Inspection on 25/02/09 for Hillview Nursing Home

This inspection was carried out on 25th February 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hillview Nursing Home 18/12/09

Hillview Nursing Home 26/02/08

Hillview Nursing Home 31/05/07

Hillview Nursing Home 22/06/06

Hillview Nursing Home 15/12/05

Hillview Nursing Home 20/07/05

Hillview Nursing Home 13/01/05

Hillview Nursing Home 10/08/04

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hillview Nursing Home 34-36 Berrow Road Burnham-on-sea Somerset TA8 2EX     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: Alison Philpott     Date: 2 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 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 31 Information about the care home Name of care home: Address: Hillview Nursing Home 34-36 Berrow Road Burnham-on-sea Somerset TA8 2EX 01278783192 01278785445 hillview@almondsburycare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Almondsbury Care Limited Name of registered manager (if applicable) Mrs Shirley Anne Ruane Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: In the event of Room 11 being vacated by the current service user, no further admission to this bedroom until work to increase the size of the bedroom has been carried out and approved by the NCSC. One existing named service in the category MD(E) to remain at the home with no further admissions for service users under this category. One existing named service user under the age of 65 years in the category DE to remain at the home with no further admissions for service users under this category. Places for up to 13 person for personal care. Registered for a total of 30 places in category DE(E). The existing Manager to be supported by a named Clinical Manager who is suitably qualified and experienced RMN (Part 3 or 13 of the NMC Register) and will work a minimum of 30 hours per week at the home. The following bedrooms should not be used for service users who require the use of a hoist or wheelchair to mobilise or staff assistance with regard to moving and handling; Rooms 2, 10, 17, 22, 23 and 26. Care Homes for Older People Page 4 of 31 care home 30 Over 65 30 0 Date of last inspection Brief description of the care home Hillview Nursing Home is situated approximately 1 mile from the seaside town of Burnham On Sea. The home is registered with the Commission for Social Care Inspection to provide nursing care for up to 30 people not less than 65 years of age who suffer with dementia. Currently Social Services have a block booking some single occupancy beds at the home and the home have a Social Services Quality Rating. Hillview is owned by Almondsbury Care Ltd. The Responsible Individual is Mr K Smith. The Registered Manager is Ms Shirley Ruane. Fees are 532 pounds to 685 pounds per week. Additional charges include, hairdressing, chiropody, newspapers/magazines, personal items and staff escorts to appointments. Any Free Nursing Care element awarded is incorporated into the fees and is not refunded to the service user. Care Homes for Older People Page 5 of 31 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 which took place over a total of 16 hours on 25th February 2009. The inspection was undertaken by Alison Philpott and Gail Richardson. Although there were two inspectors, throughout the report the term we will be used as it is written on behalf of the Commission. The preferred term for the people who live at the home is residents. This is used throughout the report. As part of this inspection we received two completed surveys from relatives and three completed surveys from staff. During the inspection we spoke with residents, management and staff. One hour was spent observing the care being given to a group of people to establish what it was like to live at the home. All observations were followed up by discussions with staff and examination of records. Care Homes for Older People Page 6 of 31 We viewed the home. We looked at three individual care plans, and looked at records relating to medication, finance and health & safety. The inspectors would like to thank residents, staff and management for their assistance on the day of inspection. The focus of this inspection visit was to inspect the relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focusses on outcomes for residents living at the home. The quality of the service is measured under four ratings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the care home does well: What has improved since the last inspection? What they could do better: Care plans do not always reflect all of the assessed needs. Information needs to be recorded and updated so that staff know how to meet residents changing needs. Some of the homes medication procedures need to be improved to make sure residents are safe. The home needs to make sure that one bedroom door has the correct name of the resident who lives there and that one window has a window covering. This is to protect residents privacy and dignity. The bedrooms that havent been refurbished yet are in need of redecoration. The home told us that they plan to refurbish all of the bedrooms. The home has been carrying out building works for over a year and there are plans to undertake further building work. Care Homes for Older People Page 8 of 31 Residents do not currently have access to a garden area and the home needs to assure us that an outside space will be provided for the approaching summer months. The home should keep us informed of how the building work is progressing and any impact this may have on the residents. Chemicals and other cleaning products need to be stored securely so that residents are not placed at risk of harm. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides information so that people know what facilities and services are available. The home carries out assessments to ensure that it is able to meet the needs of prospective residents before they move into the home. Evidence: The home told us on their AQAA that the manager or deputy manager visit the prospective service user to get to know them and their needs and all residents receive a full comprehensive needs assessment before admission. The home has its own website which gives information about the services and facilities provided. A colour brochure is also available. Care Homes for Older People Page 11 of 31 Evidence: We looked at care plans which included detailed assessments that had been carried out by healthcare professionals and the manager. The home encourages prospective residents and their representatives to visit the home and spend some time in the home to help people decide if they would like to live there prior to admission. Care Homes for Older People Page 12 of 31 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. Care plans contain a good level of information but do not consistently reflect the care being delivered. There is evidence of health care treatment and intervention but there are some gaps in information. Residents who can express a request or ask questions receive more attention from staff. The homes medication procedures do not fully protect residents. Staff respect residents privacy and dignity. The home is developing its end of life care plans. Evidence: The home is currently working with residents and representatives to create life histories with photographs. This will be a valuable source of information for staff to Care Homes for Older People Page 13 of 31 Evidence: gain a better understanding of the residents they support. A relative told us care and support is very good not only for the resident but for the carer as well. During the inspection, we spent an hour observing the care being given to five residents to establish what it was like to live at the home. It became clear that if people could ask or demand attention it was given but people who did not or could not interact did not receive any contact from staff or other people using the service. Of the five people observed two residents didnt receive any contact during the hour we observed and a further person only received contact when the lunch was served. It was observed that whilst staff were present in the room, interaction between people and staff did not always take place. One staff member spent periods of time sitting at the side of residents but did not interact unless spoken to or if one of the residents tried to stand up. Whilst people people did not exhibit any anxiety or distress, the home should ensure that it provides interaction for each resident so that their emotional needs are met. We looked at three care plans. These contained lots of information about the residents health and social care needs. Information is stored in a number of different places and this means that the main care plan is not updated and doesnt always reflect the residents current needs. Staff told us that they are given up to date information about the needs of the people they support or care for. We looked at fluid intake charts. The records showed the amount of fluid intake which was variable. There was no clear plan in place to indicate what the intake should be each day, and no guidance for staff to know when to seek advice. One care plan states maintain diabetic diet- see diabetic care plan. There was no evidence of a diabetic care plan or record of blood sugar monitoring. Another resident who is diabetic had lost weight during 2008 but records showed that they have not been weighed since October 2008. The home told us that a dietician had visited but they were unable to locate the report. The resident has been prescribed supplement drinks. There was no plan of how this was being monitored or when staff should take action. We looked at wound care plans. These contained good information about the status of the wound, evidence of regular review and photographs. The home has recorded the size and depth of the wound wherever possible. We viewed daily records which stated one resident was prescribed antibiotics. The home had not recorded the reason for this in either the record or the care plan. Another daily record gave information about agitated behaviour and a medication Care Homes for Older People Page 14 of 31 Evidence: change was noted. The changes were not reflected in any review or doctors records and the care plan had not been updated. The home must ensure that their care plans reflect all assessed needs and updates are recorded so that staff know how to meet residents needs and changing needs. The home should review the recording system for care plans to ensure that all care needs and preferences are clearly presented and easy for staff to follow. We viewed a falls risk assessment that had been updated. Information had been crossed out and it was not clear what was current. The home must ensure that where risks are identified and assessed a clear up-to-date plan is put in place so that staff know how to minimise risks and protect residents from risk of harm. We looked at records that evidenced that residents have access to GP, District Nurse, and Community Psychiatric Nurse. The home told us that they are currently sourcing a new dentist. We looked at the homes medication and records. We checked the balance of two controlled drugs and these were found to be correct. The Medication Administration Record Sheets (MAR) contained photographs of residents to help staff confirm identity. One resident is prescribed paracetamol as required. The home had not recorded the variable dose. This means that staff would not know how many tablets had been taken within a 24 hour period and whether the maximum safe dose had been reached. The home must ensure that they record the actual dose administered so that residents response to medicines can be effectively monitored and fed back to the prescriber, also preventing the risk of either under or over dosing. Where nutritional supplements had been prescribed for three residents, there were no signatures to confirm that these had been administered. The home told us that this was being recorded separately. We looked at the record of one resident who is prescribed three supplements each day. Over a period of nine days, the records showed that a total of two supplements had been administered. The home must ensure that they record when they have administered supplements to ensure that residents receive their prescribed medicines. We viewed prescribed creams in the medication trolley and in residents bedrooms. These were not dated on opening. The home must date creams on opening to ensure they are used when at their best. Care Homes for Older People Page 15 of 31 Evidence: The medication store cupboard contained dressing trays with open dressings and used forceps. We viewed prescribed dressings for people who are no longer living at the home. A number of items including bottled sterile water, blood bottles and test sticks were past their expiry date. We discussed the risk of using out of date products and use of dressings prescribed for other people with the home. The home must ensure that all medicines and dressings that have passed their expiry date are correctly disposed of and not available for use. This is to make sure that inappropriate stock is not used for residents. The home has a stock of five nebulisers. One of these was last checked in 2002. The mask of another nebuliser had not been cleaned after use. The home should ensure that nebulisers are serviced to check they are in safe working order and cleaned after use for hygiene purposes. The Controlled Drug Cupboard does not meet the current regulations for the storage of controlled medications and the Registered Manager is required to receive advice from the local pharmacist about a suitable replacement. Staff were observed respecting residents privacy and dignity. Where one resident had moved bedrooms as a result of the building work, the home had not changed the name on the bedroom door. We viewed one bedroom that did not have a covering at the window. We observed builders working outside. The home should attend to these so that residents privacy and dignity is maintained. The home is currently working with Liverpool Care Pathways team to improve end of life care and develop appropriate end of life care plans. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to develop its activities to meet individuals interest, needs and capabilities. Meals are balanced and nutritious and cater for the dietary needs of individuals. Evidence: The day before the inspection some residents had taken part in making pancakes for pancake day. The home employs staff who are responsible for activities and is developing its activities programme. The home told us that they will record individual activities on a daily basis with a monthly overview. General activities in the home include talking, pampering, looking at magazines, reminiscence. The staff undertake some one to one work with some residents. The home told us that they are planning a 1940s lounge with photographs of the local area. Residents life social histories are being developed to provide more information and photographs. Care Homes for Older People Page 17 of 31 Evidence: The home has arranged for entertainment including a singer, theatre productions, visiting donkeys and dancing dogs. Two of the residents receive regular visits from ministers of their chosen religion. Relatives of residents at the home have set up a support group. This gives people the opportunity to meet up for a chat and a coffee. The home has a four week menu. We spoke with the cook and they had a good knowledge of residents preferences and special dietary needs. We observed the lunch being served. The mealtime experience was pleasant, calm and unhurried. Staff were observed assisting residents to eat whilst speaking to them. Residents appeared to enjoy their lunch. Staff offered snacks and drinks to residents in between mealtimes. Care Homes for Older People Page 18 of 31 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. The home has a complaints procedure in place. Complaints are investigated and followed up. The homes policies relating to abuse reduce the risk of harm to residents. Evidence: The home has a complaints procedure. A copy of the policy is on the noticeboard in the front hall. One relative told us that they have a copy of the procedure. The home had received two complaints since the last inspection. These had been investigated and responded to appropriately. The home has policies relating to whistleblowing and elder abuse. Staff spoken with knew what action to take if they had any concerns. The home has an up to date copy of the Somerset Safeguarding Adults Policy. Care Homes for Older People Page 19 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to carry out building work, refurbishment and redecoration to improve the environment. Refurbished bedrooms provide a higher standard than existing bedrooms. Outside space is currently limited. Some areas of the home are cleaner than others. Evidence: The home is continuing with major redevelopment works within the home and outside. The home assured us that they try to minimise the disruption to residents by providing breaks between works. On the day of inspection, there was noise within the home whilst the builders were sawing and drilling. The home told us that there are plans for further work to improve the standard of environment. This includes removing existing double bedrooms and converting them to single bedrooms. The new bedrooms are well decorated, spacious and nicely furnished. Some bedrooms have electrically adjustable beds. Care Homes for Older People Page 20 of 31 Evidence: The other bedrooms and areas that are part of the planned improvements are looking tired and do not provide a homely environment for residents. The walls are stained in places and wallpaper is peeling off, they are in need of decoration. We viewed ceilings, radiator covers, flooring, chairs and mattresses which were stained. One bedroom viewed was small and access to the sink was restricted. The registered manager told us that once additional new bedrooms are complete, the home will move residents out of these rooms so that they can be refurbished. Some of the beds viewed appeared to be very low. The home told us that there are plans to replace these. Four bedrooms viewed did not have a lead for the call bell system. Therefore, some of the residents may find it difficult to call for assistance due to dementia or limited mobility. The home should review the system, undertake a risk assessment for each resident and provide a suitable means for residents to call for assistance, when needed. The new lounge area provides a light and spacious room for residents. Due to the works, the home does not have an outdoor garden area. The home told us that they plan to have a temporary area ready by Spring so that residents can sit outside. The home should inform us that an outside garden area will be provided for residents to enjoy in the approaching summer months. The manager told us when they can gain full access to the garden, they are planning a reminiscence garden. The home sent us a timetable for the works in July 2008 giving information and timescales. The home should send us an updated timetable so that we know how the work is progressing. We viewed liquid soap, hand towels and flip top bins throughout the home. The laundry has sufficient washing and drying facilities. The home was generally clean despite the current works. One relative told us improvements are being made and the staff do very well to keep it clean and tidy. We observed cobwebs in two bedrooms and unidentified brown stains on the floor in two of the shower rooms. Care Homes for Older People Page 21 of 31 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. The homes recruitment procedures protect residents from the risk of harm. A comprehensive induction and training programme is provided for staff. Evidence: There appeared to sufficient staff on duty at the time of the inspection. Staff told us that there usually enough staff on duty to meet the needs of residents. The registered manager told us that for the 29 residents at the home, the staffing levels are; mornings - one registered nurse and seven care staff; afternoons - one registered nurse and six care staff; nights - three waking staff. In addition to this the home has kitchen staff, domestics, activities staff and a maintenance person. The registered manager is supported by a deputy manager. We viewed four staff recruitment files. These contained all of the required checks including references, CRB disclosures, identification and evidence of qualifications. Staff told us that they received a good induction when they started work at the home, and that they receive relevant training that keeps them up-to-date with current best practice. The home is using the Red Crier training system to provide staff training in the following areas; induction; First Aid ; Moving & Handling; Health & safety; Fire Care Homes for Older People Page 22 of 31 Evidence: Safety; Food Hygiene; Risk Assessment; Diet & Nutrition; Dementia; Coping with Aggression in the Work place; Protection of Vulnerable Adults (POVA); Infection Control; Care & Administration of medicines; Death, Dying & Bereavement; Mental Capacity Act 2005; Equality, Diversity & Equal Opportunities. We discussed the need to tailor the training to the home, residents and staff so that staff have the knowledge they need to put the training into practice and work within the home. Care Homes for Older People Page 23 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the required qualifications and experience to run the home. The home has quality assurance systems in place. The home is improving its storage of residents monies. The health, safety and welfare of residents is not fully protected. Evidence: Shirley Ruane is the registered manager at the home. Shirley is a registered general nurse with many years experience in care of older people. She is supported by a registered mental health nurse. The home sends out annual surveys to relatives. The home has introduced a quality audit self assessment tool which includes service user care, information and care Care Homes for Older People Page 24 of 31 Evidence: development, quality improvement and system structure. The registered manager told us that this links to the national minimum standards. The responsible individual carries out monthly visits to the home and records are maintained. The home stores small amounts of money for residents. Receipts are kept and transactions are signed by two staff. Some of the monies are stored in individual envelopes but other monies are pooled. The home should ensure that these monies are separated and stored individually so that they can be audited and protect the interests of the residents. We viewed health and safety records. The homes portable appliance testing was carried out in January 2009. The home has an up to date electrical hardwiring certificate and the extension was checked on 20/12/08. There is a fire risk assessment in place dated 14/07/2008. The fire officer visited on 18/12/2008. Gas safety was checked on 29/01/2009. Lifts and hoists were serviced on 03/02/09 and 09/12/2009 respectively. The kitchen has achieved five stars on its food hygiene inspection. The Safer Food, Better Business pack is in use. We viewed cleaning chemicals in an unlocked cupboard, steradent in three bedrooms and nail polish remover in one bedroom. An immediate requirement was issued during the inspection. The home must ensure that chemicals, steradent and nail polish remover are stored securely as this places residents at risk. Codes for keypads were written on the wall. If a resident was to put in the code and gain access through the door, they would be able to access stairways and paint and glue that are stored there. The home must remove the codes to protect residents from accessing areas where they could be placed at risk of harm. Care Homes for Older People Page 25 of 31 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 31 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 38 13 The home must ensure that chemicals are locked and secure. This is to protect residents from risk of harm. 02/04/2009 2 38 13 The home must ensure that 02/04/2009 steradent and nail polish remover are stored securely. This is to protect residents from risk of harm. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 The home must ensure that where risks are identified and assessed a clear up-todate plan is put in place. This is so that staff know how to minimise risks and protect residents from risk of harm. 03/04/2009 2 7 12 The home must ensure that 25/05/2009 their care plans reflect all assessed needs and updates are recorded. Care Homes for Older People Page 27 of 31 This is to ensure that staff know how to meet residents needs and changing needs. 3 9 13 Arrangements must be made to obtain and fit a controlled drug cupboard meeting the current regulations. This is to keep medicines safely and reduce the risk of any diversion occurring. 4 9 13 The home must ensure that they record the actual dose of medicine administered. This is to ensure that residents response to medicines can be effectively monitored and fed back to the prescriber, also preventing the risk of either under or over dosing. The home must date medicinal creams on opening. This is to ensure they are used when at their best. The home must ensure that they record when they have administered supplements. This is to ensure that residents receive their prescribed medicines. 02/04/2009 15/04/2009 5 9 13 02/04/2009 6 9 13 02/04/2009 7 9 13 The home must ensure that 02/04/2009 all medicines and dressings that have passed their expiry date are correctly disposed of and not available for use. Also, stock Page 28 of 31 Care Homes for Older People belonging to people no longer living at the home is not available for use. This is to make sure that inappropriate stock is not used for residents. 8 38 13 The home must remove the keypad codes. This is to protect residents from accessing areas where they could be placed at risk of harm. 02/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The home should review the recording system for care plans to ensure that all care needs and preferences are clearly presented and easy for staff to follow. The home should ensure that staff provide interaction for each resident so that their emotional needs are met. The home should ensure that nebulisers are serviced to check they are in safe working order and cleaned after use for hygiene purposes. The home should ensure bedroom doors show the name of the resident who occupies the bedroom. The home should ensure that suitable window coverings are provided in the one identified bedroom. This is to ensure that residents privacy and dignity is maintained. The home should send us an updated timetable of the building work, refurbishment and redecoration so that we know how the work is progressing and any impact on residents. The home should inform us that an outside garden area will be provided for residents to enjoy in the approaching summer months. The home should review the call bell system, undertake a risk assessment for each resident and provide a suitable Page 29 of 31 2 3 7 9 4 10 5 19 6 20 7 22 Care Homes for Older People means for residents to call for assistance, when needed. 8 24 Consideration should be given to providing locks on new bedroom doors which are appropriate to the needs and abilities of people living at the home and which are of a type which allow people to lock their doors when they are not in their room. (This recommendation was made at a previous inspection). Bedrooms should have the provision of lockable storage for people. (This recommendation was made at a previous inspection). The home should ensure that residents monies are separated and stored individually so that they can be audited and protect the interests of the residents. 9 24 10 35 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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