time. Good, current information is essential when people are choosing whether or not the service is right for them. The manager told us that she was asked to work as a member of the care team for most of her working week. This meant that the process of managing and running the home, along with supporting the staff and performing administrative tasks, had to be completed in a short period of time where the manager was extra to rota. It was disappointing to find this situation; the manager must be given adequate and sufficient time to manage this service properly, control how the care staff work and perform the quality checks that are required of her. One of the most disappointing things about this home was the lack of sufficient bathing facilities. Only one small bathroom was fully operational. The other two were poorly appointed and the people who used the service did not have the choice of having a bath. There were only shower facilities available. The first floor bathroom was in a poor state of repair and was being used as a storage room for old equipment. Some work had begun on the large ground floor bathroom but this had ceased, leaving it poorly appointed, dark and un-appealing. These bathrooms were not pleasant and no effort had been made to make them more homely. There were not enough assisted bathing facilities for all of the residents at this home. The manager told us that the owner of the home visited on a regular basis. We could not find the reports that he is supposed to complete on a monthly basis to show us that he is fully aware of all the issues and needs of the home, and the views of the people who use the service and their relatives. He is required to complete these in line with the Care Home Regulations. 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 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is gathered regarding nursing and care needs before people are admitted to this home: this helps the carers to provide proper care and support. People had enough information about this home to make a decision as to whether the service was right for them. Evidence: We found that this home had information available that was given to prospective residents and their families about what services the home provides. There were two documents available; the Service User Guide and the Statement of Purpose. These contained information about the accommodation, the manager, the staff, and other important information such as the vision and values of the home, and the complaints procedure. One of the documents that we saw had not been reviewed for some time. It is important that only current information is held, and shown to prospective residents and their families. There was also a small leaflet available that gave general Care Homes for Older People Page 11 of 30 Evidence: information about the service. We spoke to three visitors to the service during this inspection. We were told that sufficient information was given to residents and their families prior to moving in. The manager also invited people to look round the home to view the services before they made a decision to move to this service. All of the care plans that we looked at contained pre- admission assessments that documented peoples needs before they moved in. These were used to assess whether the service could meet their need, and also to gather information to help ensure that current needs were met. One person had been admitted to the home the evening before our visit. An assessment had been completed and this information had been transferred to the care plan. Dietary information had been passed to the kitchen and information had been passed to the care staff about her needs. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who used this service received a good standards of care that was planned and delivered well. Some information was missing from the plans, however, and the review process was not completed correctly, which could cause confusion. Evidence: All of the people who lived at this home had a care plan that documented their daily health care and social needs. There was plenty of information in each plan regarding areas such as nutrition, skin condition, risk of falling, social and spiritual needs, and general health needs. This information was used by the care staff on a daily basis in order that peoples health could be monitored and to ensure that they received the right type of care. We found that some information, in particular weight charts, were not part of the care plan. It would be better if all this information was kept together within the plan so that information could be cross referenced quickly to ensure that weight gain or loss is picked up quickly and important changes made to address this. This is also a data Care Homes for Older People Page 13 of 30 Evidence: protection issue because important information about people was not kept separately within individual care plans. The information was on the office wall for all to see. We spoke to the manager about keeping information together, and the importance of ensuring that everyone had a separate care plan where information was easy to find. The service currently keeps all the care plans together in two large files. It is good practice for all residents to have a separate care plan where all their care information is kept. There had been some concerns raised about the number of falls that were happening with regard to the residents of the home. This was particularly evident at night. The manager had introduced falls risk assessments that were regularly reviewed, with action plans for when changes were needed. Accidental falls had been reduced in the home because of this. We also noticed that although there was evidence that monthly reviews were taking place regarding the upkeep of the care plans. There was little information to tell us what process was followed as part of this review. There were no outcome statements to provide information about any changes. The review process was poorly worded and need to be made clearer so that monthly changes in the care process are highlighted and recored properly. Only one person needed pressure area care due to the breakdown of skin tissue. This was recorded clearly within the care plan and any care she received was documented properly. There were special mattresses on some of the beds to help relieve pressure for residents who were more prone to tissue damage. There were also pressure pads and other equipment available to help prevent pressure sores. A recognised tool was used within the care plans to assess and review skin condition. There was evidence that residents were turned regularly whilst in bed to aid pressure relief. The management of continence issues were good at this home. People were assessed properly and changes were made to protect their dignity and comfort. Appropriate continence aids were used and we saw that the residents were helped to use the toilet regularly. This was a nursing home, and action had been taken by the manager to improve the quality of care available when people were nearing the end of their lives. There had been training in palliative care and a nationally recognised care pathway tool was being used to ensure that aspects of dignity and respect were being followed properly. One of the bedrooms was due to be used for those who were nearing the end of their life, special provision was also being made for relatives to stay overnight if they wished. Care Homes for Older People Page 14 of 30 Evidence: Throughout our visit we observed the care staff respectfully providing care and talking to the residents politely. We spoke to six residents and all told us that the standard of care was very good and that they were pleased with the service. One of the residents told us; Its the next best thing to living at home. The girls are good, theyre sometimes rushed but always have time for a chat. Some of the residents had been prescribed medication by their doctor. This was being stored properly and safely and there were records available to show that it was being given properly. The manager of the home was in the process of assisting people with their medication over the lunch period. We observed that this was being done appropriately. We looked at some of the medication record sheets and found that there were sometimes gaps, with no explanation as to whether medication had been administered. The manager told us that she regularly checks the sheets and had picked these up. It is important that records are kept accurately as it may put people at risk if they dont receive their prescribed medication. Overall we found the quality of care at this home to be good and people were being looked after properly, with their care planned appropriately. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities were frequently available for the residents but not planned as part of the routines of the service. Catering arrangements were very good and people commented about the quality of the food that was served. Visitors were encouraged and made welcome, ensuring that valued relationships were continued. Evidence: We sampled the lunchtime meal during our visit to this service. The meal was nicely cooked and presented, and there was a choice of food for the residents. We spoke to three residents over lunch time and all said that the quality of the catering was very good and that they looked forward to meal times. The care staff served the meals well and those that needed assistance with eating were observed doing this with respect for the person concerned. The dining area was pleasant and the tables were set nicely. One of the people who used this service commented; The food is one of the best things about the home, its always tasty and nicely cooked. We looked at the menus for the home and it was clear that a balanced, nutritional Care Homes for Older People Page 16 of 30 Evidence: meal was always planned. The Chef told us that fresh food was generally used and that there were regular deliveries of fresh meat and vegetables. This service did not have an activities co-ordinator to oversee how daily activities were provided. We did not see a planned programme of activity that the residents could view and make a decision as to whether they would like to join in. It would be good practice for this to happen. We were told by the manager that activities were regular and that games, live entertainers, sing-a-longs, organists, reminiscence therapy, music, and board games were regular feature of life within the home. Three residents confirmed that activities took place and that there was usually something to do. The manager confirmed that activities were indeed regular and that there were plans for the service to purchase a mini-bus so that people could enjoy activities within the community. There were also times when residents went out for the afternoon to the pub or to other venues. There were records available to show that the residents had the opportunity to attend arranged meetings where they could voice their opinions about the service and suggest changes. We spoke to four visitors during the inspection. It was clear that visitors were made welcome and offered privacy. One relative told us that he was always made very welcome and offered refreshments. When he visited at weekends he was always offered lunch and the chance to join in with daily life at the home. he commented that, Its always very pleasant and welcoming here, I enjoy coming. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints about the service are handled properly and taken seriously. The processes when voicing concerns about this home are clear and easy to follow, meaning that people feel listened to. People are safer because safeguarding issues are promoted and taken seriously. Evidence: We sent out surveys to the care staff who work within this service and all of the care staff who completed a survey said that they knew what to do if someone had concerns about the home. The complaints procedure was displayed in the home and was part of the Service User Guide. Timescales were given for the handling of complaints and the manager confirmed that all complaints and concerns were handled properly and seriously. The manager was aware of the homes role regarding the complaints procedure and how complaints can be used as a quality tool to ensure that the home is run in the best interests of the people who use the service. There were regular residents meetings held, and concerns could be dealt with at this level before they escalated to an official complaint level. We looked at the information that was available in the home that helped to safeguard people from harm. There were policies and procedures to guide the manager and staff in safeguarding policies. The manager was aware of what action to take should a Care Homes for Older People Page 18 of 30 Evidence: safeguarding issue arise within the service. The care staff had also been trained in protecting vulnerable adults and the staff that we spoke to were aware of safeguarding issues and how to report things that they were unsure or uncomfortable about. Most of the care staff had also received this training via a nationally recognised qualification in care (National Vocational Qualification level 2 or 3). An incident took place in July 2008, however, where these guidelines were not followed and the local authority were not informed of a potential safeguarding incident. The regulatory body at that time were also not informed of this. The manager has addressed this situation and the senior care staff at the home are now aware of what action to take shoud a safeguarding issue arise. This information is important when ensuring that the people who use this service are safeguarded from poor practice, or harm. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inadequate bathing facilities mean that the residents receive poor outcomes in this area. Evidence: The manager accompanied us on a tour of this home. The bedrooms were of a good size and there were plenty of personal possessions around that people had brought with them to make their rooms more homely and pleasant. Four of the residents that we spoke to during our visit told us that they were pleased with their bedrooms and felt comfortable there. During our last inspection in 2007 we were told by the manager that there were plans to re-design and re decorate the bathrooms at this home. We commented on the poor state of the bathrooms and that they were not very nice for people to use. The Annual Quality Assurance Assessment that the home submitted to the Commission in 2008 said that work was planned to upgrade the bathrooms. Although a new shower unit has been fitted, there has been no other work done on either the main ground floor or first floor bathrooms. This means that, at present, the home does not offer a bath to its residents. This affects the choice offered to the people who use this service as some people prefer to have a bath. Care Homes for Older People Page 20 of 30 Evidence: The first floor bathroom was dark, with poor lighting. There were no pictures, or anything to help make the room more appealing and homely. It was being used as a storage area for old and damaged equipment. There were clear safety issues here due to clutter and the central heating unit was not covered to protect the residents from excessive heat. Tiles had been removed from the ground floor bathroom and a bath had been removed. This room too was poorly lit with inappropriate neon tube lighting. Work had stopped on this facility, leaving it incomplete. This room wasnt appealing, relaxing or homely. The Care Home Regulations state that there must be one assisted bathing facility to eight residents and this clearly isnt being met by this service. The dignity and respect of the people who use this service are being seriously affected by the inability of this service to offer reasonable bathing facilities for its residents. One of the residents told us that the bathrooms were Not very nice, and that she missed having a relaxing bath. There was a smaller bathroom available on the ground floor but, again, only shower facilities were available. The owner of the home should address this situation as soon as possible as bathing facilities were poor and the main bathrooms were in urgent need of decoration. We also found that quite a lot of the bedroom furniture was mismatched, old or damaged. This needs to be replaced to ensure that the aesthetics of the home and the comfort of the residents is being addressed. We found that the decoration and furniture in the rest of the home was sufficient, although the carpet in the main lounge/ conservatory area looked worn and was in need of cleaning or replacement. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care staff are well trained and are employed in enough numbers to ensure that the residents needs are properly met. Good recruitment practices help to make sure that only suitable staff are working at the home. Evidence: There were enough care staff on duty to help ensure that the assessed needs of the people who used this service were properly met. The staffing rotas were looked at and staffing levels were consistent. We spoke to five residents who told us that there needs were being met and that the carers always had time to listen and act upon issues. Recruitment was good within this service. Each of the care staff had a file where their information was kept, along with a current photograph. This is important because good information helps to ensure that the people who use the service remain safe, and protected from unsuitable care staff. The service had a training programme and care staff confirmed that they had recent instruction in care related matters and safety issues, such as ensuring that people with poor mobility are moved around the home safely and professionally. There had also been training for the care staff in palliative care, meaning that people who receive nursing support at this home have a good standard of care. Care Homes for Older People Page 22 of 30 Evidence: Most of the care staff had achieved a nationally recognised qualification in care (National Vocational Qualification level 2 or 3). There was a good induction process to help ensure that new care staff were competent before commencing their role. Good training and instruction helps to ensure that the care staff have the knowledge, skills and ability to perform care tasks properly. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The managers ability to run this service properly was being compromised by time constraints. The safety of the residents was being addressed properly and people lived in a safer home because of this. Evidence: The manager of the home was experienced and well -trained. This helped her to run the home properly. She told us, however, that she sometimes did not have enough time to ensure that managerial tasks were completed properly. This was because, for part of her working week, she was required to work as part of the care team and provide direct care to the residents. It is important that the service is managed properly and that the manager is given enough time to complete important tasks and ensure that the people who use the service receive a good standard of care. We noticed that important quality checks were not being completed, for example there were gaps in the medication record sheets, which called into question whether or not Care Homes for Older People Page 24 of 30 Evidence: the residents were being given prescribed medication regularly. Monthly care plan reviews were not being completed thoroughly and areas where we expected the home to progress were not being carried through. The manager needs to have systems in place to ensure that regular checks take pace throughout the home by the management team. This is where things such as the medication not being signed for are picked up. This is easy to do if the manager is given time to manage the service. If she spends a lot of her time providing care for the people who use the service then things will be missed. The staff also told us through surveys that were sent to them that they were not receiving regular individual support from the manager where individual aspects of their role could be discussed. We spoke to a number of the residents who told us that they thought the home was being managed well and that their interests were being looked after. The visitors to the service that we spoke to agreed with this; one relative told us, She seems to have a good grip on things, she runs a tight ship. We were told by the manager that the owner visited the home regularly. We looked for the reports of his visits but these had not been completed. These are important documents and should be completed on a regular basis. Where the owner of the service does not actually manage it on a day to day basis they must visit at least once a month, prepare a written report on the progress of the home and retain a copy of this at the home for viewing. This tells us that he has an awareness of the service and is conscious of peoples views as to how the home is progressing. Some of the residents had small amounts of money that were being held by the service. There were records to show that this was being managed properly and checked regularly. There were certificates to tell us that safety checks on major appliances were being carried our appropriately. Safety training was being carried out for the care staff in mandatory areas, and the home was adequately insured. This helped to show that people lived in a safer home and that their well- being was being protected. There were risk assessments available on peoples care plans to help ensure that areas of potential hazard were being addressed and acted upon. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 The manager must ensure 19/06/2009 that care plans are reviewed properly on a regular basis and have clear outcome statements to indicate the current condition of the people who use this service. This is to ensure that all of the care staff have good, current information and that there is a consistent approach to providing a good standard of care. 2 9 17 The manager must ensure that medication record sheets are completed correctly. There must be no ambiguity as to whether people have received their prescribed medication. 19/06/2009 3 21 23 There must be sufficient assisted bathing facilities within the home. 31/07/2009 Care Homes for Older People Page 27 of 30 This is to ensure that all residents have good access to proper bathing facilities. 4 24 14 The manager must continue to ensure that furniture at the home is updated and renewed. This is to ensure that people live in a comfortable home with good quality, matching furniture around them. 5 32 5 The manager of the home must be given sufficient time to manage the service successfully. This is to help ensure that important areas of quality control are not missed. 6 37 26 The owner of the home must 19/06/2009 complete regular reports about how he finds the service is progressing. This helps to ensure that he is fully aware of the quality issues of the service, and the views of important stakeholders. 19/06/2009 31/07/2009 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 and statement of purpose should be reviewed on a regular basis and hold only current information about the home. All of the information gathered by the service with regards to the care of the residents should be used as part of their Page 28 of 30 2 7 Care Homes for Older People care plan. Weight records and other information should be entered on the plan. This is to ensure that all records are kept confidentially and within the law. 3 7 Care plans shoud be individually bound and information easy to locate. This is to help ensure that important information can be located quickly and updated accordingly by the care staff. A planned and organised programme of activities should be available on a regular basis. This helps to ensure that people receive mental and physical stimulation and have a choice as to whether they attend or not. The residents should have a choice as to whether they would prefer a shower or a bath. Residents should have the right enjoy bathing in appropriate, comfortable and homely surroundings. All of the staff who work at the home should have regular, individual, recorded support from the management team.This is important for their development, and ensuring that their performance and training needs are monitored. 4 12 5 21 6 36 Care Homes for Older People Page 29 of 30 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. 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