Inspection on 07/01/09 for Hill Top Lodge

This inspection was carried out on 7th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hill Top Lodge 10/01/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hill Top Lodge 93 Hill Top West Bromwich West Midlands B70 0PX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mandy Beck     Date: 0 8 0 1 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (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 29 Information about the care home Name of care home: Address: Hill Top Lodge 93 Hill Top West Bromwich West Midlands B70 0PX 01215563322 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): phaik@pressbeau.co.uk Pressbeau Ltd Name of registered manager (if applicable) Ms Phaik Lim Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 85. 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 (OP) 28 Dementia (DE) 57 Date of last inspection Brief description of the care home Hill Top Lodge is registered to provide personal and nursing care for older people. The home has three floors and each one has their own living and dining area. There are bathrooms and toilets on each floor. People who live at this home do not have to share bedrooms. Each room is furnished appropriately and with prior agreement from the manager people are encouraged to bring their own possessions with them when they move in. Each bedroom has a partial en suite facility, a toilet and hand basin. This Care Homes for Older People Page 4 of 29 care home 85 Over 65 0 28 57 0 Brief description of the care home home operates a non-smoking policy. It is situated close to the town of West Bromwich and is accessible via public transport. The fees for this home are included in the Statement of Purpose and the Service User Guide and range from £390 and £560 per week for residency. Other fees not included are extras such as newspapers and magazines, hairdressing service and non NHS chiropody. People are also expected to provide their own toiletries. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection to the home. Two inspectors and an expert by experience completed this inspection over a period of two days. An expert by experience is a person who, because of their shared experience of using services and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. We looked at all of the information that we have received, or asked for, since the last inspection of this home in January 2008. This included the annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We looked at the information we had about how the service has managed any Care Homes for Older People Page 6 of 29 complaints. We looked at what the service has told us about things that have happened in the service, these are called notifications and are legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. We have taken into consideration relevant information from other organisations. We also spent time talking to the people who use the service and to the staff who support them. We looked at the care six people who use this service in depth. This is part of our case tracking process and helps us make judgements about the homes ability to meet peoples needs. 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 29 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 –03000 616161. Care Homes for Older People Page 9 of 29 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 29 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. People who may choose to use this service will have access to the information they need to make a choice about living here. People do have their needs assessed prior to moving in. Evidence: The home has information for people about the service it provides. We looked at the Service User Guide for this home. We saw that some improvements have been made. The home has now included the range of fees people are expected to pay per week to live at Hill Top Lodge. The home has also updated the Service User Guide to show that they now provide nursing care for people. There is clear and relevant information in the guide for people to use. We looked at the care of six people in depth during this inspection. We saw that in all cases each person had an assessment of their needs. Where possible the home had Care Homes for Older People Page 11 of 29 Evidence: included the person and family in this process. The manager makes sure that she obtains copies of care management assessment for each person. Wherever possible the manager or a deputy manager will also visit people in their homes before a decision is made about moving into Hill Top Lodge. The information we saw in peoples assessments could be further developed so that a more individual feel is evident. For example in one persons assessment information was limited and did not give a clear picture of their strengths or needs. It said restlessness all night, personal hygiene, needs assistance. It would be more helpful if staff recorded the type of restlessness being observed and write in detail the type of support this person needed in order for their personal hygiene needs to be met. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home may not always have the care and support they need because improvements are needed in the record keeping systems within the home. Evidence: Each of the people living in this home has their own set of care plans and risk assessments. These documents should detail the care and support people need and the risks associated with that. We looked at the care plans and risk assessments of six people during this inspection. We saw that there had been an improvement in record keeping and peoples care plans on the whole did reflect their current needs. We noted that in some cases important information relating to changes in peoples condition had not been included in the current care plan or risk assessments. For example one person was recently discharged from hospital and needed to be moved using the hoist and sling. This persons care plan and moving and handling risk assessment had not been updated to include this information. We spoke to the staff on duty about this, they were able to tell us about this persons needs and were aware of Care Homes for Older People Page 13 of 29 Evidence: the need to use the hoist and sling. They said we use the full hoist and yellow sling it has changed since xxx came out of hospital. Whilst it is positive staff are aware of the persons needs and this will reduce the risk of injury for this person the home must improve their record keeping. Our Expert by Experience observed one member of staff attempting to move one person with a hoist on their own. They were only stopped in doing so by the person who needed to be moved. She told the carer there has to be two of you to do this. We looked at the moving and handling assessment for this person and it was clear in the assessment that only two people using a hoist should attempt any moving and handling in respect of this person. The home must make sure that staff understand and carry out the instructions in these risk assessments in order to keep people safe from harm. We found that each person has an individual nutritional screening tool. This means that each person is assessed for the risk of malnutrition and will give the home an indication of those people at risk so that they can take action to prevent malnutrition occurring. We noted that most people in the home have been referred to either the dietician or the speech and language therapist in recent months. The home had taken steps to carry out the advice of these professionals so that peoples dietary needs are met. We saw weight records of some people, staff are recording weights regularly on a monthly basis. We did see that some people had lost weight but this was minimal and is being monitored by the home. We looked at pressure area care for some people. We found that every person was assessed for their risk of developing pressure sores. The home is supported by the district nursing service in caring for people with pressure sores. In recent months there have been concerns raised about the homes ability to meet peoples needs in relation to pressure area care on the nursing unit. We saw that improvements have been made and of all the people whose care we looked at, they had appropriate equipment for their needs. We did ask the manager to consider the use of an alternating cushion rather than a soft foam cushion for one person because they did not like being turned on a regular basis. This would offer a little more protection from pressure damage. We have also spoken with the manager about the safety of bed rails in the home. The maintenance worker confirmed that there are only visual checks completed on bed rails and no written records kept. They also confirmed that they had not had training about how to fit bed rails safely and how to maintain them. Those people who use bed rails do have risk assessments in place but they need to be reviewed regularly to make sure they are still needed. Medication practises in the home are generally good. The home has satisfactory arrangements in place for the ordering, safe storage and administration of peoples medicines. At present none of the people living in this home administer their own Care Homes for Older People Page 14 of 29 Evidence: medication. Only staff that have received training in safe handling of medicines give out medication to people. We looked at the medication administration records (MAR) of six people, we have made some good practise recommendations. The home must make sure that there are no unaccounted for gaps on the MAR. They must also record the variable dose of medication. This means that when medicines are prescribed one or two tablets or 10mg or 20mg the staff should record the actual dose given. This will help the home audit medication and keep an accurate record of peoples medication. We observed staff and people living in the home throughout the day. We wanted to see how staff support peoples right to privacy and dignity. There are some improvements to be made. Generally staff are very obliging and do make attempts at respecting peoples dignity and privacy. We saw them knocking doors of peoples bedrooms before they entered. We noted that people were sometimes addressed as sweetheart or dear. The home had not recorded peoples preferred term of address and because of some peoples communication difficulties we were unable to determine if people minded being addressed in this way. The home also includes a training session about preserving peoples privacy and dignity in their induction process for new staff. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home do not always have the opportunity to take part in activities. People are encouraged to maintain their contacts with family and friends. Mealtimes need to be improved for peoples enjoyment and nutrition. Evidence: The home employs one person to provide an activity programme for people to take part in. The activity coordinator has recently completed further training that showed her how to plan effective activities for people to participate in. Our expert by experience spent time with people living at this home and also the activity coordinator. She found that people were not always taking part in the activities that had been planned. For example the activities diary showed gentle hand and feet massage in the morning and one to one in the afternoon on the day of this inspection. When we asked if this activity applied to all three floors in the home we were told yes it does but if the residents are asleep we dont like to disturb them. We were also told it can be very difficult to find activities that would be stimulating for people like this. The member of staff was referring to people with dementia. We observed people for over forty five minutes and saw that there was very little staff interaction. However when interaction did take place some of it was generally positive and cheerful and people did Care Homes for Older People Page 16 of 29 Evidence: respond well to staff. We also had the opportunity to speak to some relatives during this inspection. We asked them how they felt the home supported people and met their needs. They told us I would give the staff 8 out of 10 here, they are very good and very willing to help, the staff here are very good but there should be alot more of them to cope with the work they have to do. The home always keeps us informed of any changes and if the doctor has been called. We saw that people have the opportunity to personalise their rooms when they move in. We looked at several peoples rooms during this inspection and saw that each one had been decorated to the persons own taste and ornaments and some furniture had been bought in from home to make the room feel more like their home for people. One person told us it does feel more cosy but it isnt my own home is it really. Our expert by experience had the opportunity to have a meal with people during this inspection. They found mealtimes to be disorganised and meals took too long to be served. People were offered a choice at lunch time of cheese and potato pie, carrots and peas or gammon and vegetables, mash or chips. People said during lunch I am sick of carrots, My chips are cold. Our expert by experience reported I had chosen gammon and chips. My chips were stone cold. I put my hand on the bottom shelf of the serving trolley, which was next to me and it was cold. The gravy and parsley sauce was lumpy and unappetising and the vegetables were mushy. It was no great surprise that a lot of meals were picked at and dessert was being offered before people had finished their main course. There were no sauces or condiments such as vinegar or mustard. At our last inspection of the home in January 2008 we had identified then there was a problem with the food trolley and it was not keeping food warm. This was discussed with the manager again during this inspection. She has said the problem with the trolleys will be sorted out so that people will have warmer food in future. Other observations included people having a meal placed before them whilst they were still sleeping. One person was observed to be sleeping for over half and hour before a member of staff woke them and encouraged them to eat their meal. It was not surprising that this person didnt want to eat it, after half an hour the meal would have been considerably cooled. Care Homes for Older People Page 17 of 29 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. People living in this home can feel confident their views will be listened to and acted upon. The home will work with the safeguarding team in order to protect the people living in the home. Evidence: The home has a detailed complaints policy and procedure that is available to all people. The manager responds positively to any concerns and complaints raised. Since the last inspection the manager has told us the home has had one complaint which was dealt with satisfactorily. The home has also recently completed its own survey in which they asked for peoples views on how the home manages concerns and complaints. People responded positively and said they were happy with the way the home did this. We also spoke to some relatives during this inspection and asked them about how the home managed any concerns they may have. They told us its mainly the clothes that go missing or the wrong ones put in the wardrobe but they are trying to sort it out, I dont worry about telling them anything the staff are very good. The manager is aware of her role in reporting allegations of abuse to the local safeguarding team. The home is currently subject to an investigation with the safeguarding team around issues of poor pressure area care. Sandwell contracts and Care Homes for Older People Page 18 of 29 Evidence: monitoring team have felt the risks to people are significant enough to put a suspension of admissions to the home in place. Since the suspension has been in place the home has improved upon their care planning, staff training in relation to pressure area care and has made sure that all people who are at risk of pressure damage have been reassessed and have the correct equipment for their needs. Staff are also going to have further training in safeguarding vulnerable adults. This will refresh staffs knowledge of abuse and who to report to if an allegation is made to them. Peoples money can be kept safe by the home. We looked at the current system in place and found that there was room for improvement. We looked at the monies of four people living in the home. The manager told us that money is kept securely in the safe but we found money belonging to people in an A4 ring binder on the shelf in the office. The manager told us this was because staff had not had the opportunity to put it away yet. This meant that when we checked peoples balances they didnt add up and there wasnt really a clear audit trail of where peoples money had been spent. The home must make sure that peoples money is kept safely. The manager has assured us this was a one off situation and would not be repeated. Care Homes for Older People Page 19 of 29 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 who live in this home can expect to find the home is generally clean and tidy but improvements are needed for peoples added comfort. Evidence: We looked around the majority of the home during this inspection. We could see that some improvements have been made. Most notably is the joining together of the two buildings to make one large home. Since our last inspection the home has been registered with the commission to provide nursing care for people. The nursing unit is located on the second floor. Staff told us it is better it has stopped the them and us feeling we are one big team now. There has been a programme of improvements underway since our last visit. We saw that new carpets have been laid in lounges and peoples bedrooms. There were plans to construct a sensory garden this has not been completed yet but we did see outdoor furniture has been purchased and is set out ready for use in the garden area. People are encouraged to decorate their own rooms with personal possessions from home to make their rooms feel more personal to them. The home has told us it has further plans to improve the environment for the people living there. We found some improvements are needed to the decoration and signage within the home. Our expert by experience made the following observations the corridor areas need brightening and cheering up with stimulating, possibly tactile Care Homes for Older People Page 20 of 29 Evidence: things on the walls. There was also a distinct lack of signposting to help remind residents and visitors whereabouts they were in the building. During this inspection I was asked by 7 different residents on the first and second floors to help find their room. We were also aware of a distinct bad odour on the second floor in particular. This was discussed with the manager during the inspection. She explained to us that the home is trying to address this and were aware of the offensive odours. We also noticed the home has changed some of the seating arrangements so that people can have a better view out of the large windows in the lounge areas. Some of the lounge areas were not decorated as nicely as others, the ground floor lounge is the starkest of all. We noticed that there were not enough dining tables and chairs for people to use on the second floor. This may be because people from the residential unit spend time on the nursing unit during the day. The lounge available for people to use on the residential unit on the second floor is unused, it is cold and very unwelcoming. The staff told us no one goes in there, we use it for training instead. The staff in the home have training in infection control. There have been some gaps in the training of staff but the manager has arranged for these to be covered. The home has a large laundry and is able to keep infection control to a minimum. We have not been notified of any outbreaks of infection in the home since our last inspection. The home also supplies gloves, liquid soap and paper towels for staff and people to use in order to reduce the risk of cross infection in the home. We did find the sluice unlocked and this meant that people could have access to the chemicals that were stored in there. We have recommended either the door be kept locked at all times or the chemicals removed so that people are not placed at risk. Care Homes for Older People Page 21 of 29 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 generally satisfied with the care they receive but there are times when they may need to wait a short time for staff support and attention. Evidence: The suspension of admissions to the home placed on them by the local authority. Staff are feeling stressed and are worried about the home. They told us it felt like we were getting better and then this has happened and we feel things are getting worse again. They added the staff morale is very low at the moment we are trying hard but it is difficult when there are less of us to do it. We also spoke to relatives during this inspection who said the staff here are very good, I would give them 8 out of 10 but there should be more of them, the staff always keep me well informed about my mothers condition. We have also seen the effect of reduced staffing levels during this inspection. Activity provision in the home is suffering because the activity coordinator spends alot of her time assisting care staff by making sure that people are fed and they are having drinks. The manager has told us that staffing levels are kept under regular review and will be increased to meet the needs of the people who live there. The home continues to support its staff through their National Vocational Qualifications (NVQs). This training gives staff the basic skills and knowledge they require to do their work. The manager also told us that regular mandatory training has also been arranged. This will mean that staff have updates in food hygiene, infection control, Care Homes for Older People Page 22 of 29 Evidence: moving and handling, fire safety and first aid training. Staff told us there is training for us, I enjoyed the dementia training I did recently, the home are good with giving us training but there is alot of it. We looked at the homes recruitment practises. We saw a total of 7 new workers files. The home has the right processes in place to help prevent unsuitable people from working with vulnerable adult. They complete checks against the Protection of Vulnerable Adults (PoVA) list and also make sure that each person has a Criminal Records Bureau (CRB) disclosure. There are a few minor improvements to be made such as providing staff photographs and written risk assessments for those staff who are permitted to start working in the home without the return of a satisfactory CRB. The home should also review the current filing system so that all documents relating to staff members are kept together and will therefore be easier to find. At present this information is disjointed and did take some time for the manager to locate the information we were asking for. New staff are supported through an induction by the manager and the deputy manager. The induction meets the Skills for Care Common Induction Standards and offers new workers a satisfactory introduction to social care. Care Homes for Older People Page 23 of 29 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 using this service benefit from a manager who is trying to improve the service proivsion. The management team are aware of the shortfalls and are working towards further improvement. Evidence: The home continues to be managed by Phaik Lim. She has told us that she is trying very hard to move the home forward and make improvements for people who live there. Phaik is aware of the shortfalls in this service. We have said throughout this report that improvements are needed in record keeping systems, medication audits, activities and staff recruitment. The home does take steps through its own quality assurance system to highlight areas for improvement and take action to address this. The manager completes monthly audits of health and safety, the environment and care plans. She does this so that shortfalls can be easily identified and addressed. In addition to the managers audits the company also completed a monthly unannounced visits (regulation 26). During Care Homes for Older People Page 24 of 29 Evidence: these visits the person will spend time talking to people and staff and generally making sure that things are satisfactory for them. Since our last visit the home has also sent out satisfaction questionnaires to people. They received a very positive response with nearly all of the people answering the questionnaire saying they were more than happy with the service they received. The home has systems in place to make sure peoples health and safety is promoted. They organise regular staff training and have clear records for maintenance of equipment and servicing of hoists, lifts and other mechanical devices. We looked at records for fire training and fire drills. There are records of staff attending fire drills but when we spoke them they were not clear about the last fire drills they had attended. Care Homes for Older People Page 25 of 29 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 15 Care plans and risk assessments must contain accurate information about peoples needs and the support they require. This will ensure that people are supported in the way they need to be. 27/02/2009 2 15 12 The home must make sure that people are not waiting too long for assistance at mealtimes. This will mean that people get the assistance they need when their meal is hot. 20/02/2009 3 26 13 The home must make sure 27/02/2009 that the sluice is kept locked at all times and substances that could be hazardous to peoples health are locked away. This will reduce the risk of harm to the people who use the service. Care Homes for Older People Page 27 of 29 4 38 12 The home must make sure 27/02/2009 that it has written records of the safety checks it completes on peoples bed rails. This will show how the home is reducing the risks of using bedrails to people using this service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The home should include more descriptive detail in its assessment of peoples needs. This will help make sure that all people are aware of the support needed in meeting individual needs. Staff should make sure that all gaps on the MAR sheet are accounted for and recorded. This will help staff keep a clear record of the medication that people have taken. Staff should make sure that when a variable dose has been prescribed for people a clear record of that dose is recorded on the MAR sheet. This will help staff keep a clear record of the medication that people have taken. The home should consider providing more signage in the home so that people can find their way around more easily. The home needs to address the offensive odour that is particularly prevalent on the second floor. This should be done in the interests of the people living in the home. The home should produce a written risk assessment for each worker who begins working at the home with only a PoVAfirst check in place. This should be done so the home can demonstrate how it will be protecting the people living there until the return of the new workers satisfactory CRB. The home must make sure that peoples money is kept safely locked away. This will give people assurances their money is being kept securely. 2 9 3 9 4 5 19 19 6 29 7 35 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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