Random inspection report
Care homes for older people
Name: Address: Hawthorne Lodge 164/166 Hawthorne Road Bootle Liverpool Merseyside L20 3AR zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Claire Lee Date: 0 6 1 1 2 0 0 9 Information about the care home
Name of care home: Address: Hawthorne Lodge 164/166 Hawthorne Road Bootle Liverpool Merseyside L20 3AR 01519333323 Telephone number: Fax number: Email address: Provider web address: Lea@hawthornelodge.co.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Stirrupview Limited Property & Estates care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 25 Date of last inspection Brief description of the care home Hawthorne Lodge is registered to provide personal care for twenty five older people. The home is a mock Tudor style building located on the corner of two busy streets in Bootle. Due to its location there is good access to public transport and many local facilities are a short journey away. The shared areas include two lounges, a dining room and small back garden. Bedrooms are either single or double rooms. The home
Care Homes for Older People Page 2 of 22 Brief description of the care home has a passenger lift and there are chair lifts to access rooms that have a number of stairs to them. A keypad fitted to the front door and other doors are alarmed so that staff are aware of and can offer assistance to any resident who wishes to go out. Bathrooms have equipment to help residents with bathing arrangements. Residents have the use of a call bell with an alarm facility. CCTV cameras view public areas only. There is car parking space to the side of the premises. The weekly fee rate is three hundred and eighty three pounds a week. Care Homes for Older People Page 3 of 22 What we found:
The key inspection for this home was conducted on 19th August 2009. Following the inspection the home was rated by the Commission as poor, zero stars. This unannounced random inspection took place to monitor progress in relation to requirements issued at the key inspection. People accommodated at the home must receive a safe service. This inspection will not change the Commissions rating of the home. The medicine requirements were not assessed at this time. The Commissions pharmacist will be conducting a pharmacy inspection at a later date to follow up on the last pharmacy inspection and formal action taken by us to improve medicine administration in the home. The random inspection was conducted by two inspectors for approximately eight hours. We met with the manager, and an external care consultant who has been brought in to help the manager improve the service. Mr Hornby, the owner was present for the feedback. To find out what people thought of the home we met with residents, visitors and staff. We also undertook a tour of the premises and looked at records relevant to the service. For example, care records, staff training and recruitment, policies and procedures and health and safety. Our findings from the inspection are stated under what the service does well and what the service could do better. What the care home does well:
This was assessed in relation to improvements made since the key inspection in August 2009. Choice of Home: There are documents providing information regarding the service. These are called the service user guide and statement of purpose. The Commissions contact details are now available in the documents, so that members of the public, residents and staff can contact us if they wish to raise a concern or require general advice. The manager said she is looking to put a welcome pack together for prospective residents and this will include photographs of the accommodation. It is a requirement to display the Commissions Certificate of Registration under the Care Standards Act 2000. At the time of the last key inspection the owner had not displayed this certificate, which is an offence against this Act. The Certificate of Registration was seen to be displayed at this inspection. The manager has introduced a new assessment document for assessing residents health and social care needs. There have been no new residents admitted since the last key inspection, however we were advised that this form would be used. The assessment looks at residents daily activities of living, past medical history and medication. It is recommended that if a resident is at risk of falling, then further information is obtained from the resident, family member or a relevant health care professional. This is so that the staff have the information they need to fully support the person with a plan of care. Care Homes for Older People Page 4 of 22 Daily Life and Social Activities: Social arrangements in the home have improved. Residents have recently enjoyed a trip to Blackpool and also a fire work display. An activities plan was displayed in the main hall and residents and staff were taking part in a sing a long during the afternoon of the inspection. A relative commented on how much their family member enjoyed the Blackpool lights. During the inspection an activities record was put into the care files to record what social events the residents have taken part in. This will help to evidence their participation and enjoyment for planning future events. Residents have a menu which offers them a choice of hot and cold meals at different times of the day. A daily menu was displayed in the main hall. The manager stated that new dining room furniture has been purchased as the majority of residents attend this room for their meals. Environmental health and cleaning records for the kitchen were available to evidence satisfactory standards of food control at this time. Relatives spoken with raised no concerns at the time of the inspection and said that their family members were comfortable living at the home. What they could do better:
Health and Personal Care: Requirements were given at the last key inspection with regard to recording the care needs of the residents and ensuring their health care needs were met. Resident care files were looked at to assess whether improvements had been made. The care files seen contained a number of care documents and the manager has introduced new care plans to help improve the care planning. Concerns remain however, regarding the content of the care plans and associated documents. Care plans seen did not record accurately residents current health needs and staff did not have all the relevant information they needed to support them safely. Basic details had been recorded only. There is risk therefore that the residents care needs are not properly identified and they do not receive person centered care to promote their health. This was noted in different areas, for example, residents who have repeated falls at the care home and needed hospital treatment, or residents who needed extra support with pressure area care or diet so that staff could care for them appropriately. With regards to health monitoring, staff must be aware of when to contact external health professionals to seek advice and support. This is particularly important for residents who have repeated falls. Care files looked at showed that there is a lack of staff awareness on how to provide the care and support they need, to seek advice at the appropriate time and how to manage the risks to help keep them safe. There was no evidence to support the fact that residents and/or their relatives had given their consent to the plan of care or had been involved with any care reviews. This is important when a resident has suffered a fall or change is instigated in care or treatment. They should be advised at at all times regarding this as a mark of respect and to ensure good communication. Some monthly care reviews had been completed by the staff. These were a statement rather than a summary of care over a period of time and again did not always reflect a residents current health. For example, the number of falls a
Care Homes for Older People Page 5 of 22 resident has had, factors that may contribute to them and how the risks are being managed. This information helps to protect their welfare. A number of risk assessments for the residents were seen, for example, moving a resident safely, their nutrition and dependency on staff. These like the care plans were only completed in basic detail rather than giving staff up to date detailed information regarding the risk and how best to minimise it. Information recorded on the current care plans and the lack of risk management place people at risk. Accident reports were seen in relation to residents falls. These had basic details of the incident and apart from one, the report did not record whether the families were informed. Daily care records and the hand over sheets completed by the staff did not always record the accidents and there was none or little written evidence with regard to the support given by staff following a fall. It is strongly recommended that record keeping be improved aas a lack of written information relating to incidents has the potential to place people at risk. Environment: At the last key inspection in August 2009 the fly screens at the kitchen windows were torn. These were replaced but are now torn again. It is recommended that new screens be purchased to help ensure good environmental standards in the kitchen. Hawthorne Lodge is registered for twenty five older people. At the time of the inspection seventeen people were accommodated. A tour of the building took place and it was noted that a number of areas still require attention to improve the accommodation for the residents. Some of the issues identified put the people living in the home at potential risk and we issued some immediate requirements so that these could be addressed urgently. There were six requirements issued at the last inspection, the home have tried to address some of these and have made some improvements. For example, there is now a maintenance book so that staff can document any maintenance work needed on a daily basis and this can be attended to and an audit trail can be provided. The front and side of the building has had some paint work completed. There are now hand wash facilities in the toilets and bathrooms. The dining room has been decorated. There is also a fire maintenance contract so that the fire system can be upgraded. Some areas of the home, notably the bedrooms, are now cleaner than on the previous inspection. The trailing plant across one bedroom window has been removed so that the person can now see out the window and there is more light. Despite these improvements however, we remain concerned that lack of progress in many areas still leaves the home poor in terms of overall presentation and maintenance. The following was observed and remain unchanged from the previous inspection three months ago. A number of bedrooms viewed required decoration and new furniture. For example, some beds had no bed heads. One bed observed had a broken bed head which was leaning at an angle. One wardrobe was in a poor state of repair and another wardrobe had doors that would not close. Window restrictors have been repaired, so that people are safer from the risk of falls from upper level windows. The nature of the placement of the restrictors means however, that it is very difficult for people to open and close windows effectively. This means that rooms cannot be ventilated. In two
Care Homes for Older People Page 6 of 22 bedrooms windows cannot be closed at all, as the ropes that work the closing mechanism have been removed without any recourse to an alternative method. These rooms may therefore be cold and difficult to heat. There were numerous other snagging maintenance jobs that needed to be attended to, such as the lack of a cold water tap in one room and a soap dispenser loose in one toilet so that it would not work properly. The shared room identified on the previous inspection still has no screening available to ensure privacy. We discussed the need for this with care staff as, although no longer urgent as the second person sharing has now been given their own room, this would still be needed in the future if people were to share. We would strongly recommend the introduction of fixed curtains, as these can be easily manipulated by elderly people and would therefore provide more independence. A number of bedrooms were also being used for general storage, for example mattresses and odd items of furniture. We were concerned that in one persons bedroom there is a disused, broken TV stored. The person concerned said this did not belong to them and was possibly some one elses. We identified this to the manager. Secondary double glazing in two bedrooms was still held open by a box. Aesthetically this looks poor but more importantly it is again difficult for elderly people to manipulate these screens and may actually present as a risk of injury [for example trapped fingers]. It was noted that some of the larger bedrooms had pleasant decor but this was not found throughout the home. Bed linen seen still appeared washed out due to general wear although we were advised that new linen has been ordered. Again, some pillows did not have pillowcases. Bathrooms remain generally bare and institutional in design. There were bath hoists and a special bath which, would be beneficial for residents with limited mobility but is not used. The bath had not been cleaned for some time and had bits of debris and dead leaves in it. The walk in shower on the ground floor is still being used for general storage. Some areas of infection control in the home have been improved, such as many of the toilets and bathrooms now have liquid soap and paper towels. This enables the staff and residents can wash their hands. We did find however, that both managers and staff have limited understanding of the needs around control of infection in the home, so that there is no overall policy or understanding. This is exemplified, and we were particularly concerned, by standards of laundry management and cleanliness of some equipment used for care. The laundry was inspected and was found to be in a poor state of hygiene. There was dirt collected on the window frames and ledges and also on water pipes. There were no hand washing facilities, as there was no liquid soap or paper towels. There were no protective aprons or gloves for staff to wear. We observed commode pots underneath the sink and were advised that these are cleaned here. This may provide a major source of cross infection, as clean linen and clothing is stored nearby. The door to the garden was left open and there was a regular stream of staff walking through the area to go out side and smoke. One resident also wandered into the laundry. We understand that dirty linen and used commode pots are taken to the laundry through the dining area. The policy and procedure document for the home has been newly formulated but is not specific to the homes needs. For example, it states that the home has a designated laundry worker, which was not the case.
Care Homes for Older People Page 7 of 22 All of the above puts the people living in the home at risk due to poor adherence to good practice around infection control. We require the manager and provider to review the way laundry is managed and provide a safe service. We observed poor cleanliness and hygiene with respect to the maintenance of wheelchairs being used for residents. Those in use were dirty and could potentially provide a source of infection. Additionally, the trolley in the dining room was observed to be in a poor state of cleanliness. This could potentially provide a source of infection. We served the manager with an immediate requirement notice for the above so that they could be attended to urgently. We made a requirement at the previous inspection for a system of risk assessments to be undertaken, so that environmental hazards could be identified and then a programme of management could be instigated. We found this to be poorly devised, so that the issues we have identified in this section of the report have not been picked up by the managers. We were shown the risk assessments carried out so far, since the last visit, and these identified only three areas of the home. Given the urgency of the previous, and new findings, we are surprised that this has not been given greater urgency. Another example of poor management of the environment and lack of any progress is the smoking area near the dining room. There is a very small smoking lounge for residents who wish to smoke. The wall paper and hand sink were dirty, the armchairs and carpets had numerous cigarette burns and the ash tray was full. The only positive change has been the installation of an extractor fan. We were concerned that in addition the room has now got a drinks machine installed. The electrical wiring for this is near and around the sink and taps. The manager is trying to get the installation company to remove it but we are concerned that there is a general lack of planning and awareness when making such decisions. We spoke to the maintenance person who is involved in some routine checks of the environment but these seem to be carried out arbitrarily without reference to an overall health and safety policy or understanding of why they are important. This is discussed further in the management section. This lack of overall planning means that people may be put at risk. Another example of apparent lapse of overall control was the observation we made of prescribed lotions for a resident stored in an unsecured cupboard in one bathroom. These must be locked away when not in use. This had also been identified on the previous inspection report. This requirement for safe storage of medicines will be assessed at the next pharmacy inspection. We also observed people being moved around in wheelchairs without any footrests in place. Again, this very obviously puts people at risk of injury. We made an immediate requirement for this practice to cease. There are two lounges. One situated on the ground floor and one on the first floor. The ground floor lounge is used by the majority of the residents. Several of the soft chairs were dirty and in need of cleaning or replacement. Again, this has been identified at the last inspection but not acted on. Overall residents are currently still not living in comfortable accommodation and the lack of maintenance in relation to health and safety has the potential to place them at risk.
Care Homes for Older People Page 8 of 22 Complaints and Protection The requirement here is for staff to have training and to have awareness and understanding of abuse and how this should be reported if needed. The manager advised us that staff have had training in safeguarding over the last few months and this was confirmed by existing records and also by talking to staff in the home. The training consisted of watching a DVD and then completing a questionnaire. We spoke with staff who were able to display some understanding of the nature of abuse and how this can be initially reported to the manager of the home. Staff were unaware, however, of the wider context of reporting any allegations to statutory bodies such as social services and their role in any investigation. This understanding is important for senior staff particularly who may be left in charge of the care home, so that any issues are dealt with through the proper channels. We would require that the manager reinforces any previous training by ensuring that senior staff in particular are conversant with the contact details for the local safeguarding team. We spoke with the manager who said she understood the reporting process but could not produce a copy of the local safeguarding procedures for reference. Staffing: We looked at the two requirements made previously. These were for adequate procedures for the safe recruitment of staff so that people in the home are protected and the induction of staff when they commence employment. We looked at four staff records including the new manager. One staff had worked in the home for two years. There were anomalies in the method of recruitment. For example a criminal record check had been made [CRB] but this was dated some two months after the recorded start date. There was no evidence of any Protection of Vulnerable Adults [POVA] check having been made prior to employment to help ensure that the person was safe to work with vulnerable people. We were also concerned that suitable references were not on file. The references listed in the application form had not been taken up and the only reference on file was from another carer working in the home. We looked at more recently employed staff files. One staff had started work at the time of the last inspection and had been identified as having no staff records at all during the inspection. At the time we advised the manager that the person could not work until suitable employment checks had been made. The staff file inspected on this visit contained a CRB disclosure. There is a requirement for two written references however and only one of these was on file. This reference is from a person also not listed on the application form who has given a character reference. One staff has been employed recently. Again we could find only one reference on file. We could also not find any reference to a CRB check. The manager stated that she had seen this but could not produce a copy. The staff member concerned said that the CRB had been done. The manager said that such information is kept in a confidential file but could not locate the file when we asked for it. There was no actual start date listed on file.
Care Homes for Older People Page 9 of 22 We looked at the managers staff file. This had again been identified on the previous inspection as breaching regulations around recruitment, as there had been no recruitment checks including CRB completed by the provider [owner]. We had made a requirement that these were to be completed urgently [target date 19.10.09]. We are concerned that the checks are still not on file. We were advised that there are problems with the umbrella body responsible for processing the CRB. The POVA check, which can normally be accessed shortly after application to the CRB was also not on file. Overall the failings in the recruitment procedure for the home are still evident and this breach of regulations puts people living in the home at risk, as staff may not be suitable to work with vulnerable people. The other requirement was for new staff to have an induction programme. We looked at staff records for two staff more recently employed. One staff had a basic induction checklist completed and has also undergone some training in moving and handling, safeguarding [abuse awareness] and fire safety. The staff concerned has also commenced some NVQ (National Vocational Qualification) training. The other staff file contained no evidence of induction. This was for a person who is working in the kitchen. There was a training matrix in the staff file but there was nothing written on this. The staff concerned advised us that she needs to update her basic food hygiene certificate. The manager has also completed a staff handbook, so that new staff can be acquainted with how the home is run and some key policies and procedures. Overall there have been improvements here although there is still a need to ensure that the induction programme is in more depth and meets the common induction standards for training. Management and administration: We previously required some review of the quality of service be completed. This is so that some baseline could be established for developing the service which also includes the views of the people living in the home and their supporters [families, advocates etc]. The home have employed an external quality auditor and we were shown the outcome of this and the various recommendations. The manager is currently working through the recommendations, some of which reflect the findings in this report. We asked for evidence of the providers [owners] input into the care home. Formally this is evidenced by the completion of monthly unannounced visits, where the owner completes their own audit of standards in the home and produces a report [Regulation 26 report]. This provides extra feedback for the manager. We were given only one copy of such a report dated June 2009. Given the current nature of the concerns of regulators we are concerned that the provider has not ensured regular and consistent monitoring of the quality of care in the home. We would require that these visits and reports are consistently made available to the manager. A requirement was previously made for all staff to have necessary training in safe working practice areas. This was identified in the report as moving and handling, food hygiene, infection control and first aid. From looking at records and speaking to staff only moving and handling training has been actioned from this list since the last inspection.
Care Homes for Older People Page 10 of 22 Given the findings of the previous inspection and also this inspection in terms of infection control issues, the need for training for staff in food hygiene and infection control are paramount and need to given urgent priority. There is also no first aid policy available and none of the current staff are trained so statutory requirements to provide a trained person for first aid are not met. Again these failings put people at risk as staff are not trained and competent to deliver these areas of care. We looked at the requirement for fire safety records and fire training to be initiated and maintained. The manager informed us that the fire officer has been to advise and that there has been progress in this area. There is a completed fire risk assessment and staff have received initial training in fire safety. We looked at some records that are being maintained and fire alarm checks and checks on emergency lighting are being maintained. We are again concerned however, that despite records being made there is still alack of action when issues are highlighted. For example the routine audits conducted show that that fire doors in the corridor and kitchen are not working. We were shown the doors by the maintenance person. The kitchen door has a fire guard apparatus to ensure the door closes in the event of a fire. It is activated by the sound of the alarm. This is not working however and the door was observed to have a wedge underneath it. The fire door on the ground floor corridor also has fire guard apparatus. The power light is on but we were informed that when the alarm sounds it does not close. This has been recorded in the maintenance record since 28/9/09 but no action has been taken to correct it. This shows that environmental hazards that are identified are still not acted on. Our overall impression is that the maintenance person completes arbitrary checks, which are not based on any assessed risk or need in terms of planning time to meet an appropriate schedule. Those failings recorded [eg fire doors] do not seem to be acted on. The maintenance book should now provide an audit trail but there remain a lot of snagging jobs which we observed on the tour of the home. Staff do not seem to be reporting these things through and there does not seem to be any methodical auditing in progress. There is a lack of overall management of health and safety, which starts with the absence of an overall policy statement identifying who is responsible for carrying out the policy in the first place and also identifying key areas [although some individual policies relating to health and safety have been commenced]. There is currently no person in the home who has any formal training in health and safety so that overall management can be monitored. This includes care staff who have not received basic training in health and safety and who may not fully understand their role in maintaining safe standards. The report has highlighted continued and ongoing management failings in a number of areas. We spoke to the manager who has been in post for three months and the owner regarding this. Although there has been improvements in some areas, these are patchy and there has not been any significant progress in meeting the key requirements that protect people living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 11 of 22 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 Residents care plans must accurately reflect their current health and social care needs. Staff must be provided with the information they require to support residents effectively and safely This will help to ensure the residents needs are met in a safe and supportive manner 30/09/2009 2 9 13 Effective systems must be put in place to ensure that any service user who selfmedicates is assessed to ensure they can do it safely. This is important so that people receive the right amount of support to do it safely. 12/11/2009 3 9 18 Effective systems must be 12/11/2009 put in place to ensure that staff responsible for the administration of medication are competent to do so safely. This will help make sure they have the necessary skills to do it safely. 4 9 13 Effective systems must be put in place for the 12/11/2009 Care Homes for Older People Page 12 of 22 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is important to help make sure medicines are handled safely. 5 9 13 Effective systems must be 12/11/2009 put in place to ensure that all medication received into the home and any medication administered, disposed of or returned to the pharmacy is recorded This is important so all medicines can be fully accounted for. 6 9 13 There must be a legally compliant controlled drugs cupboard available in the home. This will help prevent mishandling and misuse. 7 9 13 Effective systems must be 12/11/2009 put in place to ensure that prescriptions and instructions from medical professionals are properly recorded and followed so that administration errors do not arise. This will help make sure medicines are handled safely. 8 9 13 Effective systems must be 12/11/2009
Page 13 of 22 09/01/2010 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action put in place to ensure that any medication administered by care staff or self administered is properly recorded, and any nonadministration is accounted for. This will help make sure medicines are handled safely. 9 19 13 A risk assessment must address all risks within the environment. For example, trip hazards, window restrictors, damp and general maintenance This will help to ensure residents have safe, well maintained accommodation 10 19 23 A programme of maintenance and decoration of the home is needed as areas are in need of repair and attention This will help to evidence work undertaken and planned to improve the environment for the residents 11 20 23 Suitable furnishings and fittings are required in the communal areas This is to help ensure the comfort and safety of the residents 12 24 16 Residents require new 19/10/2009
Page 14 of 22 30/09/2009 30/09/2009 30/09/2009 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action furniture and fittings for their private rooms This will help to ensure residents live in private accommodation to assure their comfort and privacy 13 26 13 All areas of the home must be kept clean This will help to ensure residents live in a clean environment where the risk of cross infection is minimised 14 29 17 Staff must be recruited safely This will help to ensure the ongoing protection of people who use the service 15 38 18 Staff require training in safe 19/10/2009 working practice areas. These are particualy specified for infection control, first aid, and health and safety This will help to ensure they have the skills and knowledge to undertake their work safely 19/10/2009 30/09/2009 Care Homes for Older People Page 15 of 22 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 1 22 13 All equipment / aids used for 09/11/2009 people living in the home must be maintained and used in accordance with safety requirements. All wheelchairs in use should therefore have footrests fitted when moving people in them. This will help to ensure the equipments used safely 2 26 13 All equipment used to care 09/11/2009 for people living in the home must be kept in a clean and hygienic state.This includes wheelchairs in use and the trolley in the dining area This will help to reduce the risk of cross infection and protects people living in the home 3 26 13 The manager must ensure 09/11/2009 that there are suitable procedures in place for the management of the laundry which follow good practice guidelines regarding infection control This will help to ensure that the management of laundry does not present as an unnecessary source of infection Care Homes for Older People Page 16 of 22 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 8 13 Risks to residents health must be identified in their plan of care This will help to ensure the residents health and well being is promoted to keep them safe 17/12/2009 2 8 13 Residents health care needs 17/12/2009 must be effectively supported by the staff and external health care professionals This will help to ensure the residents health and well being is promoted to keep them in good health 3 9 13 Put in place effective systems for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home This will help to ensure the health and welfare of the residents 12/11/2009 4 9 13 Put in place effective 12/11/2009 arrangements to ensure that any service user who selfmedicates is assessed to ensure that they can do so safely This will help to ensure the health and welfare of the residents 5 9 13 Put in place effective 12/11/2009 arrangements to ensure that
Page 17 of 22 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action all medications received into the home and any medication administered, disposed of or returned to the pharmacy is recorded This will help to ensure the health and welfare of the residents 6 9 13 Put in place effective 12/11/2009 arrangements to ensure that any medication administered by care staff or selfadministered is properly recorded, and any nonadministration accounted for This will help to ensure the health and welfare of the residents 7 9 13 Put in place effective 12/11/2009 arrangements to ensure that prescriptions and instructions from medical professionals are properly recorded and followed so that administration errors do not arise This will help to ensure the health and welfare of the residents 8 9 13 Put in place effective 12/11/2009 arrangements to ensure that staff responsible for the admininstration of medication are competent to do so safely This will help to ensure the health and welfare of the
Care Homes for Older People Page 18 of 22 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action residents 9 18 13 The manager must ensure 17/12/2009 that all senior staff who may be left in charge of the home are aware of the local safeguarding policy and how to contact the safeguarding team This will help to ensure that any allegation of abuse is reported and managed appropriately 10 29 23 All bedrooms must be 17/12/2009 checked to ensure that windows provide for easy and safe ventilation of the home and can be opened and closed when necessary. This is with particular reference to those rooms identified on the inspection visit This will help to ensure people living in the home can moderate the temperature in their rooms 11 33 26 The provider [owner] or 17/12/2009 representative of the provider must visit and complete a report which complies with the requirements of this regulation. The report should be made available to the manager This will help to ensure that the home is being monitored by the provider to help ensure standards are
Care Homes for Older People Page 19 of 22 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action effectively maintained and that the manager has appropriate feedback to ensure further improvements 12 38 13 There must be suitable arrangements for the training of staff in first aid This helps ensure that care staff have the ability to deal with accidents and health emergencies 13 38 23 The fire door on the ground 17/12/2009 floor corridor and to the kitchen must have the closing mechanisms fixed, so that the doors close correctly This will help to protect people in the event of a fire 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 17/12/2009 1 3 With regards to residents assessments, it is recommended that if a resident is at risk of falling, then further information is obtained from the resident, family member or a relevant health care professional. This will help to ensure the staff have the information they need to support the person. Residents and/or their families should be advised at at all times regarding the care provision. The monthly reviews completed by the staff should be a summary of care over a period of time rather than a statement. This will help to evidence any changes in the care being given. With regards to ensuring the health of the residents it is strongly recomonded that record keeping be improved. A
Page 20 of 22 2 8 3 17 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations lack of written information relating to incidents has the potential to place people at risk. 4 19 At the last key inspection in August 2009 the fly screens at the kitchen windows were torn. These were replaced but are now torn again. It is recommended that new ones be purchased to help ensure good standards of hygiene in the kitchen. Any shared room should have appropriate screens in place to ensure privacy. We would strongly recommend that fixed curtains are installed as these can be better manipulated by people and there ensure greater Independence. The induction programme needs to be developed further with reference to the common induction standards produced by skills for care. There should be an overall written statement of the policy, organisation and arrangements for maintaining safe working practices. This will help to ensure that the home is run in the best interests of both residents and staff. There should be a designated person responsible for first aid on duty at all times to meet health and safety requirements. 5 24 6 30 7 38 8 38 Care Homes for Older People Page 21 of 22 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 22 of 22 - 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!
