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Inspection on 21/11/08 for Home Of Comfort Nursing Home

Also see our care home review for Home Of Comfort Nursing Home for more information

This inspection was carried out on 21st November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The meals at the home were very well managed to the satisfaction of the service users. The service users are provided with comfortable accommodation that they say meet their needs. The internal audit system in place indicates that the provider listens and acts on the feedback from people using the service. There is a pre admission assessment process in place that looks at the needs of people prior to them moving into the home. There is a high proportion of care staff that have achieved National Vocational Qualifications in care. The provider has stated that all the carers have NVQ 2 or 3 in care.

What has improved since the last inspection?

There have been some development in care plans and assessments with the support of external professionals. There has been a review of storage of equipment to ensure that the home is less cluttered and the safety of the service users is promoted. There is an ongoing refurbishment programme in place and several bedrooms, stairways and ceilings have been decorated. The doors have been fitted with safety strips as part of fire protection procedures.

What the care home could do better:

The care plans and assessments need further development to ensure that all care needs identified are addressed. These must include accurate records of food and fluids for those identified as at risk. The medication management must be developed in order that people`s health care needs are effectively met. The activity programme should be looked into and developed in order to meet the social and cultural needs of people accommodated. The complaints and safeguarding processes are inadequate to protect people living at the home. The recruitment procedure is not robust and puts people at risk of harm. There is inadequate training in mandatory health and safety to ensure that people are not put at unnecessary risks. The management process at the service does not ensure that people are not put at risk of harm to their health and safety.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Home Of Comfort Nursing Home 17 Victoria Grove Southsea Portsmouth Hampshire PO5 1NF     The quality rating for this care home is:   zero star poor 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: Anita Tengnah     Date: 2 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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: Home Of Comfort Nursing Home 17 Victoria Grove Southsea Portsmouth Hampshire PO5 1NF 02392730063 02392730063 hocomfort@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Barbara James Type of registration: Number of places registered: The Home of Comfort Charity care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 30. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Home of Comfort is a care home providing nursing and personal care for 30 ladies over the age of 65 years. The home is owned and administered by The Home of Comfort Charitable Trust and is represented by a management committee, one of whom is the named responsible individual stated on the certificate of registration. The home is located in the pleasant residential area of Southsea, close to Portsmouth city centre and in walking distance from the sea front and local amenities. The home is two Care Homes for Older People Page 4 of 31 Over 65 30 0 Brief description of the care home converted Victorian houses on three floors with a purpose-built three-storey wing added in the 1960s. A newer conservatory lounge has been added in recent years. The home has a well-maintained garden that surrounds the home and is accessible to service users who make use of it in the finer weather. All rooms are single accommodation. There are two shaft lifts installed. 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: zero star poor 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: An unannounced inspection was undertaken on the 21st November 2008 as part of our process of monitoring the service. The inspection was completed over one day and the provider and the nurse in charge assisted us during the visit. We sent out the Annual Quality Assurance Assessment (AQAA) to the service which is one of the means of collecting data about the service. We spoke to the service users and the staff and other healthcare professionals as part of the visit. We also sampled care plans and staff records and observed practices. Information that we have received since the last inspection has also been used in making judgement about the service. Care Homes for Older People Page 6 of 31 Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The care plans and assessments need further development to ensure that all care needs identified are addressed. These must include accurate records of food and fluids for those identified as at risk. The medication management must be developed in order that peoples health care needs are effectively met. The activity programme should be looked into and developed in order to meet the social and cultural needs of people accommodated. The complaints and safeguarding processes are inadequate to protect people living at the home. The recruitment procedure is not robust and puts people at risk of harm. There is inadequate training in mandatory health and safety to ensure that people are not put at unnecessary risks. The management process at the service does not ensure that people are not put at risk of harm to their health and safety. Care Homes for Older People Page 8 of 31 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. There is a satisfactory pre admission assessment process in place to ensure that the service users needs are assessed prior to moving into the service. The nurse in charge confirmed that the home did not provide intermediate care. Evidence: We looked at the care records of two recently admitted service users as part of case tracking. The staff reported that the manager or a senior staff completed the assessment prior to people moving in to the service. We found that one of the service users relative visited the home prior to the service user moving in. Assessment record was available including recent history of fall, mobility assessment, medical history and record of exernal healthcare professionals that were involved in the persons care. The other service users record showed that Care Homes for Older People Page 11 of 31 Evidence: the assessment was completed on admission. The nurse in charge stated that this person may have come in as an emergency. Hence a pre-admission assessment was completed at the time of admission. The staff reported that the service users are issued with information such as the statement of purpose as required. 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. The care plans contained some information, however further development would ensure that they are detailed and informative to meet the assessed needs of people accommodated. The access to healthcare professionals are well managed and people are supported. Care was delivered in a respectful manner. The medication management does not fully protect people using the service. Evidence: The care plans for three service users were looked at as part of this visit to assess how the care needs of people were being met at the service. We found that assessments were completed and these included nutritional assessments, personal care, skin integrity such as Waterlow score and fall assessments. The staff reported that the care Care Homes for Older People Page 13 of 31 Evidence: plans had recently undergone a complete overhaul with the advice from the healthcare professionals. Assessments and care plans had been developed including dietary and moving and handling assessments. We found that there were some reviews undertaken for the care plans in place however these must be further developed to ensure that details of any changes are clearly recorded including action required to meet those needs. A service user had recently had numerous falls, the care plans did not contain a full fall risk assessment and review in relation to the recent falls and what action was required to ensure safety of this service user. The provider has since reported that an infrared sensor has been put in place for one of the service users. The home had two sets of care plans in use at the time of the visit and we found that these sometimes contained conflicting information about the care needs of people. This included the dietary needs for a service user receiving a pureed diet. As discussed this posed the risk of lack continuity of care and the service users needs not being met appropriately. We found that one of the service users record had conflicting report regarding use of bed rail. Also consent for their use was not in place and this must be developed. Information about continence assessments as carried out by external healthcare professionals were not available. Continence care plans did not contain clear information about type of pads and their management such as which barrier cream to use. The staff had developed detailed wound assessment and care plans that were available in the records that we looked at. These included type of dressing and frequency that they needed to be changed. The staff did not always record when wound was reviewed and updated in order to reflect Upton date information. There were dietary assessments completed in particular for those at risk of malnutrition, however the home had generic diet care plan in place that gave a list of fortified food to be used. This must be further developed in order to reflect the individual dietary support identified from their assessment to ensure that their needs are met. The staff were maintaining food and fluid charts for three of the care plans that we looked at. However the records were inadequate in particular in relation to fluids taken in the evening and overnight. The nurse in charge reported that this would be rectified Care Homes for Older People Page 14 of 31 Evidence: and staff made aware of their responsibilities to record all food and fluids accurately as we found that these records contained gaps of a number of hours. The service users were registered with the local surgery and staff ensured that they were supported in accessing medical help and referral were made on their behalf. The nurse in charge reported that they had a good relationship with the local health care trust and received support from the district nurses and the community psychiatric team. We spoke to a healthcare professional who was visiting the home and was complimentary about the care that people were receiving at the service. The service users are supported to remain with their own doctors if possible when they move into the home. Pressure relieving equipment and advice for the treatment of pressure ulcers were available as required. We looked at the medication management that the home undertook on behalf of the service users. The home was using the Nomad system that ran over a twenty eight days cycle. Medication administered were recorded on the Medication Administration Record (MAR) sheets. The staff confirmed that only the registered nurses were responsible for the administration and management of medication at the service. The record of medication administered was adequate with only one gap on the MAR sheets in the sample of MAR records seen. The staff were recording the amount of medication received into the home. However we found that the record were inaccurate and did not match with the amount received, the amount recorded as having been administered and the stock balance. This posed serious concerns as the administration records may not be accurate. There was no audit system in place for medication. The procedure for repeat prescriptions showed that the home sent their requests to the chemist who then forwarded to the GPS. The home did not have a copy of the repeat prescriptions and were not able to check to ensure that they have received the medication as requested. Further information can be found in the Royal Pharmaceutical guidelines that the home should access. Another service user had been refusing their medication for five days, the records did not reflect what action the home had taken such as discussion with the GP and action plan. Care Homes for Older People Page 15 of 31 Evidence: The nurse in charge reported that arrangement had been put in place for another service user who may need pain control via a pump. This analgesia was available at the service and the district nurses would be providing them with the pump and training. We found that the management of ointments and creams were inadequate to safeguard the welfare of people. These did not contain the names of people that they had been prescribed for and pose Giff infection control risks. The home did not have a procedure for the administration of homely remedies and this needs developing to ensure that these are managed safely and appropriately including consents from their GP. We found that the drug fridge was not locked at the time of the visit and was rectified when we brought this to the staffs attention. The home has a large quantity of wound dressings that did not contain the names of the service users that these had been dispensed for. The home must ensure that all prescribed medication including dressings and creams are only used for the named service users as required. The excess dressing stock must be reviewed an action taken to ensure their correct management. People we spoke to said that they were treated with respect and they had autonomy and choice in relation to their daily lives. Interaction observed indicated that the staff and the service users had developed good relationships with each other. Staff were seen to knock prior to entering the service users bedrooms. People spoken with said that the staff were good and felt that they were treated with respect always 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social and recreational activities would benefit from further development to ensure the service users needs are appropriately met. The meals at the home were good and offered the service users choices and met with their satisfaction. Evidence: The home has a planned activity programme that included games, skittles, bingo, crafts and a barbecue in the summer. The staff reported that the service also brought in external entertainers such as a comedian which was planned for the Christmas party. The home has the support of a person that shops for the service users on Mondays and it was reported that this worked well. The two comments we received from our surveys showed that one of them was aware of the activities as mentioned above. The other person said that they went to a quiz and bingo once and would go again if this was available. The service users we spoke to said that they enjoyed the church service that occurred Care Homes for Older People Page 17 of 31 Evidence: monthly and the accompanying organ recital as part of the service. Another service user discussed how they had taught themselves to knit and was enjoying knitting squares for a blanket as part of a joint venture with other service users. We did not observe any activities on the day of the visit and little staff interaction with the service users who were in the lounge for most of the day. This was discussed with the nurse in charge and further development including dedicated staff hours would support the social activity time for the service users. The home has an open visiting policy and people we spoke to confirmed that there was no restriction on visiting. The home maintained a record of visitors to the service as required and this showed that people visited at different times of the day. The two people we spoke to said that they did receive their visitors in their rooms and people were always made welcome. The home has a planned menu that is rotated on a four weekly basis. We discussed the meal planned for the service users with the chef. We found that meals were well organised and the service users were asked about what they wanted to eat daily. The chef maintained detailed records of all food taken and any variation from the main menu. The meals were varied , balanced and included pureed and diabetic diets as required. The kitchen was well organised and very clean. There were two choices offered to the service users for the main meals and the teatime menu was varied. We observed the lunchtime meal and found that the meals looked appetising, balanced, well presented and choices were offered. The staff were available and supported the service users with their meals in a sensitive manner. Comments from six people we spoke to were that the meals were very good and always plentiful and hot and cold drinks were available as required. One comment was that they enjoyed breakfast but did not like meat and ate vegetable and potatoes. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a lack of clear and accurate record to demonstrate how concerns and complaints are managed at the service. There was inadequate records and the process for recording allegations of abuse and any actions taken to safeguard people. Evidence: The home had a complaint procedure in place and staff said that they would report to the person in charge if any concerns were raised with them. The complaint procedure did not contain the current details of the commission , this was brought to the staffs attention and this would be rectified. We looked at the complaint log as maintained and found that there were three complaints recorded. The log contained little details of the investigation, outcome and any action plan put in place following the investigation. Information we have received showed that the home was not following procedures for reporting allegation of abuse to the Commission as required. This was brought to the attention of the registered person at the time and reports of incidents were sent to us. We have received three recent complaints that had been investigated as safeguarding. These were allegations that had serious impact on the care that people were receiving Care Homes for Older People Page 19 of 31 Evidence: at the service. We were unable to find any records of these at the service and action taken following these investigations under safeguarding. We were unable to access any of the training record for staff in relation to safeguarding as the manager was not available on the day of the visit. Staff we spoke to said that they would report to the manager. The home did not have the updated safeguarding procedure and this was discussed with the nurse in charge. This must be accessed and put in place and staff updated with its contents. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are provided with a homely accommodation that met their needs. The infection control procedures were satisfactory. Evidence: We looked around the home as part of this visit and looked at some of the service users bedrooms. The service was warm and homely and there was no adverse odour when we walked around the home. We found that the home had reviewed some of the storage facilities for equipments such as hoists and wheelchairs and this had improved. Some of these were still stored under the stairs, however the home appeared less cluttered. The bedrooms we looked at were mostly personalised and it was evident that people were supported to bring with them items of personal belongings. One of the service users talked about the large collection of teddy bears that they collected and displayed in their room. The service users were also supported to have private telephone lines that was at an extra cost. Call bells were available and accessible to people as required. Care Homes for Older People Page 21 of 31 Evidence: Positive comments were received from the people we spoke with at the time and they all said that this was home now. The home had information available about infection control procedures. These included protective equipment such as gloves and aprons. The staff practices observed at the time of the visit indicated that they were aware of these. The home has a laundry and all the service users laundry was undertaken internally. Care Homes for Older People Page 22 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is adequate staff including trained nurses cover during the week, however the weekend cover must be looked into to ensure that the service users are supported with appropriate nursing cover as required. The recruitment process is inadequate and pose risk to the safety of people living at the home. There was a lack of evidence to fully assess the staff training. Evidence: We looked at the staff roster as part of this visit to assess how the home plans to meet the needs of people accommodated. The home has two registered nurses and six carers on the morning shifts, two registered nurses until five pm and then one nurse and four carers on the afternoon to evening shifts. Night duty had one registered nurse with two carers and a carer came in at six am to support the night staff. The staff reported that the home had only one registered nurse on all the weekend shifts. This showed that there was a reduction of trained cover, however the number and needs of the service users remained the same. Care Homes for Older People Page 23 of 31 Evidence: We were unable to assess the training that the staff undertook as part of maintaining their skills as the records were not available, the manager was not at the home at the time of the visit. The nurse in charge said that there was an induction process, however we were not able to see any record of this. Information we have received from the AQAA indicated that funding for staff training was available and all the carers had completed National Vocational Qualification (NVQ) 2 in care. The home has an in house moving and handling trainer to enable facilitation of training for staff. The provider provided us with a record of training following the inspection. This showed that there is some training available to staff. However the record indicated that some staff have not received any updates or training in moving and handling since 2007. Other staff have received no moving and handling training and fire safety training since they were employed. Arrangement need to be in place to ensure that records are available for inspection as required in the absence of the manager. We looked at the recruitment process that the service had in place. The staff records of three recently employed staff was looked at. This showed that the staff had each completed an application form and references were sought as part of this process. Two of the staff records seen contained checks such as Criminal Record Bureau (CRB) and POVA first completed prior to employment as required. Evidence of staff receiving terms and conditions of employment was seen in two of the records. The provider has stated that all three records contained this document. We found that one of the staff did not have the necessary CRB and POVA first checks completed prior to starting work at the service. Records as maintained at the home indicated that the person who is a Registered nurse worked with another nurse on the first night. However on the second night they worked unsupervised without any POVA first check as the only trained nurse on night duty, this puts the service users at unnecessary risks. Evidence of the necessary checks of the registered status with the Nursing and Midwifery Council ( NMC) must also be maintained in their records. There was no evidence in the record seen that the trained nurses had current registration with the NMC to practice as registered nurses and caring for vulnerable people. Care Homes for Older People Page 24 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management process at the home is inadequate to support and safeguard people from risk of harm. The internal audit system ensures that people views are sought and listened to. There is satisfactory process in place for the management of the service users personal allowances. The home has an auditor that looks at the financial management of the service. The health and safety of people are not protected through inadequate recruitment and safeguarding procedures and practices. Evidence: The home has a registered manager who was responsible for the day -to -day management of the service. The manager was not available on the day of the visit. Staff and the service users we spoke to said that they would speak to the manager if Care Homes for Older People Page 25 of 31 Evidence: they needed to raise any concerns. The manager is also a registered nurse. We looked at the internal audit that the home has in place and this included regular visit as undertaken by the Responsible Individual. The service had completed an audit of the service users and relatives views in December 2007. A detailed analysis of the audit was available and the staff discussed the action plan that the home had implemented from listening to people. Staff reported that this information would also be available in the statement of purpose and made available to the service users. We looked at a sample of the personal allowance that the home managed on behalf of the service users. We found that records of transactions were maintained. A random check showed that the amount recorded was accurate with the balances maintained at the service. All moneys were maintained safely and in individually. It is highly recommended that two signatures should be recorded for all transactions. The home has a system in place for the regular servicing of equipment such as hoist and passenger lift, emergency lighting and these had been completed in the last six months. As reported in the previous sections the registered manager needs to address the medication management and care assessments to ensure the safety of the service users. The registered manager had failed to ensure that there is a robust recruitment process in place and people are not put at risk of poor practices and care. The reporting, recording and dealing with all allegations of abuse is inadequate to effectively safeguard people from harm and this falls within the remit of the registered manager. Information from the AQAA suggets that this is an area that the home has identified as needing improvement. Care Homes for Older People Page 26 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 27 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 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 14 The registered person must ensure that the records of food and fluids are recorded accurately. The nutritional assessments must be reviewed and detailed plan put in place in relation to nutritional needs. So that you can ensure that people receive the correct treatment and diets as needed. 15/01/2009 2 9 13 The registered person must ensure that arrangements are in place for the safe handling, recording, safe administration and disposal of medication received into the care home. So that the people accommodated can receive their medication as prescribed and they rare not put at risks of harm. 15/01/2009 Care Homes for Older People Page 28 of 31 3 16 17 The registered person must 15/01/2009 ensure that a record of all complaints made by the service users, their relatives or by persons working at the care home is maintained including the action taken in respect of any such complaint. So that you can ensure that people can be assured that their complaints are looked into. and you take action appropriately. 4 18 12 The registered person must ensure that a robust procedure is in place to record and report all allegation of abuse. So that you can assure that the service users are safeguarded from poor practice and abuse. 15/01/2009 5 29 19 The registered person must ensure that all necessary checks are completed prior to staff starting work. So that you can ensure that the service users are not put at risk of poor practices and abuse. 15/01/2009 6 30 18 The registered person must 15/01/2009 ensure that evidence of staff training is available including induction training and mandatory health and safety . So that you can ensure that staff have the skills to Care Homes for Older People Page 29 of 31 deliver care safely and people are not put at risk of harm. 7 31 12 The registered person must 15/01/2009 ensure that the care home is conducted to to promote and make proper provision for the health and welfare of the service users. So that people using the service can be assured that they will be protected from harm. 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 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. 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