Inspection on 19/03/09 for Huws Care Home

This inspection was carried out on 19th March 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Huws Care Home 21/02/07

Huws Care Home 27/02/06

Huws Care Home 21/02/05

Huws Care Home 24/06/04

Huws Care Home 25/11/03

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

Key inspection report CARE HOME ADULTS 18-65 Huws Care Home 93 Harlaxton Drive Lenton Nottingham NG7 1JD Lead Inspector David Litchfield Unannounced Inspection 19th March 2009 09:00 Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 2 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 Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Huws Care Home Address 93 Harlaxton Drive Lenton Nottingham NG7 1JD 0115 9081560 0115 9243579 huws@efitzroy.org.uk www.efitzroy.org.uk Elizabeth Fitzroy Support Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Anthony David Martin Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 2007 Brief Description of the Service: Huws care home provides nursing care and support to a maximum of 14 adults with complex learning and physical disabilities. The home is situated in an established residential area in the Lenton area of Nottingham, close to shops and local transport. Service users have the use of a communal dining room, a quiet lounge, a main lounge and conservatory. At the time of the inspection there were 8 single rooms in use with a further 2 shared rooms but following completion of the renovation work there will be 14 single rooms. Fees at the time of the inspection ranged from £1400-1600 per week. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star this means that people who use the service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people using the service and their views on it. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection involved one inspector; it was unannounced and took place over 7 hours. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive. We looked at the information held about these people, along with the service’s ability to meet their needs and expectations. We found it difficult to communicate with people using the service so in order to find out more about the care people receive we spoke to some family members. We also spent time talking with the manager and staff to find out more about the support they give people and their training and knowledge about this. We used information provided by the service and other sources since our last inspection. We also looked at other documents and records held by the service to learn more about the care they provide What the service does well: The service has good accessible information presented in a manner designed to help people who have a learning disability understand it better. This information both includes the guide to the service as well as information about how to complain. People are supported by staff who go through a robust recruitment process and get lots of training and support before they work with people. All staff then continue to receive training around the skills and knowledge they need to care Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 6 for people using the service. Staff show good understanding for people and respect for their choices. What has improved since the last inspection? What they could do better: 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. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with accessible information and their needs and expectations are established. EVIDENCE: We looked at information the service has to provide to people interested in living at Huws House. We saw that there is a guide with lots of useful information such as how people can visit the home to find out if it is the right place, and the services they provide people with. It is written in a way designed to help people with a learning disability understand it, with plain English and symbols. We found that it was not fully up-to-date with some changes to the service not fully reflected, for example it referred to a day service which it no longer operates. We heard that no one new has moved in since our last inspection and that they plan to complete some building and refurbishment work before anybody new can move in. Part of the home was recently built and we heard from the manager about actions taken to support people moving from the older part of Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 9 the building into new bedrooms in the newer part. The manager told us how they had found ways to include people in the process including those who communicate in different ways, by using colour swatches and carpet samples. A family member of someone who uses the service told us that the person had “spent days down there” which had “helped her adjust” and that the person “did quite a lot of choosing with colour schemes and carpets”. We saw that there is lots of information about people who use the service. The manager showed us they gathers lots of information about people’s needs and expectations and involve others important to the person such as family and social workers. We spoke to staff who showed us that they understand about different people’s preferences, one telling us weve had support and training about each person. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the 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’s care is planned for in an individualised way. EVIDENCE: We looked at what plans are in place to show staff how people need and expect to be supported. We found there is lots of information about each person, with individualised information about each persons care. We saw information about people’s routines, health needs and behaviours and the way staff are to support them with it. These plans are written in a style that puts the person at the centre of their care, for example with sections such as “How I make choices” and “what I like”. Staff told us they “look at care plan before supporting people”. We heard from them that the plans are very detailed – Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 11 “it’ll say if they prefer a shower or bath, their favourite shampoo, which spoon they use”. We saw that a system had been put in place to monitor these plans and keep them up-to-date, but this had not been kept up. Most of the plans we saw been written in 2006, with evidence they had been later evaluated that same year and in one case in 2007, but it was unclear if they had been checked after that time. We did find that some additional plans had been added in 2008, but we also found some plans in place that the manager confirmed were no longer in use and that described care that had since changed. We also found that the plans were not always easy to access with lots of information in a file mixed in with letters and other information about the person, along with older documents about their care. The manager agreed that it could be confusing and said it was something he was already intending to improve. Family members told us that they meet with the service to discuss people’s support. We heard that they met with the individual, the service and social worker to discuss the person’s care, activities, health and other matters. We also heard that things that make the person different such as their religion also formed part of the discussions. We found detailed records of a meeting with a person who uses the service, where efforts had been made to find out if that person was concerned about something and wanted to make changes around their support. We saw that this led to actions being taken together with that person. We found that individual risks presented by supporting people are identified and planned for. These have been regularly checked to ensure they are still appropriate and were easy to understand and follow. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16, 17 People using the 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 involved in a range of activities and are supported to live a full individual lifestyle. EVIDENCE: We looked at the activities people are involved in. One family member told us “they do so much socially”, “she goes out to theatre, out for meals, shopping”. Another family member told us “they take her out” and “they always have nice parties”. We saw that activities have become less formalised since the service stopped running a separate day service and that people are now more involved in the Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 13 life of the household. We saw that people were present in the kitchen while food was being prepared, and heard that this is a big change as this had not been possible before the changes to the building. Staff told us they find other ways to include people in maintaining their home, “when we’re tidying bedrooms we always take the person – it’s their room” and “someone always goes out shopping”. We heard that these activities recognise individual preferences, and that staff knew about the different things people did and didn’t like to do, and about how the different people communicate this to them. We saw that outside visitors come in to do different activities with people such as reflexology and music sessions and that a number of people attend day centres. However, we did hear from the manager and staff that it has been more difficult to undertake many activities with limited space in the building while work is ongoing. We found that people using the service are supported to maintain relationships with people important to them. Family told us that if the person “has a problem they always tell me” and the manager told us that they are seeking imaginative ways to help people stay in touch such as using video through the internet. Family told us they can visit anytime and are made welcome. We looked at the meals people eat. We saw that there is no set menu but that food is planned on a daily basis. The manager said this is under review, and we saw it had been discussed in staff meetings. We heard from staff that people are usually offered two choices, sometimes presenting the choices on plates to see what preference people indicate. We saw food being prepared from fresh, nutritious ingredients. A family member told us they felt people are “well-fed”. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the 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 are supported with their personal and healthcare needs, but they do not have a system in place to ensure their medication is managed safely. EVIDENCE: We looked into the way people’s health and personal care needs are supported by the service. A family member told us that “they bend over backwards” and that they “offer the very best quality of care”. Another said “she is very well looked after”. The atmosphere in the home was calm and we observed staff working with people in a respectful and friendly way. Staff are able to describe the particular needs of individuals and told us “we’ve had support and training about each person”. We heard that the service is Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 15 “very client focussed” and that they are give “clear instructions around privacy”. We found records are kept showing people are fully supported with their health needs, with detail of appointments with health professionals outside the service. We saw that meetings had been held around specific areas of support individuals needed. However, daily records were limited around other nonhealth related parts of their care, not always giving a clear record of other support provided by the service. We looked at the way people are supported with their medication. We found that the manager does not have a system in place that can be used to check if all medication can be fully accounted for, and this was demonstrated when a particular tablet for epilepsy had not been signed for and the manager was unable through systems in place at the time to establish if the tablet had been given or not. We also found two other cases of medication that had been prescribed but not signed for. Between 6 and 9 days had passed since the days these medications had been due but the manager had not been informed by any of the staff responsible for medication over the subsequent days. The manager agreed that this was a serious matter and told us he would take steps to resolve the situation and put in place a system to properly audit the medication administered. We had previously made a requirement for the service to ensure that all medication records were correct and complete and this had not been met. We have repeated this requirement following this inspection and will consider taking enforcement action against the service if it does not comply. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the 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 benefit from a robust complaints policy and systems to keep them safe. EVIDENCE: We looked at how people are able to make complaints about the service. The manager showed us that they have a complaints policy which they use to respond to any complaints received. Full records are kept of these. Since our last inspection we received one concern about the service directly which the service responded to and explained in a timely manner. We saw that people who use the service are provided with information about how to complain and a form designed to be easier to use with plain large text and symbols to help people’s understanding. Family we spoke to tell us that they knew how to complain telling us they “can speak to them if anything is wrong” and we saw records confirming this. We looked at what systems are in place to keep people safe from the risk of abuse. We saw that the service has a copy of the local authority policy around this. Staff described to us how they might recognise signs of abuse and we found that staff are aware of how to recognise signs of abuse. They are aware Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 17 of the need to report concerns, telling us if youve seen something inappropriate you go to the person in charge but not all were clear on who they were to report to outside the service although they were aware that this information could be found in the procedures and how they could check it. One concern about a temporary worker employed through an agency was reported through to the local authority and investigated. It did not reach firm conclusions but the worker is no longer used by the service. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While the building renovation goes on people live in a more compact and less homely environment. EVIDENCE: We looked at the environment where people live. We saw that the home is made up of an older building and a newly built part. The new part had seven people living in it at the time of our inspection, with the remaining five people with bedrooms in the older part but making use of the communal facilities in the new building. We heard that this is a temporary situation as major renovation work is taking place. The result will be the new building providing Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 19 bedrooms and communal facilities for six people, and the older building split into two separate flats each housing four people. We found that the newer building was generally tidy but a little cluttered, with cabinets and lockers in the hallway, and limited storage for items away from where people are living. We saw that the lounge and dining room while of a good size for the intended six people are cramped for the use of all twelve people. The manager explained that this is a temporary measure and showed us that following completion of the renovation work there would be sufficient storage and space for everybody. We saw that people’s bedrooms are comfortable and personalised in the newer part, and that homely decorations were in place around the landing and corridor areas by the bedrooms. We saw that most of the older building is now not in use. Part still has bedrooms being used, although renovation work is continuing around this area. Staff told us that the builders “always check before they start working”. We found unsecured electrical cables hanging from the ceiling. We asked the manager about this who immediately got the builders to make the environment safe. The manager told us he did not believe the cables presented a risk but we heard that there had not been a formal assessment it. We saw two bedrooms in the older part were set up temporarily, and these were cluttered and not very homely, due to the work going on and many personal items being stored in boxes. We also found that drilling had caused plaster dust to fall onto a person’s bed which the manager also resolved later that day. Some staff told that felt that people have coped well with the changes to the building saying. All the staff we spoke to felt the changes would be good when complete telling us changes will be a lot better for the residents and that with people living in smaller groups there will be “more time for that individual. We found the buildings to be otherwise clean, with facilities in place to maintain control over the risk of infections. We found suitable hand washing facilities and saw that the kitchen is kept clean with appropriate steps taken to maintain food hygiene. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 People using the 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 supported by well-trained and safely recruited staff. EVIDENCE: We looked at the staffing. We saw that there is a rota and that there are appropriate numbers of staff to support people. Family told us that there are “quite a lot of new staff” but they are “supported well”. We looked at the documents held about staff. We saw that the service undertakes checks for each new member of staff, obtaining references and checking people’s background including any criminal record. We saw that when an issue was raised in a reference that this is looked into by the service. We found that each new member of staff is given initial training and information. We saw there is an induction pack given to staff that helps to explain their role and expectations from them. We saw records that of this Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 21 initial support and staff confirmed that they were fully trained and supported to learn how to support people. Staff told us we are closely supervised when first working on our own. We saw there are full records of the training people undertake. All staff undertake qualifications around supporting people with a learning disability along with other areas crucial to their work such as helping people move and safety around the home. We saw there are systems in place to ensure training is kept up-to-date. Staff told us “the training’s excellent here” and “I’m learning so much”. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the 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 well-managed home. EVIDENCE: We looked at the management of the service. Since our last inspection a registered manager is now in post who is a qualified nurse. We saw that he had started to undertake a required qualification in managing a care home but this had not been kept up. He showed us that this will be restarted, showing us an appointment with a trainer to continue working on this. Staff told us that they feel supported by management and the “door’s always open”. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 23 We saw there are systems in place to monitor the quality of the service. The manager showed us that they are measuring it against a set of standards used across the organisation, looking at different things important to people. We saw this could be used to reach general conclusions about the service and establish a plan. We also saw a business plan is in place to set goals and actions to be taken. The manager showed us that he is assessing the achievement of the goals, but explained that the building work had made it different to make progress. We also saw that a senior person makes regular unannounced visits to the home and identifies any tasks to be completed. We also saw reports on these visits that also identified progress on the identified actions. We saw that there are systems in place around the health and safety of individuals. We saw that measures are in place based on the current building such as fire procedures and we saw there are ongoing checks of fire systems. We saw that there are policies and procedures in place to help keep people safe. However, as noted earlier, we did not see ongoing assessment of the new risks that may be presented by the progress of the renovation work. Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 2 X Version 5.2 Page 25 Huws Care Home DS0000026447.V374889.R01.S.doc Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2. Standard YA1 YA6 Regulation 5 15 Timescale for action The guide for people who use the 19/06/09 service should be kept under review and be up-to-date. Care plans must be kept under 19/06/09 review and revise this when appropriate under consultation with the person. This will ensure that people are supported the way they need and expect. The registered person must 19/06/09 ensure that all records used in drugs and medical administration are signed and documented correctly. This will ensure that people’s medication is managed safely. This requirement was not met and has been repeated with a new timescale for compliance. A quality assurance system to assess staff competence in medicine management must be in place and appropriate action taken if staff fail to administer medicines in a safe and accurate way. This will ensure that people’s medication is managed safely. Staff should be fully aware of the DS0000026447.V374889.R01.S.doc Requirement 3. YA20 13 (2) 4. YA20 13 19/06/09 5. YA23 13 19/06/09 Page 26 Huws Care Home Version 5.2 6. YA42 13 safeguarding adults arrangements in place including who to inform outside of the organisation. This will ensure people are safe. There must be ongoing identification and response to potential risks in the home. This will ensure that people are safe. 19/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Huws Care Home DS0000026447.V374889.R01.S.doc Version 5.2 Page 27 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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. 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