Inspection on 03/11/08 for Honiton Manor

This inspection was carried out on 3rd November 2008.

CSCI found this care home to be providing an Adequate 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 7 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 19/10/09

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 06/02/2009.

Inspecting for better lives 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:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Teresa Anderson     Date: 0 4 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 32 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 32 Information about the care home Name of care home: Address: Honiton Manor Exeter Rd Honiton Devon EX14 1AL 0140445204 0140445324 honitonmanor@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Howard Norman Dennis,Mrs Sarah Jane Mary Dennis,Mr David Malcolm Baker,Mrs Angela Martha Christin Name of registered manager (if applicable) Ms Gillian Sarah Mary Berry Type of registration: Number of places registered: care home 22 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 The last key inspection of this service was undertaken in November 2007. A random inspection was undertaken in June 2008. 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. Outside there is limited access to a garden and to a seating area. There is ample parking. Current charges are available direct from the Care Homes for Older People Page 4 of 32 Over 65 22 0 Brief description of the care home home as is further information about this service. Charges do not include items such as newspapers, toiletries, taxis etc. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was undertaken as part of the normal programme of inspection. The visit to the home began at 10.00am and finished at 4.30pm. A random inspection was undertaken in June 2008 in response to concerns raised about the care of one person. These concerns were upheld and the home was required to make improvements in relation to planning the care of and meeting the changing nutritional, hydration and skin care needs of any person with dementia. 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 problems. We looked closely at the care and accommodation offered to three people Care Homes for Older People Page 6 of 32 living here as a way of helping us to understand the experiences of people using this service. This is called case tracking. For example we observed the care and attention given by staff to these people, we looked at their assessments and plans of care, the environment in relation to their needs and at how their health and personal care needs are met. We spoke with one of the owners (by phone), with the person in charge, with three members of staff and with two visitors. We visited all communal and service areas in the home and saw approximately ten bedrooms. Records in relation to care assessment, care planning, medication, residents monies and fire safety were inspected. Prior to the visit to the home the manager provided information about the service in their Annual Quality Assurance Assessment (AQAA). In addition questionnaires, asking for feedback and comments about the home, were sent to people living at the home and eight were received, to staff and none were received and to health and social care staff and five were received. Their feedback and comments are included in this report. What the care home does well: What has improved since the last inspection? What they could do better: This service needs to improve the overall management of this service which needs to be more proactive in identifying shortfalls and taking action to address these. The care planning and delivery arrangements for people with dementia need to be improved. This needs to include more specialist training for staff in how to plan and deliver person centred care so that peoples needs can be met. Care Homes for Older People Page 8 of 32 Progress has been made in relation to addressing peoples changing needs, however this need further improvement (in this instance in relation to what actions to take if someone is losing weight). The provision for meeting peoples social needs has not been addressed, and is outstanding since May 2007. Addressing this area of care would help to improve the quality of peoples lives. The homes routines should be as flexible and responsive to peoples needs as possible so that people feel in control of their daily lives. Procedures relating to changing medication doses must be followed to ensure this is done safely and that each person gets the medicines they are prescribed. 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have enough information about this service on which to base their decision about where to live. They have contracts and have their needs assessed to ensure that this service can meet those needs. Evidence: We looked at the service user guide and found that it had been updated as recommended at the last inspection. People who read this document are now told that some people living here have dementia type illnesses. In the surveys we received 6 of the 8 people who responded said they had enough information about the service before moving in, which helped them to decide this was the right place for them. We looked at three contracts. We found that these contain information about the bedroom to be occupied, the conditions of occupancy and termination of contract and about what is included in the fees charged. In the surveys we received, everyone who Care Homes for Older People Page 11 of 32 Evidence: responded said they had a contract. We looked at two assessments of people who had been admitted since the last inspection. We found that each person is assessed by the manager (or deputy). The information taken about each person is written in enough detail to help staff make a decision about whether this service can meet their needs. Care plans show that this information is built upon as more information is collected. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here have their physical healthcare and medication needs met. However, person centred care planning and care delivery for people with mental health needs could be improved. The way that people have their rights to privacy and dignity met has improved, however further improvements are needed. Evidence: We looked at the care plans of three people. We found that comprehensive records are kept relating to peoples physical needs and that each person has their care needs assessed, planned and evaluated by a registered nurse. Records include what the need is, how it should be met and an evaluation of whether the planned intervention has been successful. If the intervention has not been successful there is evidence that the plan is changed accordingly. These needs include peoples nutritional, skin care and hydration needs. In surveys the majority (4 out of 5) of healthcare professionals say that individuals healthcare needs are always met and that the home seeks advice which is acted upon. Care Homes for Older People Page 13 of 32 Evidence: We saw in one care plan that staff have noted that one person is losing weight. In total this person has lost 6kg in 6 weeks. Although staff have been instructed to weigh this person more frequently, no other changes to the care plan, such as asking staff to record how much this person eats and/or to record what circumstances help this person to have a better appetite, have been made. Some people living here have dementia type illnesses. The care planning and delivery in relation to meeting these needs is not as good as it should be. For example two care plans state that people have challenging behaviours. There is no record in the plans of what these behaviours are, what might preempt them, what might prevent them or what might limit the effects of that behaviour. We spoke with staff about the care plans. Care assistants say they do not always have time to read these plans and rely on nurses to give them the information they need, or that they find information out for themselves as they get to know the person. They say they do not contribute to plans. One member of staff said, we write about the type of day they have. We observed interactions between staff and the people with mental health issues. We found the quality of these interactions to be variable, although staff were seen to be kind and well meaning. For example, one person kept trying to rise from their chair. The member of staff, for a period exceeding 15 minutes, kept (politely) asking this person to sit down as they might hurt themselves if they tried to walk. This person has dementia and could not understand these instructions, and was becoming increasingly frustrated. Their behaviour escalated from trying to move to calling out loudly. Other people in the lounge told this person to shut up. When the manager came into the lounge, she suggested that she and the member of staff walk with this person together. They did this. The person then sat down and drank a cup of tea. The care plan does not include information on how to deal with this persons need to walk. We looked at how these three peoples medications are managed. We were shown how the system works for ordering, storing and returning medications. The system in place shows that the medicines that people need are ordered in time and are available for administration. It shows that all medicines received into the home, including those which have been bought into the home by newly admitted people, are counted and recorded by two people as they should be for safety reasons. We saw that all medicines are stored safely and securely, including those medicines which require refrigeration. We looked at records relating to the administration of medicines and found them (apart from one) to be up to date and accurate. One record showed an alteration had been made someones prescription for insulin. Records did not indicate Care Homes for Older People Page 14 of 32 Evidence: who had made this change, which doctor had authorised it and on what date it had taken place. We looked at how staff meet the privacy and dignity needs of people living here. We saw staff treated people with respect. We saw in care plans that some people living here have a preferred name and we heard staff using these names. We also heard one member of staff saying good boy which is not respectful or age appropriate. We noticed that staff try to store personal items such as incontinence pads out of sight. However, lack of storage in this home does not always make this possible. Care Homes for Older People Page 15 of 32 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. Opportunities for people to have an enjoyable social life and for choice and flexibility are being limited, although links with visitors are good and people enjoy the food served. Evidence: In surveys the majority of people (4 out of 7) say that there are usually activities available which they can take part in. Comments include our relative was reluctant to go on the outing, but thoroughly enjoyed it - especially the cream tea. However, these surveys were completed prior to the activities co-ordinator leaving since when day to day activities have not been able to be arranged. Events such as Halloween and Bonfire Night continue to be planned for and celebrated. We observed during this inspection that people were not engaged in any type of activity. The TV was on in the lounge but people were not watching this and it remained on the same channel all day. We were able to talk with some people and they say they do get bored. They say they like to go to their room and get dressed for bed early (approximately 3 - 4pm) because they get bored and tired doing nothing. Care Homes for Older People Page 16 of 32 Evidence: One person said we have been sitting here all day. The inspector saw this to be the case. We noted at the last inspection in November 2007 that the activities co-ordinator had been on sick leave and that this role had not been delegated to anyone else. At that time we judged that peoples social needs were not always being met. The manager reports that a replacement activities co-ordinator is being advertised for and some interviews have been arranged. We looked at how peoples interests are assessed and found that people choose their interests from a list presented to them. However, the care plan does not include a plan as to how those interests are to be met. The manager reports that people can attend a religious service held in the home once a month and that the home does not currently cater for other religions as everyone living here is a Christian. We asked people about the church service and people could not remember that they had been. People are helped to make other choices including what they wear, what time they get up and what time they go to bed. Information relating to this is recorded in the care plan so that staff are aware of this. However, on a day to day basis some choices are not as flexible as they might be. For example, in the afternoon a number of people said they would like a cup of tea. All three staff who were asked on approximately eight occasions told people what time the tea trolley would be coming, but until five minutes before it was due did not offer to get anyone a cup of tea or bring the trolley in earlier than planned. We looked to see if people are asked if they would like a same sex carer to attend to their personal needs and found that this is not recorded. We observed a male carer attending to females, but could not determine is this was their preference or not. In surveys people say they always or usually enjoy the food served. Comments included no complaints there and always very nice. There is usually two choices of meal at lunch time and people choose what they eat for breakfast. At tea time there are usually sandwiches. The manager reports in the information provided prior to the inspection that the menus have recently changed in response to peoples preferences. Visitors to the home say they are always made welcome and that they are offered refreshments and kept up to date with developments. Care Homes for Older People Page 17 of 32 Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safe and if they have any complaints these are heard and acted upon. Evidence: Since the last inspection neither the commission nor the service have received any complaints. However, a safeguarding alert was made in relation to a person who had been admitted to hospital. This alert alleged that care planned and delivered to this person was not adequate to meet their needs. An investigation was undertaken by the Safeguarding Team and the commission carried out a random inspection. We looked at how peoples nutritional, hydration and skin care needs were being met. We found that there were shortfalls in the care planned and delivered and that this linked to staff understanding the needs of people with dementia. Since then all care plans have been reviewed and the manager reports that important lessons have been learned. We found evidence of this during our inspection, although we have again found some shortcomings in relation to the care of people with dementia (see Health and Personal care). We spoke with staff about safeguarding and they were able to tell us about the different types of abuse and about what they should do if they suspect or see abuse. Records show that staff are receiving training in relation to this. Care Homes for Older People Page 19 of 32 Evidence: People who live here and who could talk with us say they feel safe and well cared for by staff. In surveys people say they always or usually know who to speak with if they are not happy and that staff listen to them and act upon what they say. We observed at this inspection that a number of people sitting in the lounge wear lap belts. Records show that these are used to stop people from standing up or slipping out of their chair and hurting themselves. We looked at the care plans of these people and found that records are kept as to when this type of restraint should be used and when it should not be used. When we spoke with staff they say that if there is someone in the room with these people that belts are not needed. However, if there are no staff available to be in the room, for each persons own safety, belts are used. We observed during the day that this was the criteria used for the use of lap belts. We also noted during this inspection that there was usually a member of staff in the lounge, and when there was not, this was for short lengths of times. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and homely environment. Evidence: In surveys people who live here say the home is always clean and usually smells fresh. A visitor who comes to the home frequently said that the home is always clean and smells nice. We looked around the home and found it to be clean and odour free. We saw that staff are following infection control procedures by for example washing their hands and wearing protective aprons and gloves. We also saw that the home had responded to a visit by the Environmental Health Officer and installed handwashing facilities in the kitchen. We looked at the laundry and found it to be clean and tidy. Staff say they can manage the laundry and people say clothes are always kept clean. Two people say they think that the ironing is not always of a satisfactory standard. Care Homes for Older People Page 21 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here are supported by kind and caring staff who are employed in adequate numbers and recruited using robust methods. People who have dementia would benefit from improved staff training and skills in this area of care. Evidence: In surveys people say that staff are always or usually available when needed and that they always or usually receive the care and support they need. Staff are described in surveys and by people we spoke with as caring, lovely and nothing is too much trouble. We looked at the duty rota and saw that there is always a registered nurse on duty. We also saw that there are usually three carers on duty in the morning and three in the afternoon. At night there is one carer on duty with the registered nurse. We were told that there are currently eighteen people living here. The information given to us before the visit to the home told us that fourteen of these people need two staff to help with their care; thirteen are either doubly or singly incontinent and eight have either dementia or other mental health issues. In the three care plans we looked at two people are identified as having challenging behaviours. The manager currently works as a registered nurse and does not have extra Care Homes for Older People Page 22 of 32 Evidence: managerial hours. This is because the deputy manager has recently left the home. Another deputy has been appointed but has not yet started work. Support staff include a cook, a kitchen assistant and a cleaner. The home is currently recruiting for a replacement activities co-ordinator. Care staff also carry out laundry tasks. We observed that staff are very busy providing care. They say they would like to spend more time with people but do not have the time. We looked at training records and saw that all staff receive mandatory training, and some have received other training for example in understanding the Mental Capacity Act, about skin care and about using supplementary high calorie drinks. Some staff have received training in caring for people with dementia. This is a basic training aimed at giving staff a general understanding of dementia. This training is delivered by the manager who reports that she has not received any specialist training in caring for or in planning the care of people with dementia, or in person centred care planning. Although all staff were observed being kind, caring and very well intentioned, their interactions with people with dementia and the type of care planning used shows that they lack skills in these areas (see health and personal care). In the information provided by the home it is stated that three of the nine care staff (33 ) have a National Vocational Qualification (NVQ) in care to level 2 or above. A further two people are working towards achieving this qualification. This is below the national target of 50 of care staff having an NVQ in care. We looked at records relating to how staff are recruited. We found that the three most recently recruited staff have undergone robust checks to help ensure that all the staff who work here are suitable. Checks include enhanced police checks, obtaining proof of identity and obtaining two written references. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of progress in relation to person centred care planning, meeting the needs of people with dementia, meeting peoples social care needs and the reactive nature of the management demonstrate that this home is not run in the best interests of the people living here. Evidence: Honiton Manor has a manager who has worked at the home for many years. She is a registered nurse and has completed the Registered Managers Award. Until recently she was assisted by a deputy manager who has been replaced but is not yet working at the home or completed her induction. Two of the owners visit the home at least monthly when they carry out their own inspections. These visits have not identified any shortcomings with person centred care planning or with the care given to people with dementia. Care Homes for Older People Page 24 of 32 Evidence: At the last key inspection in November 2007 and at a random inspection undertaken in June 2008 the commission required that the home address issues relating to the quality of care provided to people with dementia. These needs and the legal requirements relating to them remain unmet (see health and social care). The commission also required that each person living here have their social needs and interests identified and that arrangements be made to meet peoples social needs. This requirement had also been set at a previous inspection and had not been met. These needs and the legal requirement relating to them remain unmet (see daily life and social activities). Whilst some requirements made at the random inspection in June 2008 have been addressed, these have not been achieved in a person centred way. Although each person has a care plan, staff also record in separate files when each person has their bowels open, if they have a dressing to be carried out, the results of any urine tests, their weights, monthly observations, the food intake of those people who are diabetic and if people need to be turned regularly. These are important records but addressing these needs in such a way is not up to date or good practice, may encourage task based care and will not encourage or support person centred care. Prior to this visit the manager completed an Annual Quality Assurance Assessment (AQAA) giving the commission information it had asked for. This did not give information about how previous requirements have been addressed and did not address issues relating to the diverse needs of the people living here and how the service works towards achieving equality for all people. Although the AQAA states that the home is run in the best interests of the people who live here, it does not provide evidence of how this is achieved. For example the home carries out annual quality assurance surveys and holds residents meetings. The manager reports that surveys show that people were concerned that people were being admitted to the home who have dementia (the home is not registered for this category of care) and that this was proving to be disruptive for other people. Although the information about the home has been updated to say that some people may have dementia, actions have not been taken to enhance staff skills to help them prevent and manage this disruption where possible. Records show that mandatory training continues and this includes training in fire safety, food and hygiene and moving and handling. We looked in the kitchen and found it clean and tidy. We looked at how food is stored and found this to be appropriate. The owners identified approximately three years ago Care Homes for Older People Page 25 of 32 Evidence: that the kitchen is coming to the end of its useful life, and the Environmental Health Officer (at their last inspection) also identified this. The cook reports that a refurbishment date has yet to be set. At the last inspection we required that risk assessments regarding the use of bed rails and lap belts be carried out and this has been done. 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 relatives or supporters for them to check. We looked at the fire log and saw tht fire drills and training have taken place. Care Homes for Older People Page 26 of 32 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 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 2 12 16 (20 (m) (n) Each resident must have their social needs and interests identified and you must make arrangements to enable these needs to be met. Previous timescale of 30/05/07 not met. Not inspected on this occasion. Previous timescale 31/12/07. 31/07/2008 3 38 26 The providers must visit the home at least once monthly on an unannounced basis. 31/07/2008 Care Homes for Older People Page 27 of 32 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. Care Homes for Older People Page 28 of 32 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 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 8 12 (1) (a) When there is concern that someones health may be affected, for example they are losing 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. 23/01/2009 3 8 12 (1) (a) People with dementia 20/02/2009 must have their mental health and welfare needs Care Homes for Older People Page 29 of 32 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. 4 9 13 People can only receive 23/01/2009 medication prescribed by a doctor. Where changes are made to prescriptions by nurses these must be signed and dated to say who has carried out this change. This will ensure that all changes made to prescriptions are appropriate and that each person receives the appropriate medication. 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. Care Homes for Older People Page 30 of 32 This will help to ensure that the needs of people with dementia are met. 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 10 Work should continue to help ensure that people are addressed respectfully and appropriately. This includes discouraging the use of the term good boy. Work should continue to protect the dignity of people by keeping personal hygiene items such as continence pads (as far as possible) out of sight. People should be offered opportunities to make choices and routines should be flexible so that people have as much control over their lives as possible. You should continue working towards ensuring that 50 of care staff hold a National Vocational Qualification in care. 2 10 3 14 4 28 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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