Inspection on 21/05/09 for Greasbrough Residential Nursing Home

This inspection was carried out on 21st 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greasbrough Residential Nursing... 20/06/07

Greasbrough Residential Nursing... 01/03/06

Greasbrough Residential Nursing... 02/08/05

Greasbrough Residential Nursing... 25/11/04

Greasbrough Residential Nursing... 22/07/04

Greasbrough Residential Nursing... 01/07/03

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Greasbrough Residential Nursing Home Potters Hill Greasbrough Rotherham South Yorkshire S61 4NU     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: Ramchand Samachetty     Date: 2 1 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: Greasbrough Residential Nursing Home Potters Hill Greasbrough Rotherham South Yorkshire S61 4NU 01709554644 01709559332 NONE 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) : Dr M. H. Husain,Mrs. J. M. Husain care home 60 Number of places (if applicable): Under 65 Over 65 60 0 old age, not falling within any other category physical disability Additional conditions: 0 60 The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home with Nuring, Code 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, maximum number of places 60 Physical Disability, Code PD, maximum number of places 60 Date of last inspection Brief description of the care home Greasbrough Nursing and Residential Home is registered to provide accommodation and care for up to 60 older people. The home is situated on the main road in the centre of Greasbrough, on the outskirts of Rotherham. Dr. M H Hussain, OBE and Mrs. J M Hussain own the home and the day- to- day management is entrusted to the home s manager. The building is on two levels and there are passenger lifts to facilitate access between Care Homes for Older People Page 4 of 30 Brief description of the care home the floors. There are bedrooms and communal areas located on both levels. The main lounge, the dining room and the kitchen are located on the ground floor. The laundry is based in the cellar. All bedrooms are for single occupancy and have en-suite facilities. There is a pleasant courtyard within the centre of the building and there are other garden areas. There is a car park to the rear of the home. There is a statement of purpose and a service user guide. These documents give more information on the home and its facilities. The fees charged as at 21 May 2009, were between £383.00 and £445.00 per week. Further information can be obtained from the home. 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: This key unannounced inspection was carried out on 21 May 2009, starting at 09.45 and finished at 18.30 hours. The inspection was carried out by two inspectors of the Commission. The manager, Ms Pauline Mountford was present throughout the inspection. The registered provider was also in attendance for part of the time. The service is registered to provide personal and nursing care for up to 60 older people. There were 52 people in residence at the home at the time of this inspection. Thirty-four people were receiving nursing care. All the key national minimum standards for Care Homes for Older People were assessed. The inspection included a tour of the premises, examination of care Care Homes for Older People Page 6 of 30 documents and other records, including those pertaining to complaints, staff employment, staff rota, medicines management and maintenance of equipment and quality assurance methods. We checked and used some of the information contained in the homes Annual Quality Assurance Assessment that was provided to us at the inspection. We spoke to a number of people who lived at the home and to visiting relatives. We considered the views of staff and other professionals who were involved with the service. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We gave feedback about our initial findings to both the manager and the responsible individual. We would like to thank all the people living at the home, the relatives we met, the manager and her staff for their assistance with this inspection. What the care home does well: What has improved since the last inspection? What they could do better: Although assessment of needs of people who were admitted to the home were carried out by placing social workers, there is a need for staff to improve the way they carry out the homes assessment of needs of similar people. This will ensure that there are no gaps in the information, which is used to make care plans. The care planning system must be improved to ensure that individual care plans are based on all identified needs. Care plans must be properly implemented, recorded, evaluated and reviewed. The management of medicines must be improved in order to safeguard the health and wellbeing of people who live at the home. It is important for all staff who administer medicines to be trained or provided with refresher training. They also need to be deemed competent to administer medicines. Although the privacy and dignity of people who live at the home were generally observed, there were a small number of practices, which caused a breach in this practice. These relate to seating arrangements in the entrance area of the home and keeping care documents on a reception desk. Action must be taken to ensure that the privacy and dignity of people are protected and promoted at all times. Staff should review and improve the provision of social and recreational activities with regards to the needs, preferences and capabilities of people who use the service. This will help to further improve their quality of life. Care Homes for Older People Page 8 of 30 The homes complaints and adult safeguarding procedures need to be reviewed to make sure they give sufficient and relevant information to people who use the service. Also, the management of complaints must be improved to make sure that investigations and outcomes are clearly recorded and communicated to relevant parties. It is also necessary for managers ans senior staff to be able to use procedures effectively, in order to protect vulnerable people in their care, at all times. Although, the physical environment was well maintained and pleasant, there is a need to ensure that seating arrangements and the use of communal areas do not adversely affect the dignity and privacy of those who use them. The homes staff recruitment and selection procedures must be further improved to make sure that two written references are always sought and obtained before staff start working. We advised on the need to review the nurse staffing level to ensure that it is sufficient to meet identified needs at all times. We also recommend that the management roles be reviewed and clarified in order to improve the overall running of the home. Appropriate quality monitoring methods and quality assurance system must be further developed and effectively implemented in order to improve the service. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had sufficient information to help them choose the home. Peoples needs were assessed by social workers, before their admission, to make sure that such needs could be met. However, assessments of needs undertaken by staff at the home, were often inadequate and missed important areas of needs and this could affect the way their care was planned. Evidence: A statement of purpose and service user guide was available to people living at the home and to prospective clients. The manager confirmed that the service user guide had been amended and included an updated copy of the homes complaints procedure. People who used the service and relatives told us that they were given sufficient information to help choose the home. We checked the care files of three people who had more recently been admitted to the Care Homes for Older People Page 11 of 30 Evidence: home. They showed that their needs had been assessed by their social workers before their admission. Senior staff at the home had also carried out an individual assessment of needs for each of the three people. However, such assessments were inadequate and often missed out important areas of identified needs and this could affect the planning and provision of their care. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service said that they were satisfied with the care they were receiving. The planning, provision, recording and review of care was not always satisfactorily carried out. There were shortfalls in the management of medicines. These could affect the health and wellbeing of people who live at the home. Evidence: People who used the service told us that they were satisfied with the care that was provided to them. They said that staff were always pleasant and helpful. We spoke to a few relatives and they said that the care was generally good. Some relatives told us that they were aware that the home was going through a difficult time because there had been no manager for some time. They said they were confident that things would improve with the recent appointment of a new manager. People who lived at the home stated that personal care was always provided in private. However, we noted, at the start of our inspection, that some personal care documents were left in view at the reception desk. We also observed instances where people in the front lounge, which Care Homes for Older People Page 13 of 30 Evidence: was accessible to members of the public, were being hoisted to move in and out of their seats. The necessary procedures used, breached the individuals privacy and dignity. We looked at the care plans of three people who used the service. They were laid out as summary care plans and were broadly based on needs identified at assessments. Two of the care plans did not address all the needs of the people concerned. Risks were appropriately assessed and managed. There were gaps relating to psychological, nutritional and social care needs. Records of care provided to people were often generalised and failed to reflect the actual care given. This practice led to inadequate evaluation and review of individual care. In discussion, care workers told us that they were not tasked with making any records of the care they gave to people who required nursing care. This could lead to loss of information about care issues of people they were looking after. There were records indicating that care plans were reviewed on a monthly basis, but there was no information about how such reviews were done. Care records that we looked at showed that the health care needs of the people concerned were appropriately met. At the time of this inspection, a private chiropodist was attending to some people who lived at the home. Two of them had diabetes and they told us that they had difficulty accessing the national health services chiropody services at the time they needed it and therefore had to have recourse to a private service. We checked the storage, handling and administration of medicines. Adequate storage arrangements were in place. We noted that all medicines were managed by qualified first level nurses. The amount of medicines that were received at the home were appropriately recorded. However, handwritten entries regarding prescribed medicines were not always dated and thus gave no indication of a start date for their administration. There was no clear and consistent method of recording medicines which were to be given as required. We found two items of medicines which were prescribed for one particular person being used for other people at the home who were prescribed the same medicines. We checked a sample of medicines administration record (MAR) sheets. They showed that on a few occasions, staff had signed medicines as given but the medicines were still in their packs and had not actually been given to the people concerned. In discussion, the manager told us that she had carried out an audit of medicines at the home and had also found these shortfalls. She had put an action plan in place and taken corrective action. We saw a copy of the outcome of this audit and were satisfied with action being taken. Care Homes for Older People Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who lived at the home were able to benefit from some recreational and social activities that were available to them, but these were not always what they preferred or were capable of doing. People were satisfied with the meals provided at the home. Evidence: During our visit, we observed people who lived at the home, spending time in lounges and in their rooms, watching television and listening to music. A few people were being entertained by their visitors. A hairdresser was attending the home and providing her services to people who required them and this provided a lot of interest and social interaction among people. Staff interactions with people living at the home were mostly related to the care tasks they were carrying out. The activities co-ordinator stated that there had been fewer activities at the home during the time that the managers post was vacant. However, she had organised some activities and kept a record of them. They included sing-a-longs, indoor games and attendance at a few local events. We noted that these social activities did not always take peoples needs, preferences and capabilities into consideration. We spoke to relatives. They said that they were always welcomed at the home. They Care Homes for Older People Page 15 of 30 Evidence: said that, in their view, routines at the home were flexible and this helped their loved ones in their daily activities. They could make choices about the times they wanted to get up and retire to bed, what to wear and how to spend their time. During our visit, we observed the serving of lunch, which was the main meal of the day. A menu was displayed outside the dining rooms and showed food choices at mealtimes. The menu for the day comprised of gammon joint, fish, vegetables, chips and mashed potatoes. Deserts included ice cream, fruits and yogurts. Various drinks were offered. Lunch was served in two dining rooms. People in one dining room were served directly from the kitchen and the other from a hot trolley. Staff were observed offering and helping people make their food choices. The food, including liquidised portions were well presented. However, we noted that staff were using a trolley in one dining room, to clear food remnants away from plates whilst people were still eating their lunch. This practice affected the dignity of people. Staff gave assistance to a few people to eat their lunch, in a discreet and sensitive manner. People living at the home told us that the meals were very good and tasty. Care Homes for Older People Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people who used the service and their representatives were provided with sufficient information about the homes complaints procedures, the management of complaints was not satisfactory. The management of adult safeguarding issues was rather weak. These could affect the welfare of people who use the service. Evidence: There was a complaints procedure in place and copies were provided to people who used the service. The complaints procedure did not reflect various changes that had taken place and therefore contained some inaccurate information. People who lived at the home and their relatives told us that they were aware of the complaints procedure and some of them had used it. The manager had stated in the Annual Quality Assurance Assessment document that was provided to us, that the home had received four complaints in the last twelve months. We checked the way these complaints had been managed. We found that the records and outcomes of investigations were inadequate and unclear. It was not known whether some complaints had been appropriately concluded. The manager stated that the adult safeguarding policy and procedures used at the home were being reviewed and amended. Staff confirmed that they had received training on adult safeguarding issues and could protect people in their care. Senior Care Homes for Older People Page 17 of 30 Evidence: staff at the home said that they were aware of the procedures to be used in reporting safeguarding concerns. There had been a number of adult safeguarding concerns at the home and they related to some care practices. These were being investigated by the local multi-agency adult safeguarding team. Health and social care professionals indicated that appropriate procedures were not always followed. The registered provider and staff were involved in resolving these concerns and had taken remedial action to improve care provision. Some relatives told us that they were aware that the home had faced difficulties whilst there was no manager in post. They said that things were now improving and that they continued to be satisfied with the overall service. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well maintained and offered clean, safe and comfortable environment for people who lived in it. However, the use of a communal lounge area, which was also accessible to visitors, led to a breach of privacy and dignity of people who lived at the home. Evidence: We checked the premises in the company of the manager. The building comprised of two floors and there were a set of stairs and a passenger lift to facilitate access between them. The main entrance of the home was accessible to people who use wheelchairs. Personal accommodation for people who lived at the home was provided on both floors. The communal areas consisted of two dining rooms and several lounges. However, most people were observed using a large lounge in the front of the building, which shared its space with the entrance area. Visitors were therefore able to walk in the lounge, which people at the home would be using and this often compromised their dignity and privacy. In discussion, the registered individual agreed to review the use of the communal areas and the seating arrangements for people who lived at the home. The communal areas were clean, tidy and hygienic. We viewed a few bedrooms with the permission of people who occupied them. They were clean and well decorated and Care Homes for Older People Page 19 of 30 Evidence: well maintained. The main doors in and out of the home were kept secure to ensure the safety of people who lived at the home. Some people commented that they were encouraged to personalise their bedrooms with their own items of memorabilia. Kitchen and laundry facilities were adequately provided. One lounge area led to a patio, which was being furnished with garden furniture for the summer. The surrounding grounds were also well maintained. People living at the home told us that they were satisfied with their accommodation. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment and selection procedures and staff training were not sufficiently robust to promote the safety and welfare of people living at the home, at all times. Evidence: The home was registered to provide care for up to 60 people. At the time of this inspection, there were 52 people in residence at the home. Thirty-four (34) people were receiving nursing care and eighteen (18) were receiving personal care only. Besides the manager, there were two first- level nurses and eight care workers on duty. The manager stated that the staffing levels were based on the dependency of people who lived at the home. We noted that one of the nurses was working a 14 hour shift and that there was only one first level nurse was on duty between 17.30 and 21.30 hours. One of the nurses was from an agency and she was covering a vacant nursing post. The duty rota showed that one first level nurse and four care workers were scheduled to work at night. We noted that a number of staff had left the home in the last three months and this had led to increased use of agency staff. The manager explained that she was reviewing the staffing level and that additional nursing staff were currently being recruited. There were also additional support staff on duty and they included four domestics, two laundry assistants and an activities co-ordinator. The registered provider told us that Care Homes for Older People Page 21 of 30 Evidence: he had also employed a new member of staff to provide management support, but it was not clear how this persons role would develop. People who lived at the home and relatives told us that most staff were good, pleasant and helpful. They were happy with the care being provided. We looked at the files of three members of staff who had recently been recruited. All the necessary pre-employment checks, including disclosures, for two of the three staff members, had been sought and received before they were employed at the home. There was only one written reference for the third member of staff. One new member of staff told us that she had received induction training when she started working at the home and that this had included a session on moving and handling people. We spoke to five care staff. They had all achieved their National Vocational Qualifications (NVQ) level 2. The Annual Quality Assurance Assessment document indicated that 13 of 23 permanent care workers had achieved their NVQ level in care. In discussion, staff confirmed that they had received training on a range of topics, which included, moving and handling, first aid, fire safety, health and safety, adult safeguarding and infection control. They told us that professionals from the local social services department and the health trust had been visiting the home and providing some training to staff. However, members of staff still required training on mental capacity act, deprivation of liberty safeguards and refresher courses on mandatory training topics and on management of medicines. Care Homes for Older People Page 22 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. Although adequate management arrangements were in place to ensure the day-to-day running of the home, they were not clear about issues of accountability. Quality assurance methods were rather weak. These could affect the overall management of the home. Evidence: The previous registered manager had left her post in December 2008. A new manager was appointed in April 2009. She is a first level general nurse, who has experience of working and managing care homes. She has also achieved the National Vocational Qualification (NVQ) level 4 in care and management. She was applying for registration with this Commission. People who lived at the home, relatives and staff told us that the manager was good and committed to her work. They found her to be nice and approachable. Staff stated that they felt they could work well as a team for the benefit of people who used the service. In discussion, the registered provider told us that he had also appointed a member of staff to help with the management of the home. Care Homes for Older People Page 23 of 30 Evidence: However, it was not clear yet what this new role would be. We noted that the role and responsibilities of the administrator, who also acted as an activities co-ordinator were not clear and could affect the social care of people who live at the home. We looked at quality assurance methods that were being used to obtain feedback from people who used the service and their relatives. the manager stated that she was planning to restart Residents and Relatives meetings. The manager stated that a Residents survey had been organised and the findings would be used to improve the service. The manager stated that there were some audits, which included the management of residents personal monies and health and safety issues. However, we saw little evidence of any clear outcomes. The manager stated that she was reviewing the existing audits to make them more regular and more effective. The registered provider stated that he had restarted his unannounced visits to the home and his written report relating to these visits. We advised that these reports are used as a management tool to improve the service. The manager stated that she had put in place a supervision programme for the whole staff team and that staff were receiving them, at least, bimonthly. Staff confirmed that they were receiving such supervision. The manager explained that there procedures in place for the maintenance and servicing of appliances and equipment in use at the home. There were regular health and safety checks and fire safety drills. The passenger lifts had been serviced and certified by the required date. Staff told us that they had received training and guidance on health and safety issues in relation to both the environment and work practices. Arrangements were in place to support people living at the home with the management of their personal monies. The manager confirmed that all financial transactions undertaken on behalf of the people concerned were appropriately recorded, witnessed and signed and receipts kept. All individual accounts were regularly audited and any discrepancies were investigated and remedied. People who used this facility told us that they could access their spending money whenever they required it and were satisfied with it. Care Homes for Older People Page 24 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 25 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 12 Care plans must be appropriately developed, implemented and reviewed. Care provided must be appropriately recorded and evaluated. This will help to ensure that all care needs and changes in such needs, of each person are appropriately met. 07/08/2009 2 9 13 Handwritten entries and amendments in administration records must be appropriately signed and dated. Medicines administered must be appropriately signed for and also in a consistent manner. These actions are necessary in order to safeguard the health and wellbeing of people who use the service. 07/08/2009 3 10 12 The dignity and privacy and issues regarding confidentiality of people 07/08/2009 Care Homes for Older People Page 26 of 30 using the service must be protected and promoted at all times. This will ensure that their rights are upheld. 4 12 16 The social care needs of 07/08/2009 people using the service must be appropriately assessed and catered for, as part of their overall care. Social and recreational activities that are organised must reflect the preferences and capabilities of people using the service. This will ensure that people using the service receive sufficient social stimulation and therefore be able to benefit from an improved quality of life. 5 16 22 The complaints procedure 07/08/2009 must be reviewed and improved. Complaints must be appropriately acknowledged, investigated, recorded and concluded. Outcomes of complaints investigations must be appropriately communicated to complainants and records kept. this will ensure that issues raised and dealt with can contribute to service improvement. 6 18 13 The homes policy and procedures regarding adult safeguarding must be reviewed and improved. 07/08/2009 Care Homes for Older People Page 27 of 30 This will help in providing appropriate information to people who use the service and their representatives. It will also ensure that staff receive the required guidance in addressing adult safeguarding issues. 7 19 16 Seating arrangements and 07/08/2009 the use of communal areas must ensure that the privacy and dignity of people who live at the home are maintained and promoted at all times. This will ensure that their rights are upheld. 8 33 24 Effective internal audits and 07/08/2009 quality monitoring tools, which include the views of people using the service, must be consistently developed and implemented. This will assist in the continual improvement of the service. 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 3 Staff should improve the way they carry out assessments of needs of people before their admission, to make sure that they address all relevant areas of needs. The practice of clearing food remnants away whilst people are partaking their meals should be carried out away from dining areas, in order to uphold their dignity. The roles and responsibilities of staff in administrative and Page 28 of 30 2 15 3 31 Care Homes for Older People management positions should be clarified to ensure appropriate accountability and to ensure the proper running of the home and therefore promote the welfare of people who live at the home. 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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!