Inspection on 09/02/09 for Hare Lodge

This inspection was carried out on 9th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hare Lodge 30/04/09

Hare Lodge 26/02/07

Hare Lodge 13/03/06

Hare Lodge 19/12/05

Hare Lodge 14/09/04

Hare Lodge 11/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hare Lodge 57 Harebeating Drive Hailsham East Sussex BN27 1JE     The quality rating for this care home is:   zero star poor 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: June Davies     Date: 0 9 0 2 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 35 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 35 Information about the care home Name of care home: Address: Hare Lodge 57 Harebeating Drive Hailsham East Sussex BN27 1JE 01323849913 F/P01323849913 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Harebeating Care Company (Holdings) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 32 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 32 The maximum number of service users to be accommodated is 32. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home Hare Lodge is a large, detached, purpose built care home situated in a residential area of Hailsham, approximately one mile from the town centre. Accommodation is provided on two floors and a shaft lift is available to assist those residents who may have mobility problems. The home is registered to accommodate up to 32 older people with a dementia type illness. The registered owners are the Harebeating Care Company. The home provides care and support to residents who are both privately funded and those who are funded by Social Services. The home?s fees as from 01 January 2007 range from #366.00 per person per week to #600.00 depending on the funding Care Homes for Older People Page 4 of 35 Brief description of the care home arrangements. Additional costs are charged for chiropody (approx #10) hairdressing (#5.00-#30), newspapers and dry cleaning at cost. The homes literature states that the aim of the home is to provide a high standard of personalised care and support in a homely and friendly environment which is geared to the needs of individual residents thus enabling those in the homes care to enjoy as much independence and dignity as their own condition will allow them. Care Homes for Older People Page 5 of 35 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: zero star poor 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 the 9th February 2009, over a period of seven hours, during this inspection the inspector spoke with the Area Manager, the Manager, two members of staff, four residents and a visitor. Documentation relating to all the standards inspected were viewed, a medication audit was carried out, a tour of the home took place which covered communal areas and four residents bedrooms. The inspector observed a lunch time meal, and how staff respect the privacy and dignity of the residents in the home. Some information contained in this report was evidenced from the Annual Quality Assurance Assessment which was sent into The Commission by the manager of the home. Care Homes for Older People Page 6 of 35 Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: From pre-admission assessments the inspector found that care plans do not always reflect the wishes and needs of the residents. Daily reports were very holistic and did not show how residents are treated as individuals, or how their personal hygiene needs were being met. In some cases there was evidence that where pre-admission assessments gave guidance on how some health needs should be met this had not Care Homes for Older People Page 8 of 35 been carried through to the care plan or to the daily report. There was very little evidence that the residents and or their representatives are involved in pre-admission assessments or care planning. On one care plan the inspector noted that a resident had sustained some injuries, this was evidenced via a body map, but there was no written explanation in the daily report, and no evidence of what time these injuries had been noted. Another resident had been re-assessed in regard to their care needs but there was no evidence in the daily records to suggest why this re-assessment had taken place. Medication within the home is not well managed at the present time, it was noted that Monthly Administration Records are not always signed off when medication is administered, for two residents their medication had run out for several days. Prescribed creams are not entered on the Monthly Administration Records when applied. Instructions on the patient information sheet or on the prescription are not always carried out. While there was one item of evidence in the home that some entertainment had been arranged for the residents, there was no other evidence of good meaningful activities being carried out on a daily basis. Where unexplained injuries are noted by the staff, a good record should be made including the time that these injuries are noticed, and a Safeguarding Report must be drawn up and sent to the Local Authority Safeguarding Vulnerable Adults team. While staff training has improved more work needs to be done to ensure that all staff have received Health and Safety related mandatory training to safeguard residents from risk. The manager must also be pro-active in ensuring that at least 50 percent of staff working in the home have a National vocational Qualification. The manager must register with The Commission For Social Care Inspection. Where there is an accident or incident in the home this must be recorded in the accident book. 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 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-admission assessments while providing good information need to cover all headings as outlined by the Naitonal Minimum Standards to ensure all aspects of care are covered. Evidence: Pre-admission assessments were found to be informative in areas covered, but further information needs to be gained in respect as to how oral hygiene needs are going to be met, the chiropody needs of the resident, as well as gaining information in regard to revious social interests, hobbies, religious and cultural needs. Where a prospective resident is to be funded by a local authority, the manager ensures she obtains the care manager assessment. The inspector did note that none of the pre-admission assessments had been signed by the prospective resident and or their representative. The home does not offer intermediate care. Care Homes for Older People Page 11 of 35 Care Homes for Older People Page 12 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents personal wishes are reflected on pre-admission assessments, but the care planning system is not clear or consistent and there was little or no evidence available to ensure that residents wishes or needs are being met. The systems for medication administration are poor and potentially place residents at risk. In most cases personal support is offered to residents to ensure that their privacy and dignity is respected, but one incident showed that this is not being adhered to by all staff in the home. Evidence: The inspector viewed four care plans and while there was evidence that these had been reviewed on a regular basis, all the care plans contained holistic risk assessments. Where individual risk assessments are in place these should be kept up to date, and be more specific as to what steps staff should take in helping to reduce Care Homes for Older People Page 13 of 35 Evidence: the risk. There was evidence in pre-admission assessments of residents individual wishes but there was no evidence in daily reports that these wishes had been carried out for example one resident wished to be bathed daily [night or morning] but in daily reports there was only evidence of one bath being carried out in January of 2009, ten days after the resident had been admitted to the home, no other baths had been recorded. Another resident who had recently dislocated her shoulder had seen a physiotherapist who had given her exercises that should have been carried out twice a day for ten minutes, there was no evidence that these exercises had been carried out. One resident had recently been re-assessed as the home had concerns in regard to other residents safety and having the ability to meet this residents needs, there was no evidence in daily reports or the residents care plan, that anbody in the home was finding the residents behaviour difficult to cope with or why they were a risk to other residents, daily report only suggested that resident became agitated when wanting to go out. None of the care plans gave detailed recording of visits from chiropodists or other visiting health care professionals. There was no evidence that personal hygiene tasks had been carried out or supervised by staff, for example bathing, oral and dental care, nail cleaning, hairwashing, cleaning glasses. All daily reports stated all personal care given. Daily records can be a good source of evidence to show that care is being provided as detailed in the care plan, however the term - All care given - is not helpful or adequate. Daily records when well written, help ensure a consistant approach and good quality of care for the residents. In another instance the inspector noted in one residents care plan, that the body map showed that a resident has several bruises, a laceration, and soreness, there was no reference made to these wounds in the daily report and it was only through case tracking the the inspector found that this resident had returned to the home from hospital on the date of the body map. It was not clear if the resident had returned from hospital with these wounds and if this was the case what steps the home had taken in regard to following this up. Only one care plan had been signed by the resident. While the home has an up to date medication policy and procedure, and that residents prescribed PRN (as required) medication have a seperate PRN (as required) procedure behind each of their folder dividers in the Monthly Administration Record file, there are a number of errors in the administration of medication and in some cases the home has failed to obtain medication in a timely manner, which has resulted in two residents being left without important medication for a number of days. The inspector also noted that on some Monthly Administration Records, the medication had not been signed off as being given or had been signed off but the amount of medication administered contradicted the amount of medication received into the home. Liquid medications, eye drops and ointments had not been dated on the bottle, tube or tub when the medication had been opened. For one medication that has special instructions for Care Homes for Older People Page 14 of 35 Evidence: administration on the patient information sheet this had not been adhered to. There has been a previous requirement from the key inspection on the 26th February 2007 that medication must be recorded, handled, stored, administered and disposed of in accordance within the Royal Pharmaceutical guidelines and therefore a stutory regulation notice will be served in regard to medication. While the inspector observed that generally staff respected the privacy and dignity of the residents and talked to them in a friendly and respectful manner, there was one instance when the inspector was working on documents in the care office, that she heard a member of staff somewhere in the corridor ask a resident if they wished to use the toilet, this practice is unacceptable and does not respect the dignity and privacy of residents in the home. Care Homes for Older People Page 15 of 35 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. The systems for showing that residents choices and social needs are met are not clear. The meals in the home are good but menus need to be produced in a suitable format to enable residents to make a more informed choice. Evidence: There is no evidence in the daily reports that residents are able to make choices in regards to their daily living. At the present time the home does not have an acitivities co-ordinator, and there was no evidence of suitable activities being offered to residents on the day of this key inspecction. A notice on the front entrance door showed that there was some live entertainment being offered in February 2009. The manager did speak about her plans to offer residents meaningful activities in the home but at present this is not taking place. Residents must be offered more meaningful activities, and received one to one sessions from staff on duty, this should then be recorded in the residents daily report. There was evidence in one care plan that a resident had been taken to the local shops by both the grandson and the manager. Residents have made their own arrangements for their relatives or representatives to have power of Care Homes for Older People Page 16 of 35 Evidence: attorney for the finances. From a tour of the home the inspector noted that residents are encouraged to bring personal possessions into the home with them, photographs, pictures, ornaments, small electrical items and small items of furniture. The inspector observed a lunchtime meal and noted that residents are given choice. The menus reflect that food offered to the residents is wholesome and nutritious. Residents are asked in the morning what choices of meals they would like. There are no pictorial menus which would be better suited for residents with dementia to relate to. Specialised diabetic and liquidised diets are catered for at the present time. The liquidised diet has the food liquidised seperately and is served attractively. Care Homes for Older People Page 17 of 35 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. Residents and relatives know their complaints will be listened to and acted upon. The majority of staff have a good knowledge of Safeguarding Vulnerable Adults, but must be clear about recording and reporting possible incidents of abuse. Evidence: The complaints policy and procedure is up to date and displayed in the home. The home has received five complaints since the last key inspection. From viewing the complaints file the inspector found that these complaints had been properly recorded and a recorded investigation has taken place, with the complainant being informed of the outcomes. Any complaints made to the home is also sent to head office so that directors are aware of what is happening within the home, and can insure improvements are made. There is an up to date Safeguarding Vulnerable Adults policy and procedure in place. There have been no Safeguarding referrals made since the last key inspection. The inspector did have some concerns in that a body map showed a resident had sustained some injuries, which should have been raised as a Safeguarding referral. An issue found by the inspector at this key inspection in regard to medication was reported without delay to the Safeguarding of Vulnerable Adults team. Most staff have received training in Safeguarding Vulnerable Adults and further training has been arranged for Care Homes for Older People Page 18 of 35 Evidence: this February to ensure all staff are aware of Safeguarding Vulnerable Adults. From staff personnel files the inspector found that all prospective staff have Protection of Vulnerable Adults and Criminal Records Bureau checks prior to being deployed to work in the home. Care Homes for Older People Page 19 of 35 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. The standard of decor in the home is good, but some work needs to be done on communal bathrooms. The standard of cleanliness and infection control in the home is good, ensuring that residents are not at risk. Evidence: The home is purpose built and offers spacious accommodation and communal facilties for the residents. On the day of this key inspection the home was clean and tidy, and there were no offensive odours. Communal areas and bedrooms were in good decorative order. It was noted that communal bathrooms are rather institutional and two were in poor decorative order, of the seven communal toilets viewed one was in poor decorative order, two toilets needed the flooring replacing and another needed the non slip vinyl flooring re-sealing. In general all furniture was in good condition. Carpets both in communal areas and the bedrooms were in good clean condition. To the front and side of the home there is a secure garden area that residents are able to use freely when the weather permits. The home has a laundry room which on the day of the inspection was clean and tidy. The inspector noted that there were two washing machines, one industrial with sluicing facility and the other washing machine was more domestic in style and used for washing delicate items of clothing. The laundry room Care Homes for Older People Page 20 of 35 Evidence: had provision for washing hands and there was liquid soap and paper hand towels. There is a contract with an outside laundry for the washing of all bed linen. Red alginate bags are used for foul laundry. The area manager and home manager told the inspector that there are plans to extend the home in the near future. Discussion took place in regard to risk assessments being drawn up by the home for the residents and the contracted builders to provide the manager with their risk assessments. Care Homes for Older People Page 21 of 35 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 are employed in sufficient numbers to ensure that residents receive the care they need. The standard of vetting and recruitment practices are good and residents are protected from abuse. While many of the staff have received Health and Safety related training more work needs to be done to ensure that all staff receive this training and residents are not placed at risk. Each new member of staff is expected to complete Skills for Care related induction to ensure they have knowledge of the basic standards of care. Evidence: From viewing duty rotas for the past two weeks and talking to a visitor the inspector found that there are sufficient care staff on duty every day and night to meet the residents needs. The visitor said there is always someone around when I need them. Domestic staff are employed in sufficient numbers to keep the home clean and free from offensive odours. Everyday there is a Chef or a Cook on duty to cater for residents meals, and sufficient kitchen assistants are employed to assist with cooking Care Homes for Older People Page 22 of 35 Evidence: and cleaning the kitchen. A part time administrator is also employed to assist with keeping documentation up to date. At the present time 41 percent of care staff have achieved their NVQ level two or above, and the manager told the inspector that she is encouraging other care staff to sign on for their NVQ qualification. The inspector looked at staff personnel files for two members of staff employed since the last key inspection. The inspector found that both files contained an application form, although this form did not require a full employment history, but each file did contain a curriculum vitae and this gave full details of past employment. Both files contained Criminal Records Bureau checks obtained prior to the employee taking up employment in the home. There were two written references for each employee and two forms of identification, both files also contained a recent photograph. The inspector found that many staff have completed mandatory training in Moving and Handling, Fire Safety, Food Hygiene, First Aid, Infection Control, Safeguarding Vulnerable Adults but there are still gaps in training. As this training is mandatory all staff should complete their mandatory training within the first six months of their employment. The inspector viewed the training matrix for staff and found that some staff had also completed job related training. All new employees are required to be inducted into the home, and to complete a Skills for Care related induction in basic standards of care. Care Homes for Older People Page 23 of 35 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 manager has a good understanding of what needs to improve in the home but she must register with The Commission for Social Care Inspection. The quality assurance system in the home is good, but views of external professionals must be sought to ensure the views of all people who have contact with the home are sought. Health and safety is well managed in the home ensuring that residents live and staff work in a safe environment, but where accidents occur these must be entered into the homes accident book. Evidence: The manager has only recently been recruited to work as the manager at Hare Lodge, she has many years experience at management level within a care home setting, and has also obtained her RMN. The manager has yet to be registered as a registered Care Homes for Older People Page 24 of 35 Evidence: manager with The Commission for Social Care Inspection. During the course of this inspection the inspector noted that the manager is open in her management practices, and is available to both residents and staff when on duty. When rostered on duty the manager works hands on with the staff at some point during each shift. One member of staff spoke highly of the manager saying that she was approachable and always available. One visitor said that the manager always speaks with him everytime he visits, and he would have no hesitation about approaching the manager should he need to. The quality assurance system has been well developed within the home a little more work needs to be done in ensuring that stakeholders complete questionnaires in regard to their views of the quality of care offered in the home. The views of residents and relatives are sought, the manager carries out recorded monitoring of systems used in the home. The home is visited once every three months, by another manager from one of the homes within the group. Regular Regulation 26 visits are made and a report is produced on each visit. The clinical team manager carries out an annual visit to the home and issues an independent audit, these visits can be carried more often if there are issues in the home that need to be addressed. There is a Health and Safety and Fire Risk assessments carried out covering every room in the home. Where residents personal allowance money is kept for safekeeping by the manager a seperate account sheet is kept for each resident and all incoming and outgoing monies are recorded. Each residents money is kept in a seperate wallet, safely and securely within the home. The manager is planning to carry out one to one supervion of staff at least six times per year. These supervisions are recorded and kept securely in the office. The manager has a supervision plan and this shows when each supervision is due. As mentioned under staff training, health and safety related manadatory training has been given to most staff who work in the home, but further work needs to be done to ensure that all staff have been trainined in moving and handling, fire safety, food hygiene, infection control and safeguarding vulnerable adults. The inspector saw documentation showing that all equipment used in the home has an up to date maintenance certificate. A recent legionella check has been carried out of the water systems in the home. The premises is secure and the front entrance door is fitted with a number lock. All windows have window opening restrictors fitted. The health and safety policies and procedures are kept up to date. The inspector viewed the accident book, and found that on the whole accidents are Care Homes for Older People Page 25 of 35 Evidence: recorded appropriately, but it was noted for one resident that a fall recorded in the residents daily report in their care plan has not been written up in the accident book. Care Homes for Older People Page 26 of 35 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 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person shall - 13/03/2009 a. make the service users plan available to the service user b. keep the service users plan under review c where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service users plan; and c. notify the service user of any such revision. Service users care plans should be based on the preadmission assessment and reflect their wishes and needs, to ensure their assessed needs are being met in the home. Daily records should reflect all the physical and personal care needs of the resident where staff have supervised or assisted the resident in meeting these needs. Care Homes for Older People Page 28 of 35 Residents and or their relatives or representatives should agree to and sign the residents plan of care. 2 7 15 Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service users plan) as to how the service users needs in respect of his health and welfare are to be met. The care plan needs to reflect the residents wishes as obtained in the preadmission assessment. Failing to do this does not show that the home is considering the equality and diversity of the residents in the home. 3 8 12 The registered person shall 13/03/2009 ensure that the care home is conducted so as - a. to promote and make proper provision for the health and welfare of service users; b. to make proper provision for the care and, where appropriate treatment, education and supervision of service users. Evidence should be availabe to ensure that all personal care needs are being met this includes person and oral 13/03/2009 Care Homes for Older People Page 29 of 35 hygiene for the residents in the home 4 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Failure to obtain residents medication, or not record administration appropriately placed resident at risk. 5 10 12 The registered person shall 13/03/2009 make suitable arrangements to ensure that the care home is conducted a. in a manner which respects the privacy and dignity of service users. Staff are not respecting residents privacy and dignity where personal care needs are discussed in a public corridor. 6 12 16 The registered person shall 27/03/2009 having regard to the size of the care home and the number and needs of service users m. consult service users about their social interests, and make arrangements to enable them to engage in lcoal, social and community activities and to visit, or maintain contact or communicate with, their families and friends; n. consult service users about the programme of 07/03/2009 Care Homes for Older People Page 30 of 35 activities arranged by or on behalf of the care home, and provide facilties for recreation including, having regard to the needs of the service users, activities in relation to recreation, fitness and training. Residents must be offered suitable activities on a regular basis to ensure their social needs are being met. These activities must be circulated to all residents in formats suited to their capabilities. 7 15 12 2. The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. 3. The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. Residents must be able to choose their food from a menu format possibly pictorial that they are able to relate to 8 28 18 The registered person shall, having regard to the size of the care home, the statement of purpose and 27/03/2009 19/03/2009 Care Homes for Older People Page 31 of 35 the number and needs of the service users a. ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. At least 50 percent of staff working in the care home should have a NVQ qualification, to ensure that residents are receiving care from appropriately trained staff and that their needs can be met. 9 30 12 The registered person shall 27/03/2009 ensure that the care home is conducted so as a. to promote and make proper provision for the health and welfare of service user; b. to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. All staff should receive Health and Safety related mandatory training within the first six months of their employment to ensure that residents are not placed at risk. 10 38 17 The registered person shall - 27/03/2009 a. maintain in respect of each service user a record which includes the information, documents and Care Homes for Older People Page 32 of 35 other records specified in Schedule 3 relating to the service user. Schedule 3 j a record of any accident affectin gthe service user in the care home and of any other incident in the care home which is detrimental to the health or welfare of the service user, which record shall include the nature, date and time of the accident or incident, whether medical treatment was required and the name of the persons who were respectively in charge of the care home and supervising the service user. Where a resident has an accident or incident this must be recorded in the homes accident book should it be required for future reference. 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 Pre-admission assessments should cover all the headings as outlined in National Minimum Care Standards 2000. The resident and or their representative should sign up to their pre-admission assessment. The manager to ensure that incidents where a resident has sustained multiple injuries are reported without delay to the Sageguarding Vulnerable Adults team of the local authority. Some decorative work needs to be carried out in communal 2 18 3 19 Care Homes for Older People Page 33 of 35 bathrooms and one toilet, to ensure they are more domestic in character. Care Homes for Older People Page 34 of 35 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. 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