Inspection on 21/05/10 for Goldcrest

This inspection was carried out on 21st May 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Goldcrest 28/04/10

Goldcrest 24/02/10

Goldcrest 08/02/10

Goldcrest 17/08/09

Goldcrest 12/02/09

Goldcrest 13/09/07

Goldcrest 22/08/06

Goldcrest 21/03/06

Goldcrest 30/08/05

Goldcrest 28/02/05

Goldcrest 24/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Random inspection report Care homes for older people Name: Address: Goldcrest 183 Dorchester Road Weymouth Dorset DT4 7LF zero star poor service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susan Hale Date: 2 1 0 5 2 0 1 0 Information about the care home Name of care home: Address: Goldcrest 183 Dorchester Road Weymouth Dorset DT4 7LF 01305830400 01305781810 goldcrestcare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Angela Purusram,Mr Rajendrasen Purusram Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 26 Number of places (if applicable): Under 65 Over 65 26 old age, not falling within any other category Conditions of registration: 0 A maximum of ten service users in the category of DE(E) may be accommodated. Room no.1 may be used as a double. The occupancy level at Goldcrest (the home) must not exceed 13 and prior to admitting any further admissions written consent must be obtained from the Care Quality Commission. This condition shall remain in place until such time as it is removed by the Care Quality Commission. Date of last inspection 0 8 0 2 2 0 1 0 Care Homes for Older People Page 2 of 32 Brief description of the care home Goldcrest is a large detached property situated on the main Dorchester to Weymouth road, within a mile of local amenities and one mile from Weymouth town centre. The home is run on Christian principles.The accommodation is spread over ground and first floor levels; all bedrooms have en-suite toilet facilities. Communal areas comprise two lounges, and a dining room. There is one assisted bathroom at the home but the home does not provide showering facilities. A passenger lift provides level access to most of the first floor; the remaining rooms are accessed via the stairs. Stairlifts are available on three of the four staircases. There is easy access to a pleasant garden and patio area situated in the central courtyard. Mr and Mrs Purusram are the registered providers. An acting manager is in post but not currently registered with the Commission. Details of the current fees can be obtained direct from the home. Additional charges being made for chiropody, hairdressing and newspapers. Care Homes for Older People Page 3 of 32 What we found: The visit was undertaken by two inspectors over the course of one day in May 2010. The purpose of the visit was to check the progress being made by the registered providers in addressing the outstanding requirements and recommendations. Since the key inspection ( March 2010), a notice of proposal to impose conditions to restrict the current numbers on the number of people who can live at the home has been served and accepted by the registered providers. The home can currently accommodate no more than 13 residents. During the visit we were given a copy of the statement of purpose/service user guide. this now includes details of the specific room sizes of each room available for residents as recommended in the key inspection report of August 2009. The guide does not include a copy of the latest inspection report and tells readers that the acting manager is registered with the Commission, which they are currently not. We looked at three care plans. On the first care plan looked at on the moving and handling risk assessment , a score was recorded based on the persons weight ,the range used to calculate the score was inaccurate and indicated that the resident weighed significantly more than they do. This meant that the risk assessment score was invalid. The resident manual handling assessment form includes a section for staff to indicate if the person was of thin or average build, both choices had been ticked although the care plan headed nutrition states that the resident has always been thin. The records relating to personal care were looked at and this evidenced that the person had not had a wash between the 8th and 10th of May 2010, finger nail care had only been recorded on three occasions out of a possible 21 during May 2010. There are entries recording oral care given on only six occasions in May 2010. The record headed nutritional preferences made no reference to the care plan headed nutrition which clearly stated that the person preferred puddings to main meals. the record showed that a high calorie diet was needed but food and fluid charts checked did not evidence that this was being provided. However, the physical and social assessment records that the person has a normal diet which contradicts the likes/dislikes sheet which records the need for a high calorie diet to be provided. The food preference chart clearly recorded that the person did not like offal . However, at the key inspection in March 2010 we observed that the person was offered a main meal of liver and when they refused was not offered an alternative. Food and fluid charts were in place and the amount of fluid given every day was totalled. There was no evidence that the charts were audited by the acting manager to evaluate the persons nutritional intake. There was no evidence that the person was offered a bedtime milky drink and no evidence that the person was offered a high calorie diet as detailed in the care planning records. The care plan headed mental health states that staff should leave a reminder of the day, date and year by the residents chair. However, we visited the resident twice during the day in their room and there was no evidence that this had been done. Records relating to the persons mental state had been completed and the person was described Care Homes for Older People Page 4 of 32 as angry. The resident had been unwell and the daily record showed that staff had contacted the GP on 20th May 2010 and had been advised to try and obtain a urine sample. There was no evidence on the daily record of 20th May 2010 that efforts had been made to do this. The daily record on 15th May 2010 recorded that the person had eaten very little during the day and asked night staff to offer and prompt the person to have a snack but there was no record that staff did this. A deprivation of liberty checklist was on file which records that the solicitor who has power of attorney must be involved in care plan reviews but there was no entries on the professional visit record since 11th November 2008 , so no evidence that they had been invited or attended reviews. The daily record showed that a care manager had visited the resident but this was not recorded on the professional visit record. The home uses a dementia assessment that includes a section headed negative personality traits on the care plan checked one of the registered providers had recorded petulance mostly. On the second care plan looked at the person had a palliative care plan in place that had been completed on 18th May 2010. The plan recorded that the person preferred to spend their time in their room enjoying music, their guitar and keyboard but we saw these items were still in the persons room upstairs and therefore inaccessible. The professional visit record did not record all of the recent visit by the district nurse or the GP that we saw noted in the daily record. The plan was an improvement on the persons previous care plan but the acting manager told us that the person was not in fact receiving palliative care. Advice was given that the plan should not therefore be entitled palliative care if this was not a reflection of the persons current needs. Food and fluid charts were in place and on 19th May 2010 it had not been recorded whether the person had had any breakfast or how much they had eaten at lunchtime. The fluid charts were not totalled and there was no evidence that food and fluid charts were audited by the acting manager to evaluate the persons nutritional and fluid intake to see if any action was necessary to keep the person well. The food chart on 18th May 2010 did not record any nutritional intake at lunchtime or in the afternoon. We looked at the third care plan briefly, and noted that swallowing difficulties had been recorded and that a care manager had requested a referral to the speech and language therapist be made on 15th April 2010. There was no evidence on the file that this had been actioned by the acting manager. A care plan was in place about the risk of aspiration dated 1st March 2010 and had been reviewed on 18th May 2010 but there was no risk assessment relating to this risk so that measures could be put in place to keep the person safe. The person had seen the GP since the risk of aspiration and swallowing had been noted on file but there was no reference to the GP being asked about these issues and the visit by the GP on the 17th May 2010 was not recorded on the professional visit record. It was positive to see that there was a letter from the GP on file in relation to the administration of covert medication. The daily records on the 28th April 2010 showed that the person was not having personal care from day staff and that night staff should assist Care Homes for Older People Page 5 of 32 with personal care whenever possible but the care plan relating to personal care had not been amended to reflect this. We observed that a resident who was having their lunch in their room was not offered condiments or asked if they needed the food cut up. The resident started talking to the member of staff , but the member of staff did not acknowledge this and left the room without responding. We checked this persons care plan and the care plan headed nutrition states to offer to feed the person, but there was no evidence this took place on the day of the visit. We undertook a brief tour of the premises and the home was clean and tidy. Some of the carpets that were ruched have been refitted to make them fit better and reduce the risk of people falling. However, one room that is occupied has a carpet that is badly ruched and this could present a trip hazard for the resident, visitors and staff. We noted that in the upstairs bathroom that is intended to be converted to a wet room when funds permit the floor is wooden and permeable. whilst the Bath may not currently be used there was clear evidence such as a clinical waste bin, gloves and toilet paper to indicate that the toilet in the room is being used. It was positive to see that the majority of the unoccupied rooms were locked. However, whilst the majority of the windows are restricted to keep people safe, some were not. Advice was given to the registered providers and acting manager in relation to undertaking appropriate risk assessments. We noted that two radiator covers in the ground floor covers in the ground floor corridor were not firmly fixed to the wall and fell forwards when touched. It was positive to see that a training programme is in place and that the home has an up to date training matrix, a copy of which was given to us on the day of the inspection. However, because historically training available for staff was poor it is taking some time to access training courses so that all staff have the skills and knowledge that they need to meet residents means. The training matrix showed that seven members of staff including a senior carer, have not undertaken training in adult protection. Four members of staff including the acting manager have not undertaken any training in fire safety. Five members of staff have not undertaken any training in health and safety. Three members of staff have not undertaken any training in infection control and one member of staffs qualification in moving and handling people expired in March 2009. Four members of staff have not undertaken any training in dementia care including the acting manager. One of the new cooks recently employed does not have a current qualification in food hygiene. The home employs 12 carers five of whom are qualified to at least NVQ level II (41 ). The training matrix showed that a further five carers are currently undertaking NVQ level II training. We observed that although one person had been moved to a ground floor room their personal belongings including clothing remained upstairs in their original room. What the care home does well: It was positive to see that the statement of purpose now includes details of the size of Care Homes for Older People Page 6 of 32 each room available for residents. A photograph of each resident is now kept on their individual care plan. It is positive to see that a training programme is in place and that the numbers of staff qualified to NVQ level II has increased and that other carers are being given the opportunity to undertake training. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 4 18 The registered person shall, 10/05/2010 having regard to the size of the care home, the statement of purpose and the number needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home. To make sure that peoples assessed needs are met. 2 4 18 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons working at the care home. To make sure that peoples assessed needs are met. ( Previous timescale of 12/05/2010 not met). 12/05/2010 3 7 12 The registered person must ensure that service users psychological needs are adequately met. This is to ensure that 20/04/2010 Care Homes for Older People Page 8 of 32 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action residents needs are identified and clear guidance put in place on how staff are to meet such needs. (Previous timescale of 04/01/2010 and 20/04/2010 not met). 4 7 15 The registered person must 12/05/2010 ensure that changes in service users mobility and dexterity are adequately reflected within service users planning. To ensure service users needs are identified and clear guidance put in place the staff on how to meet such needs. (Previous time scale of 04/01/2010 and 20/04/2010 not met). Outstanding timescale should read 20/04/2010 5 7 14 The registered person shall 10/05/2010 ensure that the assessment of service users need is kept under review and revise it anytime when it is necessary to do so having regard to any change of circumstances. To make sure that peoples needs are met. 6 7 15 (1) & (2) Care records must include 26/11/2009 evidence of consultation with people living at the home, and be regularly reviewed. (Previous timescale of Care Homes for Older People Page 9 of 32 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 05/06/09,26/11/2009, 04/01/2010 and 23/02/2010 not met). To ensure that residents are in agreement with the way that care is provided for them. 7 7 12 The registered person shall 12/05/2010 ensure that the assessment and service users needs are kept under review and revise at any time when it is necessary to do so having regard to any change of circumstances. To make sure that peoples needs are met. ( Previous timescale of 12/05/2010 not met). 8 7 12 The registered person must ensure that service uses psychological needs are adequately met. To ensure that residents needs identified in clear guidance put in place and how staff to meet such needs. (Previous time scale of 04/01/2010 and 20/04/2010 not met). Outstanding timescale should read 20/04/2010 9 7 15 The registered person must ensure that they review and maintain the accuracy and necessary detail within 20/04/2010 12/05/2010 Care Homes for Older People Page 10 of 32 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action service users care planning. To ensure that residents needs are identified and clear guidance put in place on how staff are to meet such needs. (Previous timescale of 04/01/2010, 23/02/2010 and 20/04/2010 not met). 10 7 15(1) The registered provider shall 22/01/2010 after consultation with the service user or a representative of his, prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. (Previous timescale of 30/10/2009 and 22/01/2010 not met) This is to ensure that residents needs are identified and clear guidance put in place on how staff are to meet them. 11 7 12 The registered person must ensure that they review and put systems in place to promote secure proper provision for the health, welfare and care of the service users. To make sure that service users needs are met and clear guidance put in place to staff. (Previous timescale of Care Homes for Older People Page 11 of 32 12/05/2010 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 30/10/09, 04/01/2010 and 30/03/2010 not met). Outstanding timescale should read 30/03/2010 12 7 15 The registered person must 12/05/2010 ensure that they review and maintain teh accuracy and necessary detail within service users care planning. (previous time scale of 04/01/2010, 23/02/2010 and 20/04/2010 not met). Outstanding timescale should read 20/04/2010 To ensure the residents needs are identified and clear guidance put in place on how staff are to meet such needs. 13 7 12 The registered person must ensure that they review and put systems in place to promote and secure proper provision for the health, welfare and care of the service users. To make sure that service users needs are met and clear guidance put in place for staff. (Previous timescale of 30/10/09, 04/01/2010 and 30/03/2010 not met) 14 7 12 The registered person shall 10/05/2010 ensure that the care home is conducted so as to promote to make proper provision for the health and welfare of service users Page 12 of 32 30/03/2010 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action To make sure peoples needs are met. 15 7 15 The registered person must 20/04/2010 ensure that changes in services users mobility and dexterity are adequately reflected within service users planning. To ensure service users needs are identified and clear guidance put in place for staff on how to meet such needs. (Previous timescale of 04/01/2010 and 20/04/2010 not met). Not looked at during this visit. 16 9 37 The registered person shall give notice to the commission without delay of any event in the care home which could adversely affect the well-being of safety of residents. This refers to the drug error. To ensure that medication practice is safe. Not looked at during this visit. 17 9 13 The registered person must ensure that the medicines ordering systems in the home are reviewed to make sure that medicines are only 14/05/2010 30/05/2010 Care Homes for Older People Page 13 of 32 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action ordered when necessary. This is reduce wastage and make sure medicine handling in the home is well managed. 18 9 13 The registered person must 14/05/2010 ensure that medicines given to people in accordance with the directions of the prescriber. All medicines must be recorded at the time of giving to people, and is medicines are regularly refused or not given, then the prescriber should be contacted for advice. To make sure that people receive medications that they are prescribed, to protect their health and welfare. Not looked at during this visit. 19 9 13 The registered person must 14/05/2010 ensure that when medicines prescribed for people to be given when required that there should be detailed guidance available to staff to help them decide when they should be given that person. This is to make sure that medicines given to people in the way their doctor is intended. Not looked at during this visit. 20 9 13 The registered person must 14/05/2010 Page 14 of 32 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action ensure that the medicines ordering systems in the home are reviewed to make sure that medicines are only ordered when necessary. This is to reduce wastage and make sure medicine handling in the home is well managed. Not looked at during this visit. 21 9 13 The registered person must 14/05/2010 ensure that when medicines are prescribed for people to be given when required that there should be detailed guidance available to staff to help them decide when they should be given for that person. This is to make sure that medicines are given to people in the way their doctor has intended for them. 22 9 13 The registered person must ensure that medicines are given to people in accordance with the directions of the prescriber. All medicines must be recorded at the time of giving to people, and if medicines are regularly refused or not given, then the prescriber should be contacted for advice. 14/05/2010 Care Homes for Older People Page 15 of 32 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This is to make sure people receive their medicines in the way they are prescribed, to protect their health and welfare. 23 12 16 (2) n People living at the home must be provided with opportunities to meet their social and leisure needs. (Previous timescale of 08/05/09, 26/11/20009 and 05/01/2009 not met). 26/11/2009 To ensure that people are provided with social opportunities and stimulation. Not looked at during this inspection. 24 15 16 The registered person must ensure that systems are in place to make sure that all residents are offered and encouraged to have a main meal every day. To make sure that peoples dietary needs are met. 25 15 16 The registered person must ensure that systems are in place to make sure that all residents are offered and encouraged to have a main meal every day. To make sure that peoples dietary needs are met. 12/05/2010 01/05/2010 Care Homes for Older People Page 16 of 32 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Not looked at during this visit. 26 18 13 The registered person shall 20/04/2010 make arrangements to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. This relates to the lack of action on serious concerns raised about staff conduct. To make sure people who live at the home are safe. Not looked at during this inspection. 27 18 13 The registered person shall 12/05/2010 make arrangements to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. This relates to the lack of action on serious concerns raised about staff conduct. To make sure people who live at the home are safe. Timescale should read 20/04/2010. 28 18 13 The registered person shall make arrangements by training staff to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. To make sure that staff know how to keep people who live Care Homes for Older People Page 17 of 32 20/04/2010 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action at the home safe. ( Previous timescale of 20/04/2010 not met). 29 18 13 The registered person shall 12/05/2010 make arrangements by training starts to prevent service uses being harmed or suffering abuse or being placed at risk of harm or abuse. To make sure the staff know how to keep people who live at the home safe. Timescale should read 20/04/2010. 30 19 13 The registered person shall ensure that all parts of the care home to which service users have access are so far as reasonable practicable free from hazards to their safety. This refers to ruched carpets in service users private rooms To make sure that the risk of people tripping and falling is reduced. 31 19 13 The registered person shall 12/05/2010 ensure that all parts of the home to which service users have access are so far as practicable free from hazards to their safety. This refers to the lack of risk assessments in relation to unrestricted windows. To make sure people who live at the home are safe. Care Homes for Older People Page 18 of 32 30/04/2010 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action ( Previous timescale of 12/05/2010 not met). 32 19 13 The registered person shall ensure that all parts of the care home to which service users have access are so far as reasonably practicable free from hazards to their safety. This refers to ruched carpets in service users private rooms. To make sure that the risk of people tripping and falling is reduced. ( previous timescale should read 30/04/2010, not met). 33 19 13 The registered person shall 30/04/2010 ensure that all parts of the home to which service users have access are so far as practicable free from hazards to their safety. This refers to the lack of risk assessments in relation to unrestricted windows. To make sure people who live at the home are safe. 34 22 13 The registered person must ensure that all residents have a call bell accessible to them when they are in bed. To make sure that people can call for assistance whenever required. Not looked at during this Care Homes for Older People Page 19 of 32 12/05/2010 12/05/2010 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action inspection. 35 22 13 The registered person must ensure that all residents have a call bell accessible to them when they are in bed. To make sure that people can call for assistance whenever required. 36 26 13 (3) The laundry must have impermeable flooring fitted. Not looked at during this inspection. (Previous timescale of 07/07/09 and 26/11/2009 not met). This is to reduce the risk of cross infection. 26/11/2009 10/05/2010 37 29 19 The registered person must 15/05/2010 ensure that they are satisfied on reasonable grounds as to the authenticity of the references provided by applicants. To keep people who lived at the home safe from the risk of harm. 38 29 19 The registered person must 15/05/2010 ensure that they are satisfied on reasonable grounds as to the authenticity of the references provided by applicants. Care Homes for Older People Page 20 of 32 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action To keep people who live at the home safe from the risk of harm. Not looked at during this visit. 39 31 8 The registered person shall appoint an individual to manage the care home where the registered provider is not a fit person. To make sure that the home is effectively managed. 40 38 23 The registered person shall make arrangements for persons working at the care home to receive suitable training and fire prevention. To keep people who live and work in the home safe. 41 38 38 The registered person must ensure that all staff are trained in health and safety. To make sure that people who live and work in the home are safe. (Previous timescale of 22/02/2010 and 20/04/2010 not met). 42 38 13 The registered person shall 01/05/2010 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This refers to the temperatures of fridges and Page 21 of 32 10/05/2010 10/05/2010 20/04/2010 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action freezers. To make sure that fresh and frozen food is stored at the correct temperature to avoid the risk of possible food poisoning. 43 38 13 (4) The registered person must 26/11/2009 take appropriate steps to ensure that people live within a safe environment. This refers to improved infection control procedures. (Previous timescale of 07/0709 and 26/11/2009 not met) This is to make sure that people who live in the home are safe. Not looked at doing this inspection. 44 38 13 The registered person must ensure that all care staff have completed training in safe moving and handling. To make sure that people who live at the home are safe. (Previous timescale of 22/02/2010 and 20/04/2010 not met). 20/04/2010 45 38 23 The registered person shall 12/05/2010 Page 22 of 32 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action make arrangements to persons working at the care home to receive suitable training in fire prevention. To keep people who live and work in the home safe. ( Previous timescale of 12/05/2010 not met). 46 38 13 The registered person shall 12/05/2010 ensure that unnecessary risk to the health or safety service users are identified and so far as possible eliminated. This refers to the temperatures of fridges and freezers. To make sure that fresh and frozen food is stored at the correct temperature to avoid the risk of possible food poisoning. Not looked at during this visit. 47 38 13 The registered person must ensure that all staff are trained in health and safety. To make sure that people live and work in the home safe. (Previous timescale of 22/02/2010 and 20/04/2010 not met). Outstanding timescale should read 20/04/2010 48 38 18 The registered person shall 20/05/2010 make suitable arrangements to prevent infection, toxic Page 23 of 32 12/05/2010 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action conditions and the spread of infection at the home. This refers to the lack of training in infection control for staff. To reduce the risk of cross infection to staff and residents. 49 38 13 The registered person must ensure that all care staff have completed training in safe moving and handling. To make sure that people who live at the home safe. (Previous timescale of 22/02/2010 and 20/04/2010 not met). Outstanding timescale should read 20/04/2010 50 38 18 The registered person shall 20/05/2010 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the home. This refers to the lack of training in infection control for staff. To reduce the risk of cross infection to staff and residents. ( Previous timescale of 20/05/2010 not met). 12/05/2010 Care Homes for Older People Page 24 of 32 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, 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 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 statement of purpose/service user guide should make clear that the acting manager is not yet registered with the Care Quality Commission. The service user guide/statement of purpose should include a copy of the latest inspection report. The scene of purpose and service user guide should make clear that the home does not provide shower facilities. This was first recommended in the key inspection report of March 2010. 2 1 3 2 The terms and conditions of residency should make clear who is responsible for paying the fees. This was first recommended in the key inspection report of August 2009. Not looked at during this visit. 4 7 Urgent consideration should be given to making sure that all care planning documentation is fully completed, dated Page 25 of 32 Care Homes for Older People 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 and signed. This was first recommended in the key inspection report March 2010. 5 7 More effort should be made to obtain residents life history and use this to inform a person centred care plan. This was first recommended in the key inspection report March 2010. Not looked at during this visit. 6 7 Consideration should be given to reviewing the mental capacity assessments forms to make sure that they reflect individuals current status. The Mental Capacity Act assessment should only be completed by those qualified and trained to do so. First recommended in the key inspection report March 2010. Not looked at during this visit. 7 8 Urgent action should be taken to make sure that issues and concerns raised by the funding authority in their reviews are addressed. This was first recommended in the random inspection report 28th April 2010. Not looked at during this visit. 8 8 Urgent consideration should be given to providing guidance to staff and actions to be taken if fluid intake is below the recommended daily level. Urgent consideration should be given to setting up an audit system to monitor food and fluid charts. This was first recommended in the key inspection report of March 2010. 9 8 Urgent consideration should be given to offering residents at nutritional risk snacks routinely as per their identified Page 26 of 32 Care Homes for Older People 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 needs. This was first recommended in the key inspection report of August 2009. 10 8 Urgent consideration should be given to reviewing risk assessments on a monthly basis. This was first recommended in the key inspection report March 2010. 11 8 Residents should be offered a bath at least weekly. First recommended in the key inspection report March 2010. Not looked at during this inspection. 12 9 It is recommended that when handwritten entries or amendments are made to medicines charts that they are checked and signed by a second member of trained staff. This was first recommended in the key inspection report of March 2010. Not looked at during this visit 13 12 Urgent consideration should be given to the activity support worker undertaking appropriate training. First recommended in the key inspection report March 2010. Not looked at during this visit. 14 15 All residents who use a wheelchair should be given the opportunity to sit in a dining room chair at mealtimes if this is at all possible. This was first recommended in the key inspection report March 2010. Not looked at during this visit. 15 15 Urgent discussion should take place by the registered providers who are running the home with the cooks to make sure that specialist diets are provided. Page 27 of 32 Care Homes for Older People 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 This was first recommended in the key inspection report March 2010. Not looked at during this visit. 16 15 Urgent consideration should be given that staff remain in the dining room until people are finished their lunch in case they need assistance and so that they can have their meals with dignity. First recommended in the key inspection report March 2010. Not looked at during this inspection. 17 15 Cups should be readily available by the water cooler so that residents whoare able to, can help themselves to drinks. This was first recommended in the key inspection report March 2010. Not looked at during this visit. 18 15 Serious consideration should be given to drawing up a menu that is balanced, nutritious and reflects the dietary needs and choices of the people at the home. This was first recommended in the key inspection report March 2010. Not looked at during this visit. 19 15 Serious consideration should be given to asking residents if they want any supper before bedtime or a suitable bedtime drink. This was first recommended in the key inspection report March 2010. Not looked at during this visit. 20 18 Urgent consideration should be given to revising the adult protection policy so that it gives staff appropriate information and guidance on what constitutes abuse and what they need to do should they observe abusive practice Page 28 of 32 Care Homes for Older People 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 or receive an allegation. This was first recommended in the key inspection report March 2010. Not looked at during this visit. 21 18 The whistle blowing policy should include the contact details of the Care Quality Commission South West. This was first recommended in the key inspection report March 2010. Not looked at doing this visit. 22 19 Urgent consideration should be given to de registering the room which has a floor that vibrates significantly on a daily basis. (not currently occupied). This was first recommended in the key inspection report of March 2010. Not looked at during this visit. 23 19 Consideration should be given to the suitability of the plastic garden furniture. Consideration should be given to refurbishing the wooden bench that is in poor condition. This was first recommended in the inspection report of August 2009. Not looked at during this visit. 24 21 The provision of assisted bathroom facilities should be reviewed to ensure that they are sufficient to meet peoples needs. This recommendation was first made in the key inspection report of February 2009. Not looked at during this visit. 25 26 All clinical waste bins should be clearly marked, clinical Page 29 of 32 Care Homes for Older People 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 waste only. This was first recommended in the key inspection report of March 2010. Not looked at during this visit. 26 26 Service users toiletries should be kept in their private room. Bars of soap should not be left in the bathroom to be used communally. All service users should have their own nail brush, the nail brush labelled bathroom used communally should be disposed of. This was first recommended in the key inspection report of March 2010. Not looked at during this visit. 27 28 28 29 Efforts must continue to increase the number of care staff qualified to NVQ level II. All references should be dated and if they are not this should be looked into by the registered provider. Any gaps in employment should be discussed with the applicant at interview. This was first recommended in the key inspection report of March 2010. Not look at during this visit. 29 36 All staff should receive formal supervision at least six times a year. Staff should be given their own copy of the supervision record. This was first recommended in the inspection report of March 2010. Not looked at during this visit. Care Homes for Older People Page 30 of 32 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 30 36 Any staff returning to work following suspension should receive prompt and regular supervision. This was first recommended in the key inspection report March 2010. Not looked at during this visit. 31 38 Records should be kept the temperature of the fridges and freezers. Advice and guidance to staff should be provided on the acceptable range of temperatures and any action that should be taken if temperatures are found to be outside this range. This was first recommended in the key inspection report March 2010. Not looked at during this visit. 32 38 Urgent action to be taken to undertake weekly running of the water in vacant rooms to reduce the risk of legionella. This was first recommended in the key inspection report March 2010. Not looked at during this visit. Care Homes for Older People Page 31 of 32 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 32 of 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!