Inspection on 19/10/09 for Honiton Manor

This inspection was carried out on 19th October 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Honiton Manor 09/12/09

Honiton Manor 03/11/08

Honiton Manor 07/11/07

Honiton Manor 06/03/07

Honiton Manor 07/06/06

Honiton Manor 16/12/05

Similar services:

Manor Lodge

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Honiton Manor Exeter Rd Honiton Devon EX14 1AL     The quality rating for this care home is:   zero star poor 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: Teresa Anderson     Date: 1 9 1 0 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 46 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 46 Information about the care home Name of care home: Address: Honiton Manor Exeter Rd Honiton Devon EX14 1AL 0140445204 0140445324 honitonmanor@aol.com oakdash@aol.com Mr Howard Norman Dennis, Mrs Sarah Jane Mary Dennis, Mr David Malcom Baker, Mrs Angela Martha Christine Baker. care home 22 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Honiton Manor is registered to provide 24 hour nursing care for up to 22 service users who have needs relating to older people. The two-storey home is an older style building situated on the main road into, and quite close to, Honiton and the local amenities. It is on public transport routes. There are eleven single bedrooms and five double bedrooms situated on the ground and first floors. One of the double bedrooms has an ensuite bathroom. A passenger lift and a staircase link the floors. Communal space is made up of a large lounge and a dining room, both on the ground floor. Care Homes for Older People Page 4 of 46 0 4 1 1 2 0 0 8 0 Over 65 22 Brief description of the care home Outside there is access to a seating area and parking. Current charges are £515.00 - £675.00 per week. Charges do not include items such as newspapers, toiletries, taxis etc. Care Homes for Older People Page 5 of 46 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: This unannounced key inspection was due to be undertaken in November 2009. It was bought forward as we had received some concerns about the quality of care that people living here are receiving. During this visit we (the commission) spoke with or observed the majority of people living here. We could not speak with some people because they have communication difficulties such as dementia. We looked closely at the care, services and accommodation offered to four people living here. This is called case tracking and helps us to make a judgment about the standard of care overall, and helps us to understand the experiences of people who live here. We looked at the care and attention given by staff to these people and we looked at their assessments and at their care planning records. We looked at the environment in relation to their needs and how their health and personal care needs are met. We also Care Homes for Older People Page 6 of 46 spoke with visitors to the home, with staff and with the manager and one of the owners. We visited the majority of bedrooms and saw all service and communal areas of the home. We looked at records relating to accidents and incidents, staff training, staff recruitment, medication and at some policies. Prior to the inspection the owners sent us their Annual Quality Assurance Assessment (AQAA) which gave us information about the home and its management and about the needs of people living here. This document asks for evidence in relation to what the home does well and what they think they can improve upon. In addition, we sent surveys to 8 people living here and 3 were returned. We sent 8 surveys to staff and 3 were returned. We sent 4 surveys to health and social care professionals and all were returned. Feedback and comments are included in the report. During this inspection evidence was taken under the Police and Criminal Evidence Act and this has been considered under our enforcement procedures. Care Homes for Older People Page 7 of 46 What the care home does well: What has improved since the last inspection? What they could do better: This home does not have a registered manager and is not being sufficiently well managed. This has resulted in peoples health and welfare needs not always being assessed or met. The care planning and communicating systems in place are not sufficiently robust to ensure that care staff have the information they need about peoples care needs and how these should be met. Staff are well intentioned but are not always on duty in sufficient numbers, and do not always have the support they need, to meet peoples needs. On one night there was not a waking Registered Nurse on duty. Staff are not recruited in a robust way and this means that people are at risk of being cared for by inappropriate staff. People are not always treated with dignity and their rights to make choices or to be engaged and sociable are not always supported. Some peoples sense of self and personal identity is in danger of being eroded by a system that is not always person centred and is sometimes institutionalised. Complaints have been made to the commission by some people. They complain that the home is not well managed and the quality of care has declined. These concerns are being investigated by the local safeguarding team. This is the second safeguarding alert that has been made since the last inspection. Whilst this investigation is ongoing, admissions to this home via health or social care services have been suspended by Adult and Community Services. Staff training is not up to date and some specialist training is being designated to people who are not qualified or experienced to carry this out. Some working practices and systems are not ensuring peoples safety. This includes moving and handling people, ensuring windows are restricted to prevent accidental falls, the maintenance of equipment and risk assessments and actions in relation to the use of restraint. Systems are not robust enough to ensure that it is clear which staff have received mandatory training and which have not. The system for recording and monitoring accidents and incidents is not being used to help prevent further accidents. The commission have not been kept informed in relation to all incidents, accidents and Care Homes for Older People Page 8 of 46 deaths in the home, as we should be so that we can monitor this type of activity in the home. Statutory Requirement Notices have been issued to the registered owners of this service. These Notices inform the providers that they have failed to comply with the Care Home Regulations 2001 in relation to planning peoples care and in relation to meeting peoples health and welfare needs. The Statutory Requirement Notices tell the providers what they must do and gives them dates by when the failures identified must be addressed. 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 46 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 46 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people move into this home without having their needs fully assessed and without agreement from the funding authority. This means that people cannot be sure that their needs will be met in an appropriate way or that they will be staying in this home. Evidence: In surveys two out of three people who live here told us that they had the information they needed to decide if this was the home for them. In addition, two out of three health care professionals say that the homes assessment arrangements usually ensure that accurate information is gathered and that the right service is planned for people. One health care professional told us that this always happens. We were told that the home had admitted two people to this home without an assessment by and without the agreement of the funding authority. When we looked at records we found these people had been admitted from a residential home owned Care Homes for Older People Page 11 of 46 Evidence: by the owners of this home. We spoke with staff who told us that one of these people had moved here because they have nursing needs and therefore need their care to be planned and delivered by registered nurses. We looked at the records of one of these people. We found that an assessment of their nursing needs had not taken place prior to their admission, or since their admission. We found that all assessments in their records have been carried out in the home they used to live in. We could not speak with this person about their feelings about the move as they have communication difficulties. We spoke with the relative of another person living here. They told us that they had looked around the home and at the bedroom the person would move into. They were able to ask questions about the home before deciding this was the right home. However, we noted that this persons care record did not contain pre admission information from health and social care professionals as it should. Care Homes for Older People Page 12 of 46 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples medicines are safely managed. However, some people are being put at risk because their health and welfare needs are not being met. People do not have their care planned in a person centred way that treats them as individuals and are not always treated with dignity. Evidence: In surveys people living here told us they usually get the care and support they need and that they always or usually get the medical support they need. Two health care professionals told us that peoples health care needs are always properly monitored and one told us this usually happens. Two also said that the staff at the home seek advice and act on it to improve well being, and one said that this sometimes happened. Comments from health care professionals include that staff act promptly to get medical help for people who need it and that some people have blossomed since living here. We looked in depth at the care plans of four people living here. We also looked at Care Homes for Older People Page 13 of 46 Evidence: some others. We found that each person has a plan of care and that these contain a large number and range of documents relating to care needs. However, these documents were not person centred, are sometimes contradictory and do not always provide care staff with the detailed information that they need to meet peoples needs. For example one person that we case tracked has been admitted from the owners residential home. This persons care plan is the care plan from that home. Staff told us that the reason this person was admitted to this home was because staff believe that they need the 24 hour care of nurses. However, nurses have not devised a care plan as to how this persons nursing needs are to be met. In addition, information recorded in the daily notes from the residential home has not been followed up. Before being admitted to this home, it was recorded that this person has a urinary catheter, is prone to urinary tract infections and needs encouragement to drink. Two days before being admitted it is recorded that this person had very strong and dark urine which means this person may not be drinking enough fluid. This person has lived in this care home for approximately 6 weeks and the care notes have not mentioned this persons urine. We asked staff about this and they told us that the night staff empty the catheter bag and that they didnt know how much urine this person passed or what colour it is. We looked to see how much this person drinks in a day because the residential care home instructions state that they should be encouraged to drink to prevent urinary tract infections. We saw records that show this person drinks between 200mls and 1050mls in a day. The records do not contain instructions about how much this person should drink in a day. We asked carers how much this person should drink to keep them healthy and they thought that this would be about 1000mls. We asked carers if they knew how much this person had drunk in the past days and they said they did not because the nurse totals up the amount drunk. A nurse has reviewed the records kept about this person and the amount they have drunk. They record, in different places in the care plan, that they have drunk a fair amount, small amount and a good amount. However, these reviews do not appear to have taken into account the days when this person has only drunk 200mls, 350mls and 400mls. We have calculated that this person, according to their weight, should have at least 1880mls to drink each day. We spoke with the temporary manager about how much people should drink. She told us she knows there is a calculation to work this out, but does not know what it is. We also noted that records show that this person does not have a drink between 6pm and 8 or 9am. This is a very long time for someone who has a catheter and is prone to urinary tract infections. We observed this person on the day of this inspection. They had numerous drinks put Care Homes for Older People Page 14 of 46 Evidence: in front of them by members of staff. No encouragement to drink was given by staff, but was given by their wife. we would estimate that this person drank approximately 50mls between 10am and 1pm. We also saw that other people do not have enough to drink. We saw in care plans that people are assessed to see if they are at risk of developing pressure sores. We saw that people we had case tracked are at risk. These people are cared for on pressure relieving mattresses and cushions as is good practice. Some people are also nursed on adjustable beds which is also good practice. We were told that one person has developed a pressure sore since coming to live here and that one person came to the home having already developed a pressure sore. We looked at some pressure relieving equipment. We found one mattress had been set to the maximum pressure indicating that the person using this mattress is heavy. When we looked in care records we found that this person is very light. We asked staff how they work out the pressure that the mattress should be set to. One person said they did not know, another said the person setting it up does it. We looked in care plans, in peoples bedrooms and on the mattress motors to see if staff have access to instructions about the pressure each mattress should be set at. We did not find any instructions. We saw in care plans that some people are at risk of malnutrition. One person we case tracked is losing weight. The GP has been informed. However, the recommendations made by the specialist nutritional tool used (MUST) have not been followed. According to this persons level of risk they should be having specific drinks to supplement their calorie intake. Records show that these are given intermittently and not routinely. We asked staff if this person has supplement drinks and they said no. We noted in another persons records that they had been having loose bowel motions and saw and heard from a relative that they had been off their food. Records also show that this person has been what is described as grumpy. This person has been weighed weekly. Although the most recent weight shows a weight gain, the general trend is that this person is losing weight. There was no record to show that this is being addressed. Staff are not keeping records of what this person eats and drinks. A nurse had recorded that they had reviewed this care plan but had not taken any action to address these health issues. This means that this persons health is not being monitored appropriately and might result in a delay in appropriate action being taken. Prior to this inspection, the owners provided us with an updated improvement plan in relation to requirements made at the last inspection about meeting peoples nutritional Care Homes for Older People Page 15 of 46 Evidence: needs. This told us that the completion of the nutritional risk assessment tool (MUST) and for taking action if risk is identified has been designated to the catering manager. This person, along with other staff in the home, has received training in relation to nutrition from a company that supplies nutritional supplements. However, this does not qualify them to carry out these assessments or to determine the actions that should be taken. Another care plan recorded that one person stays in bed all day and does not get dressed. It states the reason for this as them being immobile and having contractures of their legs. Records do not include evidence that consideration has been given, or that actions have been taken, to make arrangements or find moving and handling equipment that might allow this person to move out of their bed. We looked at other records relating to people with dementia. Care plans state for example, that some people have a poor mental state and reduced powers of comprehension. However, care plans do not provide a plan as to how these peoples mental health and welfare needs are to be addressed or met. In addition, it has been agreed on three peoples behalf, who are described as confused or having dementia, that they would like to get them up as early as 6am. One of these people has an illness the symptoms of which include stiffness, especially in the morning and fatigue. These symptoms do not seem to have been considered in the decision to get them up early. We observed that one person is at high risk of choking as they have difficulty swallowing. This person was referred to the Speech and Language Therapist (SALT) some time ago. However, a visiting health care professional observed that staff were not following the guidance given by the SALT. They asked this specialist to visit again. Instructions were left for staff to follow as to how this person is to be supported to eat. We saw that some of this guidance is being put into practice. However, we also saw that some is not. For example, we saw that nurses saw a visitor offering this person a chocolate covered wafer. They did not explain to the visitor that this might cause problems for this persons swallowing. We saw this person in their wheelchair, leaning over to one side after lunch. This person is meant to sit up for 30 mins after eating. We saw that a member of staff put this person to bed soon after lunch, lying down. We asked staff about how this person is supported to eat and not choke. They told us what they knew, but did not know that this person should be sat up for 30mins after they had eaten. Staff told us this person has a pureed diet which complies with the SALT instructions. They also told us that they give this person cake and biscuits, which puts this person at risk of choking. The care plan does not contain instructions for staff about what to do if this person chokes. One carer told us they would use their Care Homes for Older People Page 16 of 46 Evidence: common sense and try a grab and thrust movement. A nurse told us she hoped that staff would know to call a nurse or 999. This lack of instruction means that there may be a delay in this person getting appropriate help. We asked the manager how staff have been given information about this persons needs and risk of choking since the most recent visit by the SALT. We were told that the nurses had been told about the special requirements for this person, and the nurses were named, and that they give this information to the carers. We saw from the duty rota that one of these nurses had been on sick leave over this period. The manager confirmed this adding that the nurses already knew about the advice. We reminded her that the SALT referral was made again because staff were not following the advice given, and this was putting this person at risk of choking. We saw in the improvement plan provided by the owners that staff have had training from the SALT in supporting people who have difficulties swallowing. This document also tells us that further updates will be given by the catering manager. This person is not qualified to do this and this is not good practice. We have checked with the SALT and they have told us that they are happy to provide further training if needed. We saw that many people living here have mobility problems. We checked care plans to see if people had had their moving and handling needs assessed. We found that some people had not had these needs assessed. We found another that was dated April 2007 which had not been reviewed or updated since that time. Care plans give very general instructions for care staff such as needs hoist. They did not specify the type of hoist to be used or the size of sling. We spoke to a nurse about how staff know which hoist and sling to use. The nurse told us that if a person is on the ground floor they use the hoist that is on that floor and that carers make a judgment about what size sling to use. This means that carers are not being supported to ensure that they use the appropriate equipment for each person. We also noted that the hoist is often used to help people who have been incontinent of urine. We saw that people share slings which does not help to prevent the spread of infection and indicates that care is de-personalised. Care plans in this home are in two parts. There is a larger comprehensive part which contains details relating to the person and the plan of care. There is also a day to day record which the manager told us is what carers use. Instructions in these smaller records contain task orientated information such as needs feeding, hoist, weekly weight and on fluid chart. These are not person centred and do not give care staff the information they need to provide individualised care based on each persons individual Care Homes for Older People Page 17 of 46 Evidence: needs and preferences. Carers told us they do not tend to read care plans, although they do write in them. For example they record fluid and food intake if people need to have this recorded. We found that entries made by staff include impersonal comments such as pad changed, repositioned, soaking wet bed, usual day and nothing new. This type of language is an indicator that the provision of care is task orientated and de personalised. We asked how staff get the information they need about people and their needs if they do not read care plans. They told us they know people, or get to know them. They say they do not get a handover of information when they come on duty, that only the nurse gets this. They say they start work straight away. They know who needs getting up and who needs breakfast. We asked the temporary manager how it is ensure that carers have the information they need to care for people and were told that she would hope nurses give this. This means there is not a robust system in place to ensure that care staff have the information and guidance they need to ensure that peoples needs are met. We saw that care plans are reviewed by nurses. However, we noted that despite changes in peoples conditions that there were no changes to the plans of care. We also noted that reviews of care plans do not record what information has been used to make the nursing decisions. The pharmacist inspector inspected the way that medicines are managed in this home. We looked at arrangements for storing and giving medicines in the home. We checked the records that are held in the home for medicines given to people, and discussed how medicines are handled with the manager and other staff working in the home. We were told that sometimes people can look after and take their own medicines. There are not any people living in the home at the moment who do this, and people are given their medicines by nursing staff. Medicines are stored safely for the protection of people in the home. There are suitable arrangements for controlled drugs and any medicines requiring cold-storage. Records are kept of medicines received into the home, and of any unwanted medicines that are sent for destruction. Records are kept of medicines that are given to people, which helps to show that people receive their medicines as prescribed by the doctor. If a regularly prescribed dose is omitted, then a reason for this is recorded, as is good practice. Usually if a variable dose is prescribed there are clear records to show how much is given, and this too is good practice. Care Homes for Older People Page 18 of 46 Evidence: We looked at some peoples care plans to see what information is recorded about their medicines. We found written permission from the doctor to crush someones tablets before giving. Staff had not asked if other forms of the same medicines are available, such as soluble tablets or liquids, to make it easier for people to take. We found clear guidance for staff on when to administer medication that was prescribed to be given when required. This helps to show that people receive their medicines in the way their doctor intended for them. We looked at how peoples privacy and dignity is maintained. We heard people being called by their preferred names and some people were able to tell us they wear their own clothes. We saw staff discreetly helping some people go to the toilet. However, we also saw one person trying to attract the attention of staff who walked past or said hang on as they walked past and did not come back. We heard one person saying no repeatedly and we heard a carer saying yes, yes, yes in a mocking fashion. We saw in the care plans of two people that they like to be or are washed, shaved, have their hair brushed and dressed whilst sitting on the commode. This is not a dignified way to provide care. In addition a record of names of people who had taken a bath is kept in the communal bathroom. This indicates an institutional approach to peoples personal care needs and to their confidentiality. We saw one person being hoisted to be taken to the toilet. When raised out of their seat there was a strong smell of urine. After they left the lounge, the smell persisted. We smelt the chair and found that the smell was coming from the fabric of the chair, and from the pressure relieving cushion on the chair. When staff returned they put this person back onto the chair. Each time this person shifted their weight in their chair, there was an unpleasant odour of stale urine released. We saw that two people share a bedroom. There are no records to show that each person has been consulted or made an informed choice about this, as should happen. We saw that the room can be divided by a curtain. When we asked one person if this was used, they told us that it isnt always. Although this person says they dont mind, it is unclear what the other person sharing this room thinks or feels about this as they have communication difficulties. One health care professional commented that sometimes shared rooms create problems around privacy and dignity. Care Homes for Older People Page 19 of 46 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. Some peoples quality of life is enhanced by continued links with their families and friends and by the activities they take part in. However, not everyone is having their individual social needs and rights to make choices met. People enjoy an appetising, balanced diet that meets their nutritional needs. Evidence: Since the last inspection the home has employed an activities co-ordinator for 20 hours each week. This person is responsible for meeting the social needs of all the people living here and provides support with helping people to eat and with personal care such as cutting peoples nails. In surveys people told us there are usually activities they can take part in if they want to. We saw that about 4 people who spend their time in the lounge are well attended to. We saw people took part in a picture quiz, in card games and in physical activity. These people were having fun, were being included, were relaxed and were treated with respect and with warmth. We saw that one person in particular is really benefiting from having this social interaction. We also saw the the lounge is laid out in such a way that separate areas have been Care Homes for Older People Page 20 of 46 Evidence: created. This means that people can take part in different activities or have conversations without disturbing anyone else, and away from the television. The television was on throughout the day during this inspection. It was set to a very high volume and no one was watching it. One person did take an interest when the lunchtime news came on. They told us they like to hear the news, but that theyre not bothered otherwise. We saw one person enjoying knitting who also benefited from the activities organised. Other people were invited to join in and declined or were unable to do so due to their disabilities. Other people living in this home spend time in their rooms. We spoke with staff about how these people are supported to have their social needs met. We were told the activities co-ordinator spends time with these people in their rooms. We found that, whilst well intentioned and very skillful, this person cannot meet the social needs of all the people living here. People who are physically or mentally disabled spend long periods alone. One person told us they get bored lying in bed all day. Their relative said that staff come into the room, but that this is to carry out care tasks such as turning. The care plan for this person does not contain any information about their interests or religious or spiritual needs. Other care plans contain some information about peoples interests. However, knowledge about these interests is not being used to meet each persons need to be engaged and be social in an individualised way. For example each care plan has sections about peoples spiritual needs. The care plan of one person who has dementia states they are very religious and identifies their religion. The care plan section relating to social needs records that this person loves to go out. The care plan does not identify how this person will be supported to attend a religious service or how they will be helped to go out. Staff tell us this person does not go to church and does not go out. In addition, the part of the care plan relating to peoples death and dying needs states that this person should be encouraged to express their wishes regarding death as it approaches. This statement is used in all the care plans we looked at where the section on death and dying had been completed. This persons plan makes no mention of the arrangements this person might like in relation to their religion. Another persons care plan does not identify their social interests and we saw that this Care Homes for Older People Page 21 of 46 Evidence: person spent the day at the home in the lounge without being engaged in any activity. We asked staff how decisions are made about who gets up early or late. Staff told us the diabetics are always got up first and that after that it depends on where the member of staff decides to start work. This indicates that people are not offered choice. We found that the care plan for one person contains a recently written statement that they like to get up at 6am. It also states that the nurse writing this has discussed this with the person and that they agree with this. This person is described in the care plan as having dementia and being confused. We found this statement in the care plan of another person who is also described as having dementia. This means that people who cannot speak up for themselves do not make decisions and do not have control over their individual daily lives. Visitors told us they can visit when they like. And we saw visitors in the home at different times of the day and evening. Some people say that staff keep them up to date with changes and developments and others say that staff dont do this. In surveys people told us they always like the food served in the home. People we spoke with say they like the variety and the quality of food served. We heard staff asking people what they would like for lunch, close to the time this was being served. This means that people are helped to make a choice about what to eat at a time when they are ready to make this decision and when it means something to them. We were unsure how staff helped people who cannot speak for themselves to make decisions about what to eat. We asked a member of care staff who told us that they get to know what people like. We saw in care plans that there are records about some peoples likes and dislikes, but not for all people. We saw records relating to what one person eats. We saw that they have porridge for breakfast every day as far back as we saw records for (approximately 11 weeks). They had also had scrambled egg for supper for the majority of those 11 weeks. Staff told us that this person sometimes does not eat much at supper and on the day of this inspection staff told us this person only ate 2 small spoonfuls of supper. The records and conversations with staff do not indicate that staff had explored the possibility that this person might be bored with their supper diet. We heard that one person who spends all their time in their bedroom had not had breakfast on two occasions and that their morning tea had been missed a couple of times. Care Homes for Older People Page 22 of 46 Evidence: We also saw two people being supported to eat by staff whilst in their bedrooms. The support given was unhurried, relaxed and sensitive. Care Homes for Older People Page 23 of 46 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. People concerns are not always acted upon and people are not fully safeguarded from harm. Evidence: In surveys all 3 people told us that they know how to make a formal complaint and 2 told us there is someone they can speak with informally if they are not happy. One person said they can only do this with their visitors. The information given to us in the AQAA tells us that this home has received one complaint since the last inspection a year ago. This was dealt with by the home within 28 days, which is the timescale set, and it was upheld. It also tells us that one safeguarding alert was made alleging that someone living at the home was not receiving care that was safe. This was investigated by the safeguarding team in May 2009. The outcome of this was that the care provided was not neglectful or abusive, but was poor practice. Since then the commission has received two complaints about the quality of care, about staff not being available when needed, about the management of medicines and about the general management of the home. One person said they had bought their concerns to the attention of staff but did not get a satisfactory response. Another person said they thought that staff were not taking their concerns seriously enough. Care Homes for Older People Page 24 of 46 Evidence: We have looked at some of these issues during this inspection and are working with the safeguarding team who are undertaking an investigation relating to these allegations. In addition Devon County Council are reviewing the care of the people living here. The AQAA tells us that no one living here is subject to any form of restraint. However, a referral was made under the Deprivation of Liberty and Mental Capacity Act because one person is being restrained in their wheelchair. This is not a deprivation of liberty but is a form of restraint. We saw that this continues. We also saw in a care plan that another person is restrained in their chair by using a lap belt when they try to stand up. We saw that people have bed rails whilst in their beds, which is another form of restraint. There is some indication that the restraint used for people whilst sitting in their chairs might not always be appropriate. This is because records state that it is used when people try to stand up or get agitated. The use of restraint is sometimes the only action that can be taken to keep someone safe. However, records should show that all other actions to reduce risk have been tried before this action is taken. In addition, care plans do not give clear and specific instructions as to when restraint should be used and for how long. We asked staff about the use of restraint in the form of a lap belt for one person. They told us that they use it only when needed, when staff are not around, and for a few hours. This means that restraint is being used for long periods when staff are not around to supervise vulnerable and agitated people. People who live here are having decisions about forms of restraint made by staff or relatives. Sometimes this has to happen if the person involved is not able to make these decisions for themselves. The circumstances of these decisions should be recorded so that it is clear that these decisions are being made in the best interests of that person. Such records are not being kept for people living in this home. We saw three people who have bruises or broken skin. We asked staff about these. They gave us explanations for two but staff did not know what had caused the third injury. We saw in care records that one persons injury had been caused when they had resisted care. The circumstances of this have not been investigated and actions have not been taken to prevent this happening again. Another person injured them self on a bed rail and there are no records to show that actions have been taken to prevent this happening again. We spoke with staff about what they would do if they saw or suspected abuse. They told us they would tell the nurse in charge, as is good practice. We asked the nurse in charge what they would do, and the actions they describe are contrary to the guidance given in the multi-agency guidance. This person told us that they had received Care Homes for Older People Page 25 of 46 Evidence: training and had a copy of the guidance in the home. However, the guidance they showed us would not guide them to take appropriate action if abuse were suspected. Care Homes for Older People Page 26 of 46 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. People living here enjoy a homely environment. However, improvements are needed to ensure that people are fully protected from infection. Evidence: In surveys people told us that the home is usually clean and fresh. On the day we visited we found it to be clean and odour free. The home is warm, and is furnished and decorated in a domestic and homely style. There is a reception area in the large hall, where there is usually a member of staff during the day so that people visiting the home can speak with them. There is also a large board in the hall displaying the photographs and names of the staff working at the home. This is helpful so that people can identify and become familiar with staff. The home has one large lounge and a dining room. Both are decorated and furnished in a homely style. The tables in the dining room are smaller and this helps people to sit in smaller groups and to experience meals as a social occasion. The lounge is divided into smaller seating areas so that people can carry out different activities without disturbing others. This area is very bright as it has large windows to the side and rear of the house. We saw staff washing their hands and wearing protective clothing as a way of helping Care Homes for Older People Page 27 of 46 Evidence: to prevent the spread of infection. Staff use alcohol gel as another way of preventing the spread of infection, and this is also available for visitors to the home to use. However, we saw that the sluice did not have liquid soap for staff to wash their hands, and that some soap dispensers appear dirty and one was empty. Since the last inspection by the commission the home have also been visited by the fire authority. Some actions were required and these have been carried out. We saw that access from the home is controlled at the front door by a key pad system and were told that this is linked to the fire alarm. This means that when the fire alarm sounds that the door lock will automatically be opened, and is good practice. We were told that some areas of the home have been redecorated. We saw one upstairs window being replaced. We saw that staff test and record the temperature of bathing water as is good practice to ensure that accidental scalding is prevented. Care Homes for Older People Page 28 of 46 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 are not always enough staff on duty with the appropriate qualifications, training and skills to care for people living here. Practices in relation to recruitment are placing people at risk of harm. Evidence: This is a nursing home and should have a registered nurse on duty throughout the day and night. We were contacted by a person who was concerned this was not happening. We contacted the home and it was confirmed that on one night there was not a nurse on duty. We asked the owner why they had not used an agency nurse to cover this shift. They told us that this home never uses agency staff. They told us that due to staff sickness they had arranged for a nurse to sleep at the home on that night. This practice puts people at risk. The caller was also concerned that there are not enough staff on duty. We spoke to the owner about this. She told us that staffing has been reduced but that there are enough staff on duty to meet peoples current needs. We looked at the duty rota and saw that there had previously been 3 or 4 carers on duty in the morning and this had been reduced to 2 or 3 carers. In the afternoon we saw that there used to be 2 or 3 carers on duty in the afternoon, and now there are 2. On the day of this inspection there was a nurse on duty with 3 carers, an administrator, cook and the temporary manager. Care Homes for Older People Page 29 of 46 Evidence: We saw in the information given to us by the home prior to the inspection that there are 14 people living at the home who need help with undressing and dressing, and need help to go to the toilet. 11 people are incontinent of both faeces and urine and 8 people have dementia. 11 people need two members of staff to help them with their care. In surveys one person told us that staff are usually available, one that staff are sometimes available and one that staff are never available when needed. Comments included staff are not always available, and the home is very short of staff. The surveys also asked what the home could do better. People said employ more staff who can speak and understand English and train and employ more staff especially at night. Staff were however described as nice and lovely. We looked at the records relating to falls and injuries. According to these records people have been found to have fallen when there have been no staff present on 14 separate occasions since the beginning of July this year. This means that people are not being sufficiently supervised by staff to keep them safe. We know that these accident records are incomplete. We are aware that one person has fallen whilst alone, and this is not recorded. We also saw that two people had injuries which have not been recorded as accidents or incidents. We looked at the duty rota and found that is is not always accurate. For example, on some weeks the manager, who has left the home, is recorded as on duty. In addition, the temporary manager has not been included on the duty rota until September although they say they started work at the home in August. We asked to see the records of staff training. We were told that these are incomplete because the records about training have gone missing since the manager left the home. We saw that some records had been made about training, but that there were large gaps. The management team tell us that this means they are not fully aware of what training staff have had, and what training might be needed. We did see a notice that said that training has been arranged for staff in relation preventing people from falling. Staff told us they had had some training. One told us they had had training in how to provide care to people, another that they thought they had had training in relation to supporting people who have problems with swallowing. However, they went on to describe training which relates to nutritional supplements. One person thought they Care Homes for Older People Page 30 of 46 Evidence: had had training about dementia, and gave a description of how to care for someone with dementia which was an example of good practice. However, we also saw that staff record that people have drunk more than they have. We heard staff trying to persuade a confused person that their understanding of a situation was wrong, causing distress and confusion to this person. We also saw staff ignoring one person who was trying to attract their attention. The AQAA told us that 10 of the 12 carers working at this home have achieved a National Vocational Qualification (NVQ) in care, to level 2 or above. We asked the manager if there is a system in place to ensure that staff practice the skills they are taught, and to ensure they do this to the level of quality that is expected. The manager told us that this is the nurses responsibility and that there is no formal system. Care Homes for Older People Page 31 of 46 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. Lack of leadership in this home means that systems are not in place to ensure that people receive the care they need to an acceptable standard in a way that promotes their safety. Evidence: This home does not have a Registered Manager. The previous manager left in August 2009. Since that time the home has been managed on a temporary basis. The temporary manager is a Registered Nurse and is studying for a Leadership and Management qualification. She had been working as the (unregistered) manager of the owners residential home, and works from 9am - 3pm four days weekly. She is supernumerary to nursing hours and is supported by two of the four owners of this home, who are also nurses. In the last few months the commission has received comments from relatives of people living here who say the overall management of the home has declined. One person described the management as chaotic, saying that this has resulted in people Care Homes for Older People Page 32 of 46 Evidence: not getting the care they need. We looked to see if there are systems in place to ensure the home runs efficiently and safely, and that people get the care they need. We found that systems are not robust enough to achieve this. For example we looked at the system for communicating peoples needs and changing needs, and for ensuring that peoples needs are met. The owners and manager told us that this is achieved through the care planning system. However, we found that these documents are complex and contradictory in places. They do not always provide the level of detail needed by staff to ensure that they have the information they need, and to ensure that peoples needs are met in a way that is consistent and of a satisfactory quality. We found that reviews of peoples care do not include all the information available and do not always provide evidence for some of the care decisions made (see Health and Personal Care). Care staff told us they do not read care plans. We asked if they got a hand over of information at the beginning of each shift and they told us they do not. We asked the manager how information is relayed to staff. She told us that she expects the nurses to do this. The evidence in the Health and Personal Care section of this report, shows that this is not happening. We looked closely at how some decisions about peoples care are made. For example, one record states that one person cannot make a decision about having bed rails on their bed. However, records show that this person has made a decision about having repeated invasive procedures. Another person can make the decision to get up at 6am but cannot make a decision about what they eat. We looked at how risks in the home are managed. We found that people are identified as being at risk of falling. Care records instruct staff to observe them. Records show that a lot of falls have happened to people when staff are not present. Although there is a system for recording this information, there is not a system for monitoring and analysing this information, and therefore actions have not been taken to help prevent and reduce the number of falls. We looked to see if there is a safe system in place for moving and handling people with mobility problems. We found that assessments have not been carried out or had been carried out a long time ago and have not been reviewed. We found that decisions about the type of equipment to be used are based on the equipment that is available and not on what would be the most suitable for each person. The manager reports that staff have not had training in how to carry out moving and handling assessments. Care Homes for Older People Page 33 of 46 Evidence: We looked at how other risks in the home have been managed. We found that the temperature of hot water is restricted to help ensure that people are not scalded. We found that windows have restricted openings to prevent people falling. However, we found one window, that had been replaced that day, did not have a restricted opening. We told one of the owners who told us they thought that it had been restricted since we last looked. When we looked again, it had not. We looked in the kitchen and found it clean and tidy. The owners identified approximately 4 years ago that the kitchen is coming to the end of its useful life, and the Environmental Health Officer also identified this. The cook reports that a refurbishment date has not yet been set. We looked at how equipment is maintained. We found that the weighing scales had been weighing inaccurately for some time meaning that people at risk of malnutrition could not be weighed accurately. The lift broke down for at least 2 days in October. We looked at how the home involve people in the running of the home and how the management team get feedback from people and improve the quality of care given. We were told by relatives that meetings are sometimes held to which they are invited. One person told us at that at the last meeting they had been informed there were going to be a lot of changes in the home. They asked for, and the management team agreed they could have, a list of these changes so that they could prepare their parent for these changes. They have not received this. We looked at the results of the most recent quality assurance survey (June 2009). Some people had said they were not satisfied with the length of time it took to answer call bells. One person said that new staff were not given enough training meaning that they had to take instruction from the person they were meant to be caring for. Two people thought that improvements should be made to laundry and one to ironing. We asked how these issues had been addressed and the owner did not know because the survey was carried out when the previous manager was employed. We checked to see if previous requirements set by the commission have been met. We found that requirements relating to health and welfare, care planning, safeguarding people, meeting peoples social needs, staff skills and improving the overall management have not been met. We did not check any personal allowance accounts of the people living here as the home does not hold any money on behalf of people. Instead they run a debit account, recording all monies spent on peoples behalf. Records and receipts are given to Care Homes for Older People Page 34 of 46 Evidence: relatives and supporters for them to check and to pay for retrospectively. During our inspection it came to light that the commission are not being notified of all incidents that affect the welfare of people living here as they should be. In addition the owners of the home have not been carrying out monthly unannounced visits to the home as they should, They have since informed us that they plan to restart these. Care Homes for Older People Page 35 of 46 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 (1) People who have 20/02/2009 dementia must have their care planned in a way that is person centred; identifying all their needs and detailing how these needs should be met. By doing this people with dementia will have their needs better understood and met. 2 7 15 (1) People who have dementia 31/07/2008 must have their care planned in a way that is person centred; identifying all their needs and detailing how these needs should be met. Care given must be reviewed in a way that helps the care planner to make a judgement about whether the planned care is meeting that persons needs. Previous timescale of 31/03/08 not met. Not inspected on this occasion. Previous timescale 11/07/08 3 8 12 (1) (a) When there is concern that someones health may be affected, for example they are losing 23/01/2009 Care Homes for Older People Page 36 of 46 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 weight, appropriate actions must be taken to address this. In this way appropriate actions will be taken to prevent or limit as far as possible health deterioration. 4 8 12 (1) (a) People with dementia 20/02/2009 must have their mental health and welfare needs met. This includes working towards understanding what people with dementia are trying to communicate and taking action to address what is being communicated. In this way each individual with dementia will have their mental health and welfare needs understood and met. 5 12 16 (2) (m) (n) People must 20/02/2009 have their social needs and interests identified and you must make arrangements to enable these to be met. This will help to improve the quality of life of the people living here. 6 30 18 (1) (a) People with dementia 13/02/2009 must be supported by people who are suitably qualified and competent in this area of care. This will help to ensure that the needs of people with dementia are met. Care Homes for Older People Page 37 of 46 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 7 31 10 (1) (a) The management of this home should manage the home with sufficient care, competence and skill. This will help to ensure that the health and welfare needs of each person living here are met. 13/02/2009 8 38 26 The providers must visit the home at least once monthly on an unannounced basis. They must do this so that they can form an opinion as to the standard of care provided in the home. They must record their findings and send these to the commission after each visit. Previous timescale of 13/04/07 not met. Not inspected on this occasion. Previous timescale 31/12/07. 31/07/2008 Care Homes for Older People Page 38 of 46 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 3 14 People must not be admitted 07/12/2009 to this home unless their needs have been assessed by a suitable person. This assessment must include health and social care assessments if the placement takes place through health or social care services. This will help to ensure that each persons needs are identified and can be met. 2 7 15 You must ensure that care 07/12/2009 plans provide clear and up to date instructions on how each persons care needs are to be met, recorded and monitored. Information recorded in care plans must be relevant and appropriate. All parts of the care plan must be reviewed and updated as appropriate. All irrelevant parts of the care plan must be removed. Page 39 of 46 Care Homes for Older People 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 By doing this staff will have the information they need to ensure that people have their needs better understood and met. 3 8 12 You must ensure that there is a system in place to ensure staff are aware of and are up to date with peoples health and welfare needs. You must ensure that this system is accurate and up to date. You must also ensure that there is a system in place that monitors the health and welfare needs of people and that actions are taken and recorded when appropriate. 30/11/2009 This will help to ensure that peoples needs are met in the most effective way. 4 10 16 You must ensure that the 31/12/2009 home is conducted in a way that ensures people are treated with respect and in a dignified way. This will help to ensure that people are treated appropriately. Care Homes for Older People Page 40 of 46 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 5 12 16 People of all abilities must be supported to have their need to engage and have their social needs met. This will help to improve the quality of life experienced by people living here. 26/02/2010 6 12 16 People must be supported to 31/12/2009 practice their faith and have the opportunity to attend religious services if they wish to. This will help to improve the quality of life experienced by people living here. 7 14 12 People of all abilities must 31/12/2009 be supported to make their feelings and wishes known and to make decisions about their daily lives. This will help people to have autonomy and control over their lives, and will help to improve the quality of life they experience. 8 15 16 People must be offered meals regularly and you must ensure that people are encouraged to eat by offering them a variety of foods that suit their needs and preferences. 07/12/2009 Care Homes for Older People Page 41 of 46 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 This will help to ensure that people are supported to remain healthy. 9 16 22 The complaints procedure 31/12/2009 should be appropriate to the needs of the people who live here and concerns raised must be investigated thoroughly and actions taken to address the findings. This will help to ensure that concerns are taken seriously and acted upon. 10 18 13 Staff must be aware of the reporting procedures relating to safeguarding people. All injuries must be investigated and action taken to keep people safe. This will help to ensure that people are safeguarded from abuse and harm. 11 26 13 You must ensure that adequate infection control procedures are in place. This will help to ensure that the spread of any infections are limited as far as possible. 07/12/2009 31/12/2009 Care Homes for Older People Page 42 of 46 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 12 27 18 You must ensure that there are always enough suitably qualified and skilled staff on duty. This will help to ensure that peoples needs can be met. 31/12/2009 13 29 19 You must ensure that recruitment procedures are robust. This will help to ensure that people are cared for by appropriate staff. 31/12/2009 14 31 8 An application must be made to register a manager for this home. This will help to ensure that people benefit from living in a home that is managed by a suitable and from management systems that help to ensure peoples safety and well being. 07/12/2009 15 33 24 Results of the system for monitoring the quality of care should be acted upon. This will help to ensure that people are involved in the running of the home and that actions are taken to improve the quality of care provided in the home. 26/02/2010 16 38 13 Risks to people living here, to include but not exclusive 29/01/2010 Care Homes for Older People Page 43 of 46 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 to, the risk of falling should be identified and as far as possible should be eliminated. This will help to ensure that people are kept safe. 17 38 13 You must ensure that the health and welfare needs of people living here are met. This must include, but is not exclusive to, moving and handling people safely, maintaining equipment and restricting window openings as appropriate. This will help to ensure that people living here are kept safe through safe working practices. 18 38 26 The providers must visit the home at least once monthly on an unannounced basis. They should do this to help them to form an opinion as to the standard of care provided in the home. They must record their findings and send these to the commission after each visit. 19 38 23 You must ensure that equipment provided at the home for use by people living here is maintained in good working order. 31/12/2009 07/12/2009 07/12/2009 Care Homes for Older People Page 44 of 46 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 This will help to ensure that people living in the home are safe. 20 38 37 All incidents and events, including deaths, must be reported to the commission. This will ensure that the commission are kept up to date about events in the home. 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 07/12/2009 1 9 Where someone cannot swallow medicines, actions should be taken to find out if the required medicines are available in another, for example liquid, form. Injuries sustained by people must be fully investigated and appropriate actions must be taken to protect people from injury. You must ensure that the duty rota always shows accurately who is on duty and in what capacity. You must ensure that staff have had the training they need to care for people appropriately. 2 18 3 4 27 30 Care Homes for Older People Page 45 of 46 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 46 of 46 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!