Inspection on 02/03/09 for Halsey House

This inspection was carried out on 2nd March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Halsey House 20/08/09

Halsey House 21/03/07

Halsey House 01/11/05

Halsey House 09/06/05

Halsey House 27/01/05

Halsey House 01/07/04

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Halsey House 31 Norwich Road Cromer Norfolk NR27 0BA     The quality rating for this care home is:   two star good 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: Jane Craig     Date: 0 2 0 3 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Halsey House 31 Norwich Road Cromer Norfolk NR27 0BA 01263512178 01263513630 smills@britishlegion.org.uk 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) : The Royal British Legion care home 74 Number of places (if applicable): Under 65 Over 65 74 0 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 1 The Royal British Legion is the leading charity safeguarding the welfare of those who have served in the Armed Forces, and their dependants. A major part of its work is to provide short and long term care for ex Service men and women and their dependents. Halsey House is one of the Legions seven nursing/residential care homes. Previously a school, the Home was opened by the Legion after the Second World War and now accommodates 74 people. It is set in delightful gardens and is a short walk from the centre of Cromer on the North Norfolk Coast. Halsey House comprises of an original house that has recently been refurbished, and a large extension. Most of the rooms are en suite and all rooms have access to a wide range of bathrooms and toilets. Lifting equipment is available when needed. The service caters for people who have nursing needs as well as those requiring personal care. There is 24 hour qualified nursing care, supported by the local medical practice. A licensed bar with pool table is enjoyed by people using the service and their guests, there is also a private chapel that is used for Sunday Services or for quiet contemplation. At the time of this key inspection the Care Homes for Older People Page 4 of 30 Brief description of the care home home was undergoing building work to enhance the accommodation. Information is sent out to anyone making enquiries about admission. The latest inspection report is available from the manager. At March 2009 the fees ranged from 420 to 660 pounds per week. Extras were charged for toiletries, hairdressing and private newspapers. 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: two star good 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: The last key inspection on this service was completed on 21st March 2007. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 2nd March 2009 by one regulatory inspector. At the time of the visit there were fifty five residents living at the home. We met with some of them and wherever possible asked about their views of Halsey House. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. Nine residents also Care Homes for Older People Page 6 of 30 returned questionnaires. We talked to the registered manager, staff and visitors. We looked around the home and viewed a number of documents and records. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. What the care home does well: What has improved since the last inspection? There had been significant improvements in the environment. Some residents had moved into a new building, which had a high standard of decoration and furnishings. Other areas had been refurbished. Throughout the home there was equipment to assist people to remain independent. Residents were satisfied with the home and their bedrooms. One told us, I fell in love with this room as soon as I saw it. There was a more thorough system for monitoring the quality of the service, which meant that residents had more opportunities to make their views known. The manager acted upon any suggestions for improvements. Care Homes for Older People Page 8 of 30 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process ensured that prospective residents had enough information to make a decision as to whether the home was suitable for them and staff had a clear understanding of the residents needs and how they were to be met. Evidence: New residents were given a copy of the Residents Handbook, which gave them a good idea of the facilities they could expect at the home. Eight out of nine residents who completed surveys indicated that they received enough information to help them to make a decision about moving in. One resident told us that they had a copy of the handbook and still referred to it from time to time. The manager was in the process of reviewing information about the home to reflect the changes to the environment. She was also exploring ways to make the handbook available in different formats, to help to make the information more accessible to prospective residents. Care Homes for Older People Page 11 of 30 Evidence: The manager advised that anyone who met the criteria for admission to the home was usually placed on a waiting list. When a suitable place became available the manager or deputy carried out a pre-admission assessment to ensure that the persons needs could still be met at the home. The assessment covered all areas of health, personal, social and spiritual well being and provided staff with comprehensive information about the persons strengths and needs in these areas. A member of staff confirmed that they were given enough information about new residents to enable them to provide the right care. A number of residents attended day care at Halsey House or had a short stay before they moved in permanently. One resident said that this had influenced their decision because they were comfortable with the place and the staff. Other prospective residents were encouraged to visit and spend some time at the home. Everyone who completed a survey had received a contract. Following a recent review of the admission process, the manager had started to send contracts out to people before they moved in. This helped to ensure that people were clear about the terms and conditions of their residency and had opportunities to clarify anything they did not understand before taking the final step of moving in. Standard 6 was not applicable as Halsey House did not provide intermediate 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs were met, despite some shortfalls in care records. Evidence: The home was introducing a system of person centred care planning that had been developed in conjunction with Bradford university. The new system encouraged staff to record detailed information about the residents needs, their preferences and how they wished to be supported. The staff were still receiving training on how to use the documents and as a consequence the standard of the care records varied. Some care plans were very specific. This helped to ensure that staff provided consistent care in the way the resident preferred and in a way that helped to maintain their independence. Other plans were too vague. For example, the plan for one person instructed that they needed to have their position changed regularly to prevent pressure sores but did not specify when. A member of staff we spoke to confirmed that the resident was turned but was not clear about how often it should be done. Care Homes for Older People Page 13 of 30 Evidence: Residents or their relatives were encouraged to participate in assessments and care plans, which helped to ensure that they had a say in how care was to be provided. Care plans were reviewed every month and plans were amended when changes in needs were identified. Seven out of the nine residents who completed surveys told us they were well looked after and they received the medical attention they needed. One wrote, I have lived here for 10 years and can honestly say I have always received the care and support that anyone could wish for. The other two who filled in surveys said they usually did. Care records showed that people had routine health checks and were referred to health professionals when appropriate. The service employed a physiotherapist and occupational therapist on a sessional basis. In addition to treating individual residents, the therapists assisted nursing staff to assess risks to residents health and draw up suitable plans. For example, there were some very detailed moving and handling plans on files. Plans were in place to minimise other risks caused by falls, poor nutrition and pressure damage. However, a number of residents had bed rails in place to prevent them falling out of bed. Two of the care plans we saw did not have risk assessments to evidence that this was the most appropriate and safe equipment to use. The annual quality assurance assessment (AQAA) told us that the service used the Liverpool Care Pathway to support people who need end of life care. This helped to ensure that the resident and their family received the individual support they required. Two residents had advance care plans that had been drawn up in consultation with their family and medical staff. Staff who administered medicines had appropriate training but there were some indications that the training was not always put into practice. Residents who managed their own medicines had risk assessments in place to ensure that they were able to do so. However, there was no evidence that staff reviewed the assessments or carried out checks to monitor that they continued to be safe. In one case staff were not clear about how a resident was storing their medicines. Other residents were happy for staff to manage their medication. One said, I dont have to worry about prescriptions they do it for me. Medication was stored in individual residents rooms in locked metal cabinets. There were records of medicines received each month. Prescribed creams were not always signed as being administered. It was not clear whether this was due to poor recording Care Homes for Older People Page 14 of 30 Evidence: or whether people did not always receive their medication as it was prescribed. There were no other gaps on medication administration record (MAR) charts. Records of medication to be disposed of were complete. There were some handwritten entries on MAR charts. These were not signed or witnessed which could increase the risk of transcribing errors. Some residents were prescribed medicines to be given when needed. There was a lack of clear guidance to direct staff when these should be given. This increases the risk of residents being under or over medicated. The instructions for some medicines were to take one or two tablets. Staff did not always record how many had been given, which meant that they would not be able to monitor how effective each dose was. Controlled drugs were stored, administered and recorded according to the policy. Staff received training on core values during their induction and NVQ training and during the course of the inspection we observed the majority of staff speaking to residents politely and with respect. The staff we spoke to described how they promoted residents privacy during their day to day work. One said, we always make sure we close doors and curtains when we are helping with personal care. Another commented, The residents room is their domain and we enter it with respect and ask before we do anything. Residents confirmed that staff treated them with respect. One said, they are very good, they dont talk down to people. 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. The daily routines, meals and activities suited the majority of people at the home. Evidence: Staff recorded very detailed information about residents lives, their preferences and interests. Although this was not routinely transferred to their care plan, the manager acknowledged that this should improve as staff have further training in person centred care. At the time of the visit residents told us they were satisfied with their lives at the home. One resident who had been at the home for a number of years said he was still very happy. Another said, I have no regrets at all, I am thrilled with the place. Although there were some staff led routines, such as the bathing rota, the staff we spoke to said they tried to ensure that residents were given as much choice as possible. One said, We know everyone so well we know what they like. Residents also described flexible routines and choice in all aspects of their daily lives. One said, there are not many rules, it is quite relaxed. A number of people went out regularly by themselves. One person said he appreciated Care Homes for Older People Page 16 of 30 Evidence: the fact that he was free to come and go. Another said they liked to go out for a daily walk. There were organised trips twice a week for people who needed more support to go out. There was an extensive programme of therapeutic, social and recreational activities for people to choose from. Half of the residents who filled in surveys indicated there were always activities they could take part in. One wrote, Every week day there is always something that you can join in if you so wish. In addition to the usual games, the staff responsible for organising activities tried to keep residents interests by introducing new pursuits. One resident told us she was really enjoying the art classes at the home. Another spoke about going to the air show and said there had been some very nice choirs recently. The manager told us that, following suggestions from residents, they were planning to install a gym and a computer room where residents could have lessons. The residents we case tracked had care plans to address their social and recreational needs. These comprised a list of activities they liked and disliked but the directions for staff were not specific enough about how they could help the resident to pursue their interests. There were a number of people who were not able or did not want to join in the group activity programme. For example, one resident wrote that they did not often join group activities because it involved them having to be hoisted into a wheelchair and it was too much for them. The manager told us that she was increasing the network of volunteers to ensure that these residents had more access to one to one support. There was a chapel in the grounds of the home and services were held every month. Care plans included instructions for staff about the residents wishes with regard to their spiritual needs at the end of their life. Visiting times were clearly displayed in the home and included in the residents handbook. The records of meals served showed that people were offered a varied diet with at least two choices at every meal. We observed the lunchtime meal. The dining room was attractively laid out. Residents tended to sit in the same place each time and their favourite condiments were on the table for them. The mealtime was a social occasion for most people. We saw some good examples of staff offering sensitive assistance to residents who were not able to eat independently but other staff were not as skilled and did not make attempts to communicate with the people they were helping. There were mixed views about the meals. Most of the people we spoke to said they Care Homes for Older People Page 17 of 30 Evidence: enjoyed the food. One said, On the whole it is good and the variety is good. The majority of residents who completed questionnaires indicated they usually liked the meals. One wrote, I dont eat meat and our chef usually provides an alternative such as fish. However, a few said the quality had deteriorated quite recently. One resident wrote that they never liked the meals, which they described as inedible. Other residents told us the food had, gone down hill, and, It used to be a lot better. There was a book in the dining room for residents to record their comments and these were a mixture of positives and negatives. The manager told us she was planning to invite some residents to join a group to look at meals and nutrition. Care Homes for Older People Page 18 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. Residents were protected by the complaints and safeguarding procedures applied in the home. Evidence: The complaints procedure was on display on the residents notice board and everyone was given a copy in their handbook. The procedure explained how complaints would be dealt with and when the person could expect a response. All the residents who returned surveys indicated that they knew who to speak to if they were not happy and they knew how to make a complaint. One person wrote, On the odd occasion I have had to make a small complaint there has always been someone on hand to talk to. The Commission had not received any complaints about the service. One minor complaint had been made directly to Halsey House since the last inspection. The records showed that the complaint had been investigated and resolved within the timescales set out in the procedure. The service had a clear procedure to inform staff about abuse and how to respond to any suspected or alleged incidents. They also had the local authority procedure to refer to. Care Homes for Older People Page 19 of 30 Evidence: New staff received training in safeguarding during their induction and were given refresher training every year. The staff we spoke to had an understanding of how to recognise abuse and knew who to report it to. The manager was also clear about her role. There had been no safeguarding referrals. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lived in a comfortable, safe and well maintained home. Evidence: From looking around the building we could see that the home was well maintained. There were regular safety checks to ensure that water temperatures were safe and fire and emergency call systems were in good working order. The home had undergone major refurbishment since the last key inspection. Some residents had recently moved into the new extension. The new building offered a high standard of furnishings and decoration. All rooms were single with en-suite facilities. Those that were occupied by residents requiring nursing care had overhead tracking for the hoist. One resident said, I like the tracking, it feels much safer. It is 100 percent better than my old room. There were a number of smaller lounges to ensure that residents had a choice of quiet areas as well as TV rooms. There were satellite kitchens to enable residents to make drinks and snacks when they chose. One resident described the facilities in the new area as Like a 5 star hotel. A new staff call system had been installed. However, the call points in the lounge areas were located in places that would make it difficult for residents who were not mobile to access them, even with extension leads. The manager said she would monitor this and Care Homes for Older People Page 21 of 30 Evidence: if necessary have extra call points installed. The older part of the building had been refurbished. All areas had been decorated and most had new carpets. Residents there were happy with their accommodation. One said they liked the fact that their room had character. Another said, I fell in love with this room when I saw it. The communal space in this area was also well thought out. In addition to serving alcohol at set times during the day, the bar also contained a drinks machine so that residents could help themselves to tea and coffee at any time. One resident told us that they liked to go to the bar because they could always meet up with someone there. There were a number of assisted bathrooms around the home. Care had been taken to make them as homely as possible. Some of the outside space was still inaccessible to residents because of the building work still going on. Courtyard gardens had been built to ensure that residents had safe places to sit and there were raised beds for those who enjoyed gardening. At the time of the visit the home was clean and free from offensive odours. Residents who returned surveys indicated it was always like this. One wrote, my own room is cleaned every day. Another told us they were glad to return from hospital because Halsey House was, much cleaner. There was a new laundry, which was well equipped for the size of the home. There were no complaints about the laundry and we observed that residents clothing looked well cared for. All staff had received infection control training and staff had appropriate guidance to follow in the case of an outbreak of infection. Care Homes for Older People Page 22 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. Residents were protected by the recruitment practices and staff had sufficient training to help them to understand and meet residents needs. Evidence: Most residents who completed surveys indicated that staff were usually available when they needed them. There were some positive and negative comments. For example, one person wrote, Staff have always been there for me no matter what time of day I make a request. However, another commented, There is a staff shortage whereby waiting for attention for the toilet can be uncomfortable. A third said that there was sometimes a delay in having their call bell answered. Staff also had mixed views about the staffing levels. Two staff said that there were always enough staff to provide good basic care and everyones health and personal care needs were met. However, they also said there was not always enough staff to sit and spend quality time with residents. The manager told us that this was more of an issue about the deployment of staff, although she was in the process of reviewing staffing levels because of the changes in the layout of the building. There was a clear recruitment procedure, and staff were recruited with regard to equal opportunities guidance. We looked at the files of two recently appointed staff. All the Care Homes for Older People Page 23 of 30 Evidence: required pre-employment checks were carried out to make sure that staff were suitable to work with residents. Their files were complete and contained all the relevant documents and information. New staff were supernumerary and worked alongside a supervisor for the first two weeks. They completed a thorough induction training programme which covered the standards recommended by the national training organisation. The training included written assessments to ensure that they had the basic knowledge to help them understand and meet the needs of the residents. Most staff continued on to do NVQ training and the AQAA told us that over half of the care staff were qualified to level 2 or above. Staff told us that opportunities for training were very good. In addition to the mandatory health and safety topics staff said they were able to attend other courses that were relevant to the work they did with the residents. The manager said that they tried to find courses to match staff interests. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and well managed and people living there are able to influence service development. Evidence: There had not been any changes in the management since the last key inspection. The registered manager continued to keep her practice up to date and attended clinical and management courses. She was supported in her role by a deputy and senior nursing and care staff. There were organised management and administration systems in place, which helped to ensure that the home was well run. Since the last inspection the British Legion had developed a new and comprehensive system for ongoing monitoring of the quality of their services. This included customer satisfaction surveys and internal audits of processes and records. The latest report for Halsey House identified areas of strengths and areas for improvement and included a plan of how they intend to make the improvements. The AQAA showed us that a Care Homes for Older People Page 25 of 30 Evidence: number of these service developments had already been started. There were regular resident and staff meetings which helped to ensure a good exchange of information. Residents who were not able or did not wish to attend were provided with a copy of the minutes. In addition to these formal mechanisms one resident told us, They are always coming round and asking is everything alright. The manager did not act as appointee for anyone at the home. Residents who were not able to manage their own finances had families or other representatives to assist them. A number of residents had small amounts of money held at the home for safekeeping. There were secure facilities and the manager told us that records were kept of any financial transactions. All staff received fire safety training and those we spoke with were aware of the procedure to be followed in the event of fire. The fire risk assessment had been reviewed and a new evacuation plan was being drawn up. Fire alarms were tested regularly and other fire safety equipment had been serviced. The AQQA showed that the maintenance and servicing of other equipment and installations were up to date, which helped to protect the health and safety of people living and working in the home. Care Homes for Older People Page 26 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 27 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 8 13 There must be risk assessments in place to support the use of bed rails. The assessments must be kept under review. In order to ensure that bed rails are appropriate and safe. 31/03/2009 2 9 13 People who administer their own medication must have risk assessments in place. The assessments must be kept under review. To protect the health and safety of residents who administer their own medicines. 31/03/2009 3 9 13 There must be complete records of all medication administered to residents. To ensure that residents receive their medication as it is prescribed and to continue the audit trail. 31/03/2009 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans should be detailed enough to ensure that staff have clear enough directions to provide consistent care in the way the resident prefers. To reduce the risk of transcribing errors, handwritten entries on MAR charts should be signed and witnessed. There should be clear criteria to direct staff when to give when required and variable dose medication. The position of the staff call bells in the lounges in the new unit should be reviewed to ensure that residents who are not mobile can call for assistance if needed. 2 3 4 9 9 22 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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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