Inspection on 24/11/08 for Herondale

This inspection was carried out on 24th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Herondale 26/06/06

Herondale 04/11/05

Herondale 08/06/05

Herondale 02/12/04

Herondale 02/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Herondale Bridewell Lane Acle Norwich Norfolk NR13 3RA     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: Judith Last     Date: 2 4 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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: Herondale Bridewell Lane Acle Norwich Norfolk NR13 3RA 01493750716 01493752026 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Age Concern Norfolk care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home may from time to time admit a maximum of two service users living in the home aged between 52 and 64 years. Date of last inspection Brief description of the care home Herondale is a short stay residential care home providing personal care and accommodation for 28 older people and 6 who need help with rehabilitation. It is operated as a short term, respite, care service owned by Norfolk County Council, and managed by Age Concern Norfolk. The home comprises of a single storey building set in its own grounds and can accommodate 34 older people in 22 single rooms and 6 shared rooms. All bedrooms contain a washbasin and there is communal access to four bathrooms and thirteen toilets situated throughout the home, a main lounge in the centre of the home, two smaller lounges, a lounge for the use of those that smoke, a dining room and a shop and bar. One of the wings Swallow Lodge has been established as a re-enablement unit to give support to 6 service users to regain independent living skills, with support from a dedicated staff team. The home has well kept gardens surrounding the property with ample areas to sit, a patio and is designed to provide Care Homes for Older People Page 4 of 30 Over 65 34 0 Brief description of the care home pleasant designated walkways. There is parking to the side of the property and the home is located in the village of Acle and is sited close to a medical centre, library and local amenities. Fees for people booking the service privately, are £69 per night. Social services block book other beds and the manager says that they explain to people whether and how much they will need to contribute to their stay. 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: Before we visited the home we reviewed the information we had asked the manager to send us and looked at all the other information we have available about the home. We visited the home unannounced and spent just over 7 hours there. While we were there we looked at records and spoke to people living and working there. We also looked at the surveys that people, their representatives, or staff completed while we were visiting the home. The main method of inspection we used is called case tracking. We use this to see what records say about peoples needs and to find out from observation and discussion how well peoples needs are being met in their daily lives. Care Homes for Older People Page 6 of 30 We looked at all the information we gathered and used the rules we have, to see how well people were being supported. What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 8 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Except in the case of emergency, people (or their representatives) generally have information about the service that helps them make an informed choice about whether to use it. Peoples needs are assessed before they come to the home so they can be sure care is taken to make sure the service will be able to meet them. Evidence: This is a respite service and so regularly needs to distribute information to people who have not stayed at the home before. There is a service users guide in each persons bedroom which contains detail about the service so people can be fully informed about the service when they arrive. People also have a booking letter that tells them basic information and what they need to bring with them because it is not provided. Nine people using the respite or rehabilitation service wrote to us about the home. Six people said that they did get enough information to decide whether the home was the Care Homes for Older People Page 11 of 30 Evidence: right place for them. One person did not answer, one said their placement was an emergency so there wasnt time to find out about it. This indicates the home does try to make sure people have the information they need before they arrive. The manager says they do not admit people without having received information about peoples needs. One person told us I was visited in hospital by senior staff here. The respite admissions coordinator we spoke to confirms that people are not admitted without an assessment and showed us an additional form that has been introduced to gather more information or to update what the home already has. Where people make repeat visits it is clear from records that there is no assumption their needs will have remained the same, and that guidance for staff is updated to reflect whether there has been any change. Staff confirm that peoples needs are updated. Seven out of nine people using the service who completed our surveys, say that they always receive the care and support they need. All three relatives who completed surveys given to them, say that they feel the home always meets the needs of the person. There is a dedicated rehabilitation unit in one wing of the home. This has its own staff and facilities. There are links with other professionals who can help . Two people who completed our surveys are using this service. One says that after a spell in hospital I have been taken care of by patient and loving staff. Another person comments that the service has been a great help to me in the past 6 weeks. The home does not offer long term 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. The health and personal care that people receive is based on their individual needs. The principles of privacy and dignity are generally upheld. Evidence: We looked at written records for four people. People are admitted only for short periods for respite care or rehabilitation. Records show that peoples needs are set out and that they are updated or reviewed with guests or their relatives when people make repeat visits. This means that staff should know how to support people with meeting their current needs. While we were there we saw information about someones mobility having declined over recent days and staff told us about this. They had arranged for a doctors appointment to check this out. Information about peoples health care and any changes was passed to incoming staff at the handover we observed. This was clear in showing what had happened and what follow up had been made. Although people do Care Homes for Older People Page 13 of 30 Evidence: not stay at the home for long periods, records show that staff are alert to changing needs and follow these up promptly. The service has recently introduced use of Pabulum blue books. These are books that people or their relatives can fill in about important wishes and preferences in the day to day lives of those who stay at the home and can help staff to establish what the persons preferred routine is. There is a leaflet to explain the books to people or their representatives. The manager says these are particularly useful in helping people to settle, where they may have difficulties with their short term memory. There is information about peoples difficulties with mobility and staff have access to aids and adaptations to help them move and handle someone safely. We looked at systems for managing and storing medication. Staff told us that they had training in this. The person responsible on the afternoon we were there, was able to give a clear account of the process. Medication brought is in recorded when people arrive. Staff are clear that they accept medication only in containers prepared by the pharmacy and not by relatives, so there is clear accountability for safety. Records and discussion showed that where medication supplied had caused concern it had not been used but that a replacement prescription had been obtained promptly so that supplies were clearly identified, marked and labelled. People who are able to and wish to, can continue to manage their own medication. There are arrangements to supply keys for the lockable facilities in peoples rooms so that they are able to store this safely. Medication that is returned to family members, carers or the person themselves at the end of their stay, is also recorded on the administration record. This means that there are systems in place to help ensure peoples medicines are administered safely. The policy for the home about unexpected death does not make clear that any medication should be retained for a minimum period of 7 days, pending any coroner or police enquiry. Support plans are stored securely in the staff office, and people have copies of their own information in their rooms. Peoples preferred names are recorded in their plans and interactions between staff and people living there were polite and respectful. There is policy guidance that the Care Homes for Older People Page 14 of 30 Evidence: manager hopes to embed in day to day practice to support privacy and dignity. This refers to personal boundaries and the professional conduct of staff saying words such as love, dear, darling or sweetheart are to be kept to a minimum or avoided. It also says that the acceptability of personal touch to people will be recorded in their care plans. We saw one staff member welcome a guest with a kiss on the cheek but there was nothing in the care records to confirm this is acceptable to the person. We discussed this with the manager as potentially overstepping professional boundaries although staff (based on observation,) knew the person and were doing their best to make them feel welcome. 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. People are able to make choices about their daily lives. However, social and recreational activities do not always meet peoples expectations. Evidence: The Pabulum blue books that some people complete, set out their preferences and routines so that staff will be aware of these. We also saw from records that staff had discussed with someone the sort of furniture the person had at home and this was comfortable for them. The records were updated to show staff on other shifts how they could better support the person as if they were in their own home by using a recliner chair similar to their own. Social events that happen in the home are posted on a notice in the main sitting area, so that people would know what was happening. Before we visited a Norfolk Day had taken place and there were still some items for sale to relatives and guests. There are periodic events of this type. However, of the nine people who completed our surveys, only three were able to confirm there were always activities arranged by the home that they could take part in Care Homes for Older People Page 16 of 30 Evidence: on a day to day basis. Two people wrote that they felt there could be more activity in the home that they could take part in, one said that quizzes or bingo would be welcome. We spoke to four people about what went on and all of them said that there could be more to occupy them and to keep my mind active. One person felt that they were stuck in front of the television most of the time. One person making a repeat visit says that there are rides out sometimes during the summer, but that it was more difficult this time of year. Staff say that they are often stretched to meet peoples needs when there is a very dependent group of guests staying and this makes it difficult to spend time with people. Those we spoke to felt that staff did not always have time to help organise activities and suggest things, and they were not sure whether there were games in the home that they could use for themselves. This represents a decline from findings at our last visit. Records do not clearly show what activities have been offered to people and what they have participated in. There is a small bar in the home and we saw that some people purchased drinks before the lunchtime meal. During our visit there were regular visitors to the people staying at Herondale. People are able to use their own rooms if they wish, but in practice, most people were receiving their friends or family members in the main lounge area. A machine for dispensing hot drinks is available so that guests and their visitors can help themselves to drinks at any time and there is also a water cooler. We asked people about the food and they said that it is very good. One person commented that they thought there had been a change in the chef on duty recently because food had been a little bland but it was still good and was much tastier in the last three of four days. Menus are displayed and people say that they do get a choice. There are meetings that take place quarterly between staff or management and guests who are staying, and the chef is involved in these so can respond to suggestions and discuss what people would like to see changed. Care Homes for Older People Page 17 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. People who use the service and their representatives have access to an effective complaints procedure and know that their concerns would be taken seriously. There are measures in place to help protect people from abuse. Evidence: Five of the nine people who completed our surveys say that they know how to make a complaint if they need to. Four people did not answer the question. However, everyone says that they usually or always know who to speak to if they have concerns. Each person has a copy of information about how to complain, in their own rooms. Records of quarterly meetings with people who are staying at the home at that point, show that people are given the opportunity to raise any concerns they may have. People we spoke to had no complaints about their care and say that the staff are very good. However, none of them was aware that there was a comments book that could be used to make suggestions or minor concerns known. We saw that this was behind the quality assurance report and so people could not see or access it easily. We looked at the way that money people brought in was managed, if they wanted the home to take care of this for them. Records showed that it was checked and recorded and that people signed when this was returned to them. People who wish to can retain their own monies and can be given a key to lockable facilities in their rooms if they Care Homes for Older People Page 18 of 30 Evidence: wish to do this. We checked balances of monies held for two people and found these to be accurate. Systems contribute to the protection of people using the service. However, records from the providers representatives, who visit to assess the quality of the service do not show that these are among the records that are checked periodically. Relatives who completed our surveys say that they know how to complain if they need to and three say that they have not needed to raise any concerns. Staff have training in awareness of abuse of vulnerable people and there is underpinning guidance about what staff need to do if they have any concerns. People tell us that the staff are very good and one person described them as very kind. This indicates that people feel comfortable and safe in the home. Care Homes for Older People Page 19 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. People live in a comfortable and clean environment with access to aids that will meet their needs. However, the safety of people in the event of fire is compromised on occasion by poor housekeeping practices. Evidence: Areas of the home that we saw were clean and bright. The manager has acted to increase the availability of domestic staff at weekends to help maintain standards. Some bedrooms are small and the manager and respite admissions coordinator say that this is taken into account when admissions are planned, to make sure appropriate rooms are allocated that can accommodate the aids to mobility which people need. The equipment for fire safety is checked regularly and staff have training in what to do in the event of fire. However, we were concerned that routine housekeeping measures or staff awareness were not sufficient to ensure that exit routes were maintained as free from obstruction. We saw that the main exit from the lounge to the rear of the home was obstructed by a stepladder left laying on the floor. This also presented a trip hazard to anyone who wanted to do the jigsaw puzzle on a nearby table. Further round the home we saw that another fire exit was restricted by a smaller ladder and tool box against the wall and a pile of unused yellow bags for clinical waste that had been left in Care Homes for Older People Page 20 of 30 Evidence: a corner. Later we saw the width of a corridor leading to a fire exit was restricted by a chest of drawers needing repair and which had been left against the wall. There is guidance for staff about infection control and people have access to protective equipment to help prevent the spread of infection. The manager says that staff have worked to guidelines to limit the spread of infection where this has happened in the past. There are hand sanitizers available in toilet and bathroom areas for staff to use when they have finished assisting people with personal care. This indicates that there are measures in place to help ensure that people are protected, so far as is practicable, from the spread of infection. Care Homes for Older People Page 21 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. People are supported by a competent and committed staff team. There have been times when staffing levels have not been wholly adequate but the manager has plans to address this. Evidence: When we visited we spoke to staff about the demands upon their time, and also to people staying at the home about staffing levels. Staff tell us that, at the time of our visit, the workload was not as heavy as it is on some weeks. They say that sometimes there are a lot of people staying at Herondale at the same time, who have high levels of need for support with their personal care. We were told that, on occasions, this means staff are not able to properly complete the tasks they need to within the time that is available on shift. This was supported by feedback we saw from one person given to the home in September, that they felt the level of caring has gone down and that more staff is urgent need. Those who completed surveys while we were there (and at a period of time when staff said dependency levels were more manageable) say that staff are always available when they need them. Two people went on to tell us that everyone is cheerful and helpful and that the Care Homes for Older People Page 22 of 30 Evidence: staff are very, very helpful. Staff recognise that the employment of an additional person to provide support in the evenings when people wish for assistance before bed, has been positive and has contributed to better support for people. They commented that when the person was not there it was sometimes difficult to deliver the support people needed when they wanted it. They also commented that sometimes staffing was difficult at weekends. Three staff who completed surveys for us say that there are usually enough staff. None was able to confirm that this was always the case and one added that sometimes the neede extra staff to cover evening shifts and weekends. People we spoke to said that the staff are very good but that they are very busy and they agreed this may be why routine day to day activities were sometimes a problem. The manager says that progress has been made in setting up a bank of carers who could provide additional staffing hours when dependency levels are high so that peoples needs can be met more easily. This will help improve flexibility when bookings have been made for increased numbers of people with higher support needs than was the case when we visited. For this reason we have not made a requirement about ensuring the adequacy of staffing at all times. The staff team were clear in their responsibilities, based on observation of the handover process and allocation of tasks as well as staff taking these on for themselves. Team leaders described their colleagues as very thorough. The training matrix and information that the manager sent to us, shows that over half of the staff have National Vocational Qualifications. We looked at recruitment records and talked to the manager and her line manager about the process. This provides for checking to make sure that people are suitable to work with vulnerable adults. The manager says that no one is taken on until full checks and references have been obtained and that the providers head office confirms this to her so she knows when appointments can go ahead. All three staff who completed survey forms say that they felt their induction covered what they needed to know very well. The training matrix shows that opportunities are open to people for regular training updates, including first aid and moving and handling. There are other training courses available that relate to particular individual needs as these arise. Care Homes for Older People Page 23 of 30 Evidence: Staff we spoke to were not always clear what was available and open to them and how staff were selected for courses. One staff member who completed a survey for us says that Im under the impression there isnt much available here apart from the mandatory training e.g. moving and handling, first aid etc. All three people who wrote felt that their training was relevant to their role and helped them to understand and meet peoples needs. One person felt that it did not as yet keep them up to date with new ways of working because they had taken on some additional responsibility from time to time. However, appraisal records do show what has been discussed with individuals as being appropriate training for their development. 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. People benefit from a home that is well run and where their views are taken into account in effective quality assurance systems. Evidence: The manager is qualified, experienced and participates in updates to training as necessary. There are clear lines of accountability to ensure the home runs smoothly, with designated staff being in charge of each shift. The staff we spoke to were clear about these responsibilities. The information we asked for about the quality of the service was completed very thoroughly and told us what plans there were to improve things still further. In addition, there are systems for involving people who use the service in commenting about the quality of it. This includes quarterly meetings with those guests who are staying and members of the staff team. People are also asked to complete a survey when their stay is finished and these results are incorporated into a report which is Care Homes for Older People Page 25 of 30 Evidence: available in the reception area. There is also a range of questionnaires available to other people who may visit the home ( for example other health professionals) so they have the opportunity to comment about service quality. Staff surveys are sent out separately by the providers head office so that the manager does not know who has completed them. However, overall findings, comments and analysis of this are not incorporated into the current quality report. There are regular visits by members of the trustees who visit the home to report on service quality on behalf of the providers. We asked staff about these visits. They told us they are not always aware of the nature and purpose of the visit and so do not always have the opportunity to comment on service quality at these monthly visits. The home has achieved an Investors in People Award. This takes into account the quality of the service and the development of staff. As explained in the section about safeguarding, we looked at systems for managing service users money where they do not do this themselves. These show proper records are kept. Two staff sign them where appropriate to show what has come in and what has gone out and guests will also sign when items or money is returned to them. Staff tell us that supervision is done by team leaders. The manager supervises the senior staff. Staff we spoke to say they are supported by their colleagues on shift. Three people who completed our surveys say that they meet regularly with their manager to discuss their work. This means there are systems in place to ensure that everyones work is monitored and to support and supervise staff. We saw records to show that staff have training in areas that will contribute to the safety of those living at the home, including first aid and moving and handling. The training matrix shows that training in infection control is also available. The practical implementation of fire safety training and awareness of routine housekeeping presented concerns for safety while we were visiting. Care Homes for Older People Page 26 of 30 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 33 24.1 The registered person must 31/12/2006 ensure that the views and feedback of staff members is included in the quality assurance report and action plan. 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 19 13 There must be suitable 12/12/2008 arrangements for maintaining fire exits as free from obstruction at all times. This is so unnecessary risks to people staying or working in the home are avoided. This is to ensure that people are able to get out of the home as quickly as possible in the event of 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 1 9 Guidance about unexpected death should make clear that medicines are to be retained for a period of at least 7 days in case they are needed for a coroners inquest. The manager should look at the provision of social and recreational activities and see how she can increase these to meet peoples expectations. Visits on behalf of the registered providers, should periodically provide for checks on the way peoples Page 28 of 30 2 12 3 17 Care Homes for Older People valuables or monies are managed. This is so random checks help ensure systems designed to protect people are robustly implemented at all times. 4 27 Pending full operation of the proposed bank staff arrangements, admissions should be looked at to ensure a balance of needs among service users so that staffing levels are always adequate to meet them. The manager should discuss with the full staff team how they can access training other than what is mandatory, and how this will be prioritised. This is so staff are more aware of what is open to them and can pursue this if they feel it is needed. 5 30 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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