Inspection on 03/08/09 for Hylton View Residential Home

This inspection was carried out on 3rd August 2009.

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

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

Other inspections for this house

Hylton View Residential Home 09/08/07

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hylton View Residential Home Old Mill Road Southwick Sunderland SR5 5TP     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: Sam Doku     Date: 0 4 0 8 2 0 0 9 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. 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. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Hylton View Residential Home Old Mill Road Southwick Sunderland SR5 5TP 01915496568 01915498071 hyltonview@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Healthcare (Focus) Limited care home 40 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: The maximum number of service users who may be accommodated is 40. The registered person may provide the following category of service only: Care home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 40 Dementia Code DE, maximum number of places 5 Physical disability, Code PD, maximum number of places: 5 Sensory impairment, Code SI, maximum number of places: 1 Date of last inspection 5 0 5 1 Over 65 0 40 0 0 Care Homes for Older People Page 4 of 31 Brief description of the care home Hylton View Care Home is a two-storey purpose built care home for 40 older people, some of whom may have a mental and or physical health problem. The home was recently been taken over by Southern Cross Healthcare which now owns it. The home provides care with nursing for up to 40 places. It is also registered to provide care for up to 5 people who are suffering from dementia, 5 people with physical disability and 1 person with sensory impairment. The home is sited in a prominent location in Southwick and it is on a direct bus route to the village shopping area and the city centre of Sunderland. It is very close to many local amenities such as the shops, Post Office, Church, Library, Medical Health Centre, social club and the pubs. There are twenty single bedrooms on each floor level, all with en-suite facilities as well as a range of lounges, dining rooms, assisted and standard bath and shower facilities. On the ground floor service users have the use a conservatory to the rear of the home through the dining room, which has also an access into the garden area. The car park is located to the side of the building that has a security camera to survey the area. Service users enjoy events at the neighbouring Red House Community Centre and take trips to the city and surrounding areas. The scale of charges for the home is between 407.00 and 513.30 Pounds per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating of this service is 1 Star. This means the people who use the service experience adequate quality outcomes. The inspection was unannounced and commenced on 03 Augusty 2009 and completed on 04 August 2009. Before the visit the inspector looked at: Information we have received since the last inspection visit on 09 August 2007. How the home dealt with any complaints and concerns since the last inspection. Any changes to how the home is run. The providers view of how well they care for people, as highlighted in the details provided in the Annual Quality Assurance Assessment (AQAA). The views of the people who use the service. Care Homes for Older People Page 6 of 31 During the visit the inspector did the following:- Talked to the people who use the service, the nurse in charge and the staff. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff have the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it is safe and secure. Checked what improvements have been made since the last inspection. The inspector told the area manager for Southern Cross Healthcare what he found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The care plans that were viewed were illegible and both a representative of Southern Cross Healthcare and the inspector were not able to read these. The care plans also lack information to staff on how specific care needs are to be carried out. For two residents whose files were looked at, the home had not carried out a preadmission assessment to make sure that the home has the necessary resources and the skills to provide care for the individuals. One residents has been in the home for five days (at the time of the second day of the inspection visit) and there was still no care plans in place for her. Furthermore, as no pre-admission assessment was carried out, the staff had little or no information about her care needs. The current staffing arrangements are inadequate and the staff who are involved in the day to day care of the residents raised concerns about the home not taking into consideration the high dependency levels of the residents, particularly those on the nursing unit. The residential unit of 20 residents has only one carer on night shift. This is inadequate and unsafe and the area manager for Southern Cross Healthcare was told about the concerns of the inspector over the staffing arrangement in the home. The home is registered to provide care for up to 5 people with dementia. Some care staff, including senior carers were unable to identify which of the 20 residents on the residential unit have been assessed as having dementia. The kitchen was found to be dirty in some areas and it was generally an untidy and disorganised environment. An inspection report by the Environment Health Officer in November 2008 made recommendations for health and safety issues to be addressed. Care Homes for Older People Page 8 of 31 These matters have not been satisfactorily addressed by the manager. The inspector observed very poor attention to cleanliness of the cutlery that the residents use for their breakfast. The tables had been set for the residents breakfast but the inspector found that some of the cutlery was dirty and some was stained with the previous days dinner. Furthermore, the plate mats and table cloths were stained with food from the previous days dinner. Staff who work in the home feel that their concerns are not taken seriously, and this has had the effect of low moral amongst the staff team. The staff on night shift have not had the necessary fire instructions needed to ensure that they are up to date with the fire safety precautions in the home. 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.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 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides good information about the home, including an invitation to visit, which enable prospective residents to make informed decisions about whether to live in the home. Generally, residents are assessed before admission but in some cases this was not the case. Such omission could potentially compromise the welfare of those who have not been assessed before being admitted to the home. Evidence: The home provides good information to prospective residents in the form of a service user guide and other relevant information. Some of the information is freely available at the reception area for visitors to see. The manager stated in the Annual Quality Assurance Assessment (AQAA)form that it is the policy of the home to invite people who are wishing to go into care to visit the Care Homes for Older People Page 11 of 31 Evidence: home and to see the place and assess it for themselves before making decisions about coming to live at Hylton View. Two residents who were spoken with confirmed that they were supported by the home to visit and to spend some time there when they were making inquiries about care homes. The manager also stated in the AQAA that the home carries out their own assessment before admission is arranged. However, this was not the case in two of the five cases that were examined. In both cases, no pre-admission assessment were carried out by the home. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of some of the care plans should be better in order to fully reflect the care needs of the residents. This potentially compromises their helath and welfare. Evidence: The inspector selected five residents on the nursing unit to examine their care plans and to see how the home is meeting their personal and healthcare needs. Three of the files contained assessments of needs and those relating the physical care needs are identified. However, the care plans relating to how those needs are to be met could be better, in providing sufficient information on how those needs are to be met. For example, in one case the care plans tell staff to orientate the resident to time and place at all times. The plan did not tell the staff how to go about this task and how often and under what circumstances. In a number of cases, the care plans were merely statement of incidents. For example, Mrs X was found with buzzer cord round her neck. Then a further written Care Homes for Older People Page 13 of 31 Evidence: statement to say full watch at night. There were no instructions or guidance to staff on who should be responsible for the full watch. There was no indication if a written record should be maintained or completed when the watch is carried out. There was no indication of how often the watch is to be carried out and for low long, or what is meant by full watch. This care plan and many like it were inadequate and unhelpful to the staff. The care plans on the nursing unit are illegible and both the inspector and an officer from one of the sister homes were not able to read them. The nurse in charge was able to read the care plans out for them. This poor quality of writing of the care plans was commented on by the area manager in his last monthly visit report but no action has been taken to address this. However the care needs of residents were being met. There were two instances from the files selected on the nursing unit where the home had not carried out a pre-admission assessments. One of them was a privately funded resident with no evidence of a nurse visiting her to carry out a pre-admission assessment. In another case, a resident recently admitted, was visited by the manager to carry out an assessment but only her details of address, date of birth and next of kin were recorded on the pre-admission assessment form. No assessment of her needs were carried out. Five days into her residency, there was still no care plan for her and care staff had no written care plan to work to in order to meet her complex personal and nursing care needs. The residential unit is registered to cater for 5 people with dementia. When the inspector spoke with the staff they were unable to tell him who the five EMI residents were. One senior who was interviewed about this said that she thought that the EMI residents were on the nursing unit. Eventually two people were identified and when the inspector looked at their files, there were no care plans to address their EMI needs. The care plans were all about their physical needs and there was no indication that the residents have been assessed as EMI residents. During lunch, the inspector noticed that one resident had long finger nails and were ingrained with dirt. The nurse on duty was advised of this immediately. Two other residents were also noted to have long finger nails that needed attention. The medication system on the nursing unit was examined and there were no discrepancies noted. The nursing staff follow the companys medication administration procedures. Care Homes for Older People Page 14 of 31 Evidence: Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides activities that are enjoyed by the residents. This contributes to their sense of well being. The residents are provided with a good variety of wholesome and nutritious meals, which promotes their health and wellbeing. However, attention should be given to the cleanliness of knives and forks used by the residents. Evidence: A new activities organiser has recently been appointed. Staff and residents commented that she is very proactive in ensuring that there is always something for the residents to do when she is on duty. One residents described the activities that are organised for in the home. They include gentle exercise activities, bingo, card games, sing-a-long, films and outings. At the time of the inspection, a small group of residents were engaged in social activities with the activities organiser. The organiser described how she frequently assists and supports some more able residents to access community facilities. often, with the help of care staff. She said she manages to take individuals out to the local Care Homes for Older People Page 16 of 31 Evidence: community to visit local shops and other amenities. The residents who were spoken with on the residential unit confirmed that they get up and go to bed when they want. This was evident when the inspector arrived on the second day of the inspection and noticed that most of the residents were still in bed and those who were up stated that they prefer to get up early in the morning for their breakfast. The dining rooms were pleasantly decorated and furnished to a good standard. The inspector had his lunch with the residents on the first floor. The tables were appropriately set and residents had their meals in pleasant and comfortable environment. The residents were given plenty of time to enjoy their lunch and people who require help from staff with the meals were given that support in ways that preserved their dignity. On the second day of the inspection the inspector noticed that the dining tables on the nursing floor had been set for breakfast but some of the knives and forks were dirty and the table cloths and mats were also badly stained with food from the previous day. Residents said they like the food and that there is always plenty to eat. They described the food as excellent and they commented on the choice of menus that they get. However, one residents said although she does not like some of the foods provided, on the whole they get good variety and plenty to eat. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and relatives have information about how to make a complaint thus promoting the residents right to express their views about the service. Staff are aware of safeguarding adults procedures and have received suitable training which safeguard the residents from any form of abuse. Furthermore, there are suitable arrangements in place for accounting for the residents personal allowances. Evidence: The home has a complaints procedure and a copy of this is posted in the reception area for residents and visitors to see. A summary of the complaints procedure is also included in the service user guide. The inspector spoke with residents and relatives about the complaints procedure. They said they are aware of the procedure and feel confident about raising any concerns with the manager if they were unhappy about anything. Staff members were also spoken with about the homes complaints procedure. They showed good knowledge and understanding of the complaints policy and procedure, and knew how to support residents if they wish to make a complaint. The training record shows that the majority of the staff have had training in safeguarding adults and arrangements are being made to provide a refresher training Care Homes for Older People Page 18 of 31 Evidence: to some of the rest. In the last twelve months the home had received 6 complaints and the records show that these have been appropriately dealt with. The home has a good system in place for accounting for the residents personal allowances. Receipts are available for purchases made on the residents behalf. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally provides a safe, secure, clean, warm and pleasant environment for the residents to live in. However, the general cleanliness in the kitchen is not up to the standard and could potentially compromise the welfare of the residents and staff. Evidence: The home is generally clean and maintained to a good standard. The bedrooms were clean and personalised, reflecting individual tastes and preferences. Residents have been encouraged to furnish their rooms with personal items which enhanced the homeliness of their rooms. All rooms are single occupancy with an en-suite facility. The bedrooms are spacious and have good ventilation and natural lighting. Residents and relatives described the bedrooms as comfortable and homely. Window restrictors have been fixed to all windows for safety, and all radiators have suitable covering to prevent any accidents to the residents. Checks of hot water at randomly elected bathing outlets confirmed that hot water did not exceed the safety level of 43 degrees centigrade. There are good arrangements in place for regular maintenance work in the home. Care Homes for Older People Page 20 of 31 Evidence: The home has suitable infection control policies in place, although the staff training log is not up to date with the training that staff have received in the past. The administration officer indicated that refresher training is being organised for the staff. The kitchen was dirty in some parts and the overall cleanliness and organisation is not up to standard. The Environmental Health Officers report for November 2008 made recommendation for the flooring in the freezer store to be replaced. This was done but the standard of the work is poor and the flooring is lifting again and needs to be repaired. There were two other recommendations to repair or replace the broken shelve inside the oven and also replace the knobs to the cooker to allow the gas rings to be used safely. These recommendations have not been acted on by the provider. There is a cleaning rota showing how the domestic staff keep up with the cleaning activities in the kitchen. Records relating to food temperatures and other food hygiene measures are maintained. The laundry was found to be well ordered, and appropriate COSSH notices are in place. The laundry machines are suitable for cleaning foul linen. There are good infection control measures in place. The laundry assistant is very knowledgeable about how to prevent the spread of infection. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels are are not satisfactory to meet the care needs of the residents over the 24 hour period. This compromises the safety and wellbeing of the residents. Evidence: The inspector spent some considerable time talking to the staff about the staffing levels. Staffing levels on the nursing unit were described as inadequate due to the high dependency levels of the residents. Staff expressed concerns about the stress that they are experiencing as a result of this. The staff said that very often they are unable to take their breaks as they are always very busy seeing to the residents. The care staff also said that their stress levels are compounded by other staffing issues which has resulted in them often refusing to do extra shift when there is shortage of staff. According to the staff this issue has been openly raised but no action has been taken to resolve it. There are two staff on night duty on the nursing unit for the 18 residents, one nurse and a carer. During the day there is one nurse and four carers but staff described a number of instances where there were staff shortages and staffing level frequently dropped below this level. Again the staff expressed concerns about the low moral and Care Homes for Older People Page 22 of 31 Evidence: the stress that they are under. On the residential unit on the ground floor staff stated that although there two staff on duty during the day, very often there is only one carer either due to sickness or when a carer had to undertake escort duty to accompany a resident to hospital or other appointments. On the day of the inspection, one carer had to accompany a residents for their appointment and that left only one carer on the floor to look after 20 residents while doing the medication and organising the tea. The staff described how very often the domestic and laundry staff would step in to help in such situations. Several such situations were described to the inspector. On night shift, there is only one staff on the residential unit to look after the 20 residents. The area manager for the company was told by the inspector to ensure that there is no less than two staff on night duty on the residential unit on night shifts to ensure the safety and welfare of the residents. Staff records show that the staff have received training in moving and handling, first aid, protection of vulnerable adults, fire safety, food hygiene and health and safety training. However, the fire record shows that the night staff have not been receiving regular fire safety instructions. The area manager was advised to ensure that all staff on night duty have up to date training in fire safety and regular fire instructions. The nursing staff continue to receive refresher training to update them on nursing practices. The files for the most recently employed staff were examined to check on the recruitment process by the manager. The files show that the home has been following good recruitment procedures. All the files contain completed job applications, copy of job description, appropriate references, evidence of CRB checks and record of induction and training. Information in the AQAA indicates that 85 of the care staff have NVQ Level II or above. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the whole, the home is not well managed and therefore potentially compromises the welfare of the residents. Evidence: The registered manager has experience of managing a residential care home and has attained the registered managers award. However there is lack of management overview of the care practices and routines in the home. Care plans need to contain more detailed information to enable the staff to provide the care that is specific to the individuals need. The lack of knowledge among senior and care staff about who are the EMI residents has implications for the care that is provided. This lack of knowledge is concerning. Additionally, the care plans for the EMI residents did not provide any information Care Homes for Older People Page 24 of 31 Evidence: about their mental healthcare needs. The failure to carry out pre-admission assessments for two of the residents whose records were examined, compromises the services ability to determine whether or not the home has the necessary skills and resources to meet the needs of the individuals. Furthermore, the lack of a care plan for a resident who had been on the nursing unit for five days (at the time of the second inspection visit) potentially undermines the care provided to this person. The Environment Health Officer inspected the home in November 2008 and made recommendations about health and safety issues in the kitchen but no action had been taken to resolve these issues satisfactorily. Staff moral is very low and some staff indicated that their concerns are ignored and not taken seriously. A number of staff have expressed concerns to the inspector about the stress that they are under and the low moral that they are experiencing and feel unsupported. Quality audits are carried out on a monthly basis to make sure that the service is delivered in a consistent manner and that the views of the people who use the service are taken into consideration. However, some of the issues picked up in this report were not identified in the monthly reviews. The regulation 26 visit report highlighted the inadequacies of the care plans but it appears that no action had been taken to address what is a very important aspect of the care of the residents. There is a good system in place for managing the residents monies. Receipts are available for all transactions that have been made on behalf of residents. The administration officer confirmed that regular audits are carried out by herself and the manager. The company Health and Safety policies remain in place. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH), protection of vulnerable adults, infection control, disposal of clinical waste and record keeping. Servicing records confirm that all portable appliances have been tested. A record is maintained of regular water temperature tests in the home. Regular servicing of fire Care Homes for Older People Page 25 of 31 Evidence: equipment, passenger lift, bath lifts and hoists, gas and electrical appliances have been carried out by the contracted companies. All the servicing records that were examined were up to date. These included servicing of passenger lift, hoists, water treatment, electrical installation and gas servicing. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The home must carry out a thorough assessment of needs of prospective residents before admission is arranged. There were examples where pre-admission assessment was not carried out by the home. 30/09/2009 2 7 15 All residents must have care 30/11/2009 plans on admission or immediately after admission. One resident had been in the home for five days and care plans were still not available for staff to work to. 3 7 15 Care plans must acurately reflect the care needs of the residents. Some care plans lack information on the actions that need to be taken by staff to meet the individuals care needs. 30/11/2009 Care Homes for Older People Page 28 of 31 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 4 8 12 Food hygiene methods must be observed by staff as failure to do so may potentially affect the health of the residents. Knives and forks were dirty and not in good hygienic state. 31/08/2009 5 25 16 Action must be taken to address the health and safety recommendations made by the EHO regarding the cooker in the kitchen. The EHO made recommendations in their report in November 2008 and no action had been taken to address this. 30/09/2009 6 26 16 The kitchen must be kept clean and in hygienic condition to prevent food contamination for the residents. Parts of the kitchen were dirty and needed thorough cleaning. 31/08/2009 7 27 12 The registered person must carry out a review of the staffing level to ensure that there are sufficient and experienced staff on duty at all times to meet the needs of the residents. This review must take into account the 31/08/2009 Care Homes for Older People Page 29 of 31 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 dependency levels and safety and welfare of the residents. The current staffing arrangement is not sufficient to meet the needs of the residents. 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 2 7 28 Care plans should be legible so that all staff can follow the instructions in the care plans. All staff on night duty should receive up to date training in fire safety and arrangements should be made for them to receive regular fire instructions. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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