Inspection on 16/06/09 for Holmers House

This inspection was carried out on 16th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmers House 15/09/08

Holmers House 24/06/08

Holmers House 27/06/07

Holmers House 21/08/06

Holmers House 20/12/05

Holmers House 14/09/05

Holmers House 25/01/05

Holmers House 03/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Holmers House Holmers Farm Way Cressex Road High Wycombe Bucks HP12 4PU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Chris Sidwell     Date: 1 6 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Holmers House Holmers Farm Way Cressex Road High Wycombe Bucks HP12 4PU 01494769560 01494769566 alison.pulley@heritagecare.co.uk www.heritagecare.co.uk Heritage Care Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Lorraine Coe Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 48. The registered person may provide the following category of service only:Care home personal care - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Physical disability (PD) Old age- not falling within any other category (OP) Date of last inspection Brief description of the care home Homers House is a purpose built residential home. It is owned and managed by Heritage Care. Accommodation is provided in single rooms. The home is divided into smaller units, each with its own sitting room, dining room and kitchenette. the home is Care Homes for Older People Page 4 of 28 48 0 48 Over 65 0 48 0 Brief description of the care home adapted to meet the needs of people with disabilities. There are safe, accessible gardens to the rear and side of the property and car parking to the front. The home is in a residential area of High Wycombe, which has all the amenities of a large market town and has good commuter links. Public transport is accessible and there are leisure facilities nearby. There is a large national department store and national chain supermarket in the same area as the home. Service users are registered with general (GP) practitioner practices and all service users have access to local national health services through GP referrals. Community Nurses visit the home and provide support to the home as needed. Care Homes for Older People Page 5 of 28 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: The last inspection was undertaken on 25th June 2008, when the quality rating was good. Although registered for older people, people with disabilities and those with dementia, the home currently only takes people with dementia. This inspection was conducted over three days and included a review of the information we hold about the service and an unannounced visit to the home of six hours. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment and questionnaires were sent to the home for distribution to residents, families and staff. Residents were spoken to on the day of the unannounced visit. Discussions took place with the manager, care and ancillary staff. Care practice was observed and the care of a small number of residents was followed Care Homes for Older People Page 6 of 28 through in detail. A tour of the building and examination of records was also undertaken. The homes approach to equality and diversity was considered throughout. Most people are funded by the local authority. They may make a variable financial contribution to the fees dependent on their means. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Although there is information available to people, they or their families did not always feel that they had seen it or had enough information to decide whether the home could meet their needs. The homes registration categories do not accurately reflect the care that is offered. The home is registered to accept people with dementia, older people and younger physically disabled. The home currently offers only dementia care. Care Homes for Older People Page 8 of 28 Consideration should be given to reviewing the categories of registration in order that people looking for a care home are not misled into thinking the home can meet their needs. Peoples health and social care needs are not always assessed by the homes staff before they move to the home, to ensure they can be met. Not everyone has a contract or copy of the terms and conditions of their stay, which may lead to a lack of clarity for residents and their families. The manager should ensure that all residents and families know who to speak to if they are not happy and how to make a formal complaint, as some people who returned the questionnaires said that they did not know who to speak to or how to make a complaint. Infection control standards could be improved. Hand washing facilities should be available at the point of care for staff and alcohol hand sanitizer should be available for staff, to help minimise the risk of cross infection for residents. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there is information available to people, they or their families did not always feel that they had seen it or had enough information to decide whether the home could meet their needs. Peoples health and social care needs are not always assessed before they move to the home, to ensure they can be met. Not everyone has a contract or copy of the terms and conditions of their stay, which may lead to a lack of clarity for residents and their families. Evidence: There is information available to prospective residents in the form of a statement of purpose, which describes the services provided by the home and a home brochure. Prospective residents and their families are welcome to visit the home and stay for a trial period before deciding whether the home is for them. Twelve people or their families returned the surveys we sent to them and of those ten said that they did not have or did not know whether they had received enough information before moving to the home. None said that they had a copy of the term and conditions of their stay. Care Homes for Older People Page 11 of 28 Evidence: The manager said that all residents or their families received a welcome pack which contained these details. The care files of three residents who have moved to the home since the last inspection were checked. They held copies of the care managers assessments where appropriate. Two people had moved to the home as an emergency, one from their own home and one from another care home. They had not been assessed before they arrived but had been assessed on arrival. One person who was in hospital had been assessed before they arrived at the home. Care staff said that they would normally assess everyone when they received a care managers referral, before they move to the home to be sure that the home could meet their needs. The assessment documentation prompts staff to take note of peoples faith wishes, although not cultural needs, as well as their health and social care needs. The files of three residents were checked at random to see whether they had been given contracts or terms of conditions covering their move to the home. None had contracts or terms and conditions of their stay in the files held at the home. Two were funded by the local authority but should have had a copy of their terms and conditions and one paid a top up fee directly to Heritage Care. He too should have had a copy of his terms and conditions. This must be addressed. Residents should have a contract or terms and conditions of their stay irrespective of their funding source. Care Homes for Older People Page 12 of 28 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. In general residents diverse personal, health and medication needs are met in a manner which protects their dignity, promoting their wellbeing. The general practitioner must be told when residents are refusing essential medication, to ensure that they do not come to harm. Evidence: The care of six residents was followed through. All had support plans which had been updated regularly with them and with their families. Not all plan entries were signed and dated. Residents diverse needs were recognised and recorded. All held falls risk assessments and moving and handling risk assessments. All had a nutritional assessment although a recognised nutritional risk assessment tool had not been used. There were records to show however that residents are weighed regularly and those whose care was followed through had maintained or put on weight since moving to the home. There were good examples in the care plans of peoples life histories, which were sensitively described. Staff were also observed to be managing challenging behaviour well with the support of the Community Psychiatric Nurse (CPN). The Care Homes for Older People Page 13 of 28 Evidence: person centred care plans also focused on peoples abilities and not deficits which is important in the care of people with dementia. There were records in the team leaders daily log, although not in individual care plans, to show when residents saw healthcare professionals, including the general practitioner and most residents appeared to have seen a general practitioner and other members of the healthcare team when necessary. The manager said that residents keep their own general practitioner if possible but may have to register with a local general practitioner and this can be difficult. The home currently has residents registered with nine general practices and many different general practitioners. Heritage Care and the Local Authority, which purchases most of the care, should discuss this with the local Primary Care Trust as it makes coordination of care for residents complex for staff. The staff said that they had requested a general practitioner visit one resident and the district nurses had visited instead. Another resident had been refusing essential eye drops and staff were unclear as to whether the general practitioner had been told. No records could be found to show that she had. This must be addressed. Accurate records of the involvement of healthcare professionals must be kept in residents individual files. The general practitioner must be told when residents are refusing essential medication, to ensure that they do not come to harm. There are medication policies and procedures in place and the staff spoken to were aware of these. Records are kept of medication delivered and disposed of by the home. Residents individual medication administration records were completed in full and appropriate steps were taken to ensure that supplies were received regularly and new medication started promptly. Appropriate procedures were in place to deal with variable dose medication such as warfarin. The care plans did not contain individual prn protocols to guide staff as to when and why to offer medication which is not given regularly but only when needed. These should be developed. There is information on our website, www cqc.org.uk, about medication which is prescribed to be taken when required. None of the residents managed their own medication at the moment although there are policies and procedures in place to support this if residents wish. The staff spoken to said that medication was never given covertly. If a resident did not want to take their medication, this would be recorded. Controlled drugs were stored correctly and the records were correctly completed. The stock levels of controlled drugs were checked and found to be correct. Two people sign all entries in the controlled drug book. Care Homes for Older People Page 14 of 28 Evidence: Residents said that care staff were discrete and that all care is given in residents rooms. People who returned the surveys said that always or usually received the care that they needed and made positive comments such as on the whole we do very well, they look after us well and keep every one happy. Care Homes for Older People Page 15 of 28 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 can choose how they spend their day and are supported to take part in activities in the home if they wish. The standard of food is good meeting residents social and nutritional needs. Evidence: Residents spoken to said that they had a choice as to when they got up and when they went they went to bed. There are two activities coordinator in post and they arrange a programme of activities and 1:1 sessions with residents. The home has access to a minibus and outings have been arranged to local beauty spots, the River Thames and a local Open Farm. Seven of the twelve people who returned the surveys said that there were always or usually activities on offer and five said sometimes or never. Those spoken to said they had a choice as to whether they joined in. One lady said I am happy in my room, I have plenty of knitting and the staff help me with wool. There are accessible gardens for people with disabilities and the staff are supporting residents to grow vegetables in pots. The lounges are tidy and there are a few games and books available, although not a great deal of stimulus for people with dementia. Most were dozing in their chairs. The manager has recently introduced dolls as therapy and said that one lady in particular had found the doll comforting and her mental state had calmed since its introduction. The organisation has recently Care Homes for Older People Page 16 of 28 Evidence: commissioned an audit by a specialist dementia care charity and a number of recommendations have been made to improve the environment for people with dementia, which the manager said she would be introducing. A number of family members were spoken to and all said that they could visit at any time and were made to feel welcome. They said that they were kept up to date with the relatives needs and were told of any untoward event. There is an acting cook at the moment and the manager said that she had advertised for a chef. The cook was knowledgeable about residents likes and dislikes and said that she could provide menus to meet residents cultural wishes. There is a varied menu and all food is home cooked. There is a choice of menus at each meal. Most residents eat in the dining rooms attached to the lounges. These were pleasantly laid with tablecloths, cutlery and glasses and mealtimes were a sociable occasion. Most people who returned the questionnaires said that they always or usually enjoyed the food, although three said never. Carers were observed to be supporting residents, who could not eat unaided, discretely. One family member was visiting and he said that he visits often and that his wife usually enjoys her meals. He commented that they offer me lunch sometimes. I enjoy eating with my wife. Care Homes for Older People Page 17 of 28 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 live at the home are protected from harm and their concerns are listened to and addressed. The manager should however ensure that all residents and families know who to speak to if they are not happy and know how to make a formal complaint. Evidence: There are complaints policies and procedures in place. These are displayed in the entrance hall to the home along with information about local advocacy services. Two family members were spoken to said that knew how to make a complaint although they had not had occasion to do so. The complaints records were checked and showed that verbal and written complaints are recorded. The manager said in Annual Quality Assurance Assessment (AQAA) that the home had received fourteen complaints in the last year, of which one had been resolved within the timescales set and ten had been upheld. These were mostly received before she was appointed to the home in March 2009. There has been one complaint since her appointment, which was responded to promptly. The response showed that action had been taken. People who returned the questionnaires varied as to whether they knew how to raise a concern. Six people said that there was someone they could speak to informally and that they knew how to make a formal complaint, five said that there was someone who they could speak to informally but that they did not know how to make a formal complaint and two said that they did not know who to speak to informally or how to make a formal complaint. The manager should ensure that residents and families know who to speak to if they Care Homes for Older People Page 18 of 28 Evidence: are not happy and how to make a formal complaint. The home has a copy of the local multi agency safeguarding policies and procedures and staff have a received training in safeguarding vulnerable people. There are whistle blowing policies and procedures in place. The staff were very clear that they would report any concerns and could describe the categories of harm that residents might experience. The manager said in the AQAA that two safeguarding referrals had been made since the last inspection, which were investigated by the local authority, which is the lead agency in these matters. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, safe and homely environment for residents. Measures to minimise the risk to residents of acquired infection are in place although these should be improved if they are to meet the latest guidance from the Department of Health. Evidence: The home is on two floors and is accessible to people with disabilities. It is set in well maintained gardens. There is an ongoing programme of maintenance and redecoration. Carpets and flooring has been replaced as necessary and rooms have been redecorated. All rooms are single and have ensuite facilities. Residents are supported to personalise their rooms with small items of furniture and personal mementos. Many had chosen to do so. The home was clean and tidy on the day of the unannounced visit and there were no offensive odours. There are infection control policies and procedures in place and the home has a copy of the Thames Valley Health Protection manual on Infection Control which includes the latest guidance from the Department of Health. The laundry is well organised and the washing machines have programmes to deal with soiled linen and clothing. Soiled laundry is segregated and there is no need for laundry assistants to handle soiled laundry. Staff were observed to be wearing protective clothing correctly. Soap and paper towels are not available in residents ensuites for the use of staff and visiting professionals and alcohol hand sanitizer is not routinely available for the use of staff. Care Homes for Older People Page 20 of 28 Evidence: Staff said that residents would have to share hoist slings although no residents was using the hoist at the moment. The home should review the infection control procedures to ensure that they are in line with the latest Department of Healths (DH) guidance. Hand washing facilities for staff should be available at the point of care. Further information about infection control is available on our website www.cqc.org.uk and the DH website www.dh.gov.uk Care Homes for Older People Page 21 of 28 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 receive care from kind, well trained staff, in a timely way. Recruitment procedures are thorough, protecting residents from unsuitable carers. Evidence: The duty rota showed that there was good continuity of care staff. Care staff are usually allocated to one unit where they get to know the residents and residents get to know them. People who returned the questionnaires said that staff were always or usually available when they needed them. One resident spoken to said that the staff were a band of angels. She said that they always answered her call bell, including at night. There are five care staff on duty at night and whilst they have to undertake some domestic duties the manager said that there was always one on duty in each unit to respond to residents. One staff member said that this was sometimes difficult if residents needed two people at night or if they became active at night. This should be monitored to ensure that residents needs can be met and staff do not feel they are working alone at night. The manager has recruited to the deputy manager post, care practitioner post and team leaders post. The rota showed that there was always a senior person on duty to support the care team and to respond to residents needs. The atmosphere in the home was relaxed. Staff were observed to speak to residents politely and to support them with whatever activity they wished to do. There is an ongoing training programme. The training records showed that staff are up Care Homes for Older People Page 22 of 28 Evidence: to date with mandatory training in safe working practices to reduce the risk of harm to residents, or themselves, arising from care. The manager said in the AQAA that twenty staff members had completed an induction programme. Records may not be available for staff who started sometime ago and the manager said that all staff now have an induction programme to give them the skills and knowledge to care for older people. The six staff members who returned the questionnaires said that they had had an induction programme. The manager said that thirty of the forty-nine carers hold the National Vocational Qualifications in Care at Level 2 or above and a further nineteen are registered. The manager is an accredited trainer for the Alzheimer Society Yesterday, Today, Tomorrow training programme and all staff are now enrolled on this. Staff said that it gave them greater insight into the care of people with dementia. Six members of staff returned the surveys and all said that they were given up to date information about residents and that the home carried out checks before they started work. The recruitment files of two members of staff who had started at the home since the last inspection were checked. The required checks had been undertaken to protect residents from potentially unsuitable staff. There was evidence that the staff members identity had been checked. Criminal Records Bureau disclosures and two references had been sought before the staff member started work. The application form showed the staff members work history and interview records were kept. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the interest of the residents. Evidence: The manager has been in post since March 2009. She holds the National Vocational Qualifications in Care and Management at Level 4 and has applied to register with us. She said that she had an open door policy and staff confirmed that she was very approachable. An operational manager is registered with us the responsible individual. A care manager and community psychiatric nurse returned the questionnaires. They said that peoples social and healthcare needs were properly monitored and that the service sought advice and acted upon it to improve peoples well being. They also said that the home liaised well with families and that the manager was developing staff and introducing more training. Both said however that senior staff should be involved in reviews of residents care and that documentation should be more specific, to ensure relevant information is noted. There are regular resident, family and staff meetings. Heritage Care has Care Homes for Older People Page 24 of 28 Evidence: commissioned a specialist trust, The Guidepost Trust, to undertake an audit of the dementia care, which included seeking the views of residents and families as well as staff. The audit was comprehensive and aimed to identify good practice in dementia care, a learning organisation and an enabling environment. The manager is developing an action plan to implement the findings of the audit. The manager holds regular residents, families and staff meetings to ascertain peoples views of the service. Although care plans are updated monthly, there are no formal audit tools to measure the quality of care planning, medication administration and recruitment practices. These should be considered. Records of untoward events are kept, including accidents to residents, and are monitored by the organisation. A senior manager undertakes a regular visit to the service to monitor the quality of care and a record of these visits is kept. The home does not manage residents financial affairs. A small amount of personal allowance may be kept at the home. This is banked separately and individual receipts are given and records kept. There are health and safety policies and procedures in place and health and safety matters are discussed at staff meetings. Maintenance records were up to date and there was evidence that essential safety checks of services and equipment are undertaken. Water temperatures are tested regularly and there are window restrictors to upper floors to reduce the risk to residents of falling. The home was last inspected by the Fire Safety Authority in July 2008 and by the Environmental Health Officer in August 2008. The manager said that the recommendations made following these visits have been implemented. The training records showed that most staff members had had training in safe working practices, including moving and handling, fire safety and infection control. Care Homes for Older People Page 25 of 28 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 28 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 9 13 The general practitioner must be told when residents are refusing essential medication To ensure that residents do not come to harm. 31/07/2009 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 9 Care plans should contain detailed information about medication prescribed as required including why it has been prescribed and when and how it should be given. There is information on our website, www cqc.org.uk, about medication which is prescribed to be taken when required. The manager should ensure that residents and families know who to speak to if they are not happy and know how to make a formal complaint. The home should review the infection control procedures to ensure that they are in line with the latest Department of Healths (DH) guidance. Hand washing facilities for staff should be available at the point of care and residents should not share hoist slings. 2 16 3 26 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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