Inspection on 08/04/10 for Iceni House

This inspection was carried out on 8th April 2010.

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

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

Iceni House 15/06/09

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Iceni House Jack Boddy Way Swaffham Norfolk PE37 7HJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ruth Hannent     Date: 0 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Iceni House Jack Boddy Way Swaffham Norfolk PE37 7HJ TBC Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross OPCO Ltd Name of registered manager (if applicable) Rachael Marie Claxton Type of registration: Number of places registered: care home 74 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 74 The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Both whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical Disability Code PD Date of last inspection Brief description of the care home Iceni House is a new, purpose built care home on the outskirts of Swaffham in Norfolk. It is part of a group of homes owned by Southern Cross, a large corporate provider of care homes nationwide. The building is a large 74 bedded home on two floors that has Care Homes for Older People Page 4 of 29 Over 65 0 74 0 74 0 74 Brief description of the care home been divided into three areas to accommodate older people with physical disabilities, people with dementia and people who have nursing needs. The home is spacious and offers individual bedrooms with en-suite facilities. The home has garden areas for people to sit in, an activities room and various lounges and dining rooms. There is a large supermarket directly opposite the home and a G.P. surgery next door. The town centre is a short walk away with a number of shops and churches. The fees to date range from £388 to £700 per week according to need. Care Homes for Older People Page 5 of 29 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 carried out on the 08/04/10 by 2 Regulation Inspectors and 1 Pharmacist Inspector. The inspection process took place over a period of 6 hours. Throughout the day various areas of the service were looked at in detail that included health and safety, medication, care plans and staff training. A tour of the building took place and we talked to residents, and staff who were on duty on the day of this inspection. To complete the report information received from residents, families, staff, professionals and other stakeholders have been taken into consideration Care Homes for Older People Page 6 of 29 What the care home does well: 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 Care Homes for Older People Page 7 of 29 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 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 9 of 29 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. The home will offer information about the home, assess and ensure the needs can be met before admitting a new resident to the home. Evidence: The AQAA tells us that residents and their families are welcomed to visit Iceni House at any time. There is an information pack that is sent to all potential residents. This pack was seen during this visit along with an up to date service users guide that was in each residents bedrooms. We are also told that each potential new resident will have a pre assessment visit to ensure that the service can meet the individuals needs if they choose Iceni House as their home. Pre assessment documentation was noted in the care plans and was looked at on the day of this inspection. Families do inform us in the surveys returned to the Commission that the Manager or Deputy Manager will visit their relative and carry out an assessment. Care Homes for Older People Page 10 of 29 Evidence: Care Homes for Older People Page 11 of 29 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 home does have details of care requirements that are reviewed but which could be improved upon to show clear person centred care is considered for every resident. Evidence: We looked at a number of care plans during this visit that were informative and written in some detail. The information was completed on all the relevant forms within the care plan with some showing person care support that is required. Risk assessments have been completed and information on how to manage the risks have been identified. The home does record and show how health professionals from the community have been contacted and involved in the care support required. Noted were the involvement of GPs, CPNs, Dieticians, Diabetes Nurses, Continence Advisors, Opticians and Chiropodists. The home uses the MUST tool to monitor peoples nutritional intake and regular weights are recorded to ensure residents are supported with the correct diet and/or advice if concerns arise. Although these care plans are in place some improvement would be required to ensure they are a complete working tool to assist the staff fully in the person centred care Care Homes for Older People Page 12 of 29 Evidence: required. For example it was noted that the weaknesses of the individual are recorded but not always the strengths of what the person can achieve. It was also noted that information about the people who suffer from dementia did not have details recorded about how they are helped with their memory loss or disorientation. (A few residents were noted to be wandering and anxious). There is also limited information about the persons life prior to their need for residential care that would again help the staff understand the person and help them with their needs. It was noted that a resident who requires medication covertly had been through the correct process to assess his mental capacity and the details were found in the care plan. What was not clear was how this decision on this persons capacity was reviewed nor how often this should be done. It would be good practise to ensure an assessment of capacity is reviewed on a regular basis. Care plan reviews do take place but some changes are not always clearly transferred to the main care plan. It was noted in a recent review that a resident had a change of support through the night but this information had not been updated on the main care plan. Another residents care plan review showed a need for a different procedure for moving and handling but again this was not written on the main care plan. Medicine management was inspected by the Commissions pharmacist inspector Mark Andrews who looked at how medicines are stored, administered and recorded. The home has a central storage area for the safekeeping of medicines where there are robust wall-mounted cabinets for the storage of medicines and medicine trolleys are kept securely when not in use. On arrival for inspection we found the room locked and medicines secured, however, we found that the cabinet used to store controlled drugs whilst locked within another cabinet was not fitted to the wall in line with Misuse of Drugs Regulations. The home keeps daily room and refrigerator temperature records and records we examined showed that temperatures have been within accepted ranges, however we found one medicine prescribed for external application needing refrigeration was being stored at room temperature. Shortly after arrival for inspection the registered nurse on duty informed us that all medicines scheduled for morning administration had been given to people and that the morning medicine round is normally completed by 09.30am. We did not observe medicine administration practices however we noted a tablet in an unmarked and open plastic pot within one of the medicine trolleys that had not been administered. We discussed this with the manager and reminded that leaving medicines out in containers for later administration is unsafe practice. We identified that some monitored dosage system containers of medicines were not synchronised with medication charts and discussed this with the manager as a matter for consideration Care Homes for Older People Page 13 of 29 Evidence: in enhancing medicine administration safety. We looked at supporting written information alongside medication charts such as protocols and care planning and found generally these helpful for staff to consider when administering medicines, however, for one person there was information available that conflicted with medicines written on their medication charts. For another, there was information available about a medicine that was no longer written on their medication chart. For a third person, we examined supplementary insulin administration administration records and found that on one day recently insulin was recorded as administered but this was not reflected on the supplementary record and that their blood glucose levels later the same day were higher than normal. We discussed this with the manager and asked her to investigate if an error in the administration of insulin had arisen. For second person prescribed insulin we found no such issues. We audited a number of medicines to attempt to account for them and evidence that they are being administered to people in line with prescribed instructions. With a few minor exceptions we found they could be accounted for and that generally record keeping relating to medicine receipt, administration and disposal is of a good standard. We note that the home is conducting frequent medicine audits. We found one medicine, however, where a yellow sticky note was attached to the medication chart indicating that the dose of the medicine had increased to twice daily but where records indicating the medicine was still being given only once daily. The note was not dated and the medication chart entry itself had not been changed. We discussed this with the manager as unsafe practice. During general discussion with the manager we also discussed concerns relating to when some people have not receved their medicines because they had not been available at the home. The manager said that she has recently resolved these problems by taking control of all medicine ordering at the home. We saw no evidence of medicines being unavailable during the current 28day medication chart period. Staff throughout this visit were observed carrying out their tasks in a dignified respectful manner that showed consideration to the residents for their dignity and privacy. Care Homes for Older People Page 14 of 29 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. Residents do have the support and lifestyle that is suitable but some improvements need to be made to improve further the understanding needs of people with dementia. Evidence: The home has recruited recently an Activities Co-ordinator who has begun a programme of activities and events to ensure residents have some stimulation and occupation throughout the day. This person was seen interacting calmly and politely with residents in the unit where people who have dementia now live. During the afternoon the residents were encouraged to make biscuits and although the staff member took some time to gather all the items required, leaving the residents who were at the table waiting, the task was enjoyed and the end results were eaten. In the entrance to the home there is details on the notice board of activities taking place. There is also plenty of signs in the activities room of arts and crafts that have been taking place. The AQAA tells us that the local churches now offer religious services in the home for any denomination that may be requested and that the community library service now visits the home regularly. There is also an improvement in the centre of the home where a garden has now been improved with some raised garden beds and garden Care Homes for Older People Page 15 of 29 Evidence: furniture for people to use. The area is a bit stark at present but plans are in place to plant and brighten up the area with colour and smells. It is a much improved area for people who need to wander with access through the lounge patio doors that is safe and secure. Residents families, who have replied to our questionnaire, tell us that they are encouraged and do take part in the life of the home. Parties take place that families are invited to, residents meetings are held (31/03/10) being the latest held and by the number of entrys in the visitors book the home have many people visiting regularly. The residents are offered a choice at mealtimes. On the day of this inspection the choice was sweet and sour pork with rice or an omelette. The details of peoples dietary requirements are in the care plans. For example it was noted that one person will only eat when the food is cut into tiny pieces which was done on the day of this inspection. The chef does cater for all diets and noted on the day of this inspection was the food liquidized appropriately for one resident. The choice of what they would prefer is made during the morning. Samples of the food is not available and nor are there any picture formats for the residents to see. This has already been identified by the Manager who is working with the chef to improve the way menus are presented to people who have memory loss. The dining experience observed was suitable with residents who needed support being offered their meal in an appropriate manner. The sweet was a choice of rice pudding with jam or a yogurt. Staff calmly and correctly showed the choice to the residents allowing choice to take place. Some concern was shared with the Manager over the hot trolley in the one unit that is put on to heat up at 11.30 and is then left unattended, creating a risk. The chef does not serve the food. The care staff take on this task in both areas where residents reside. The home needs to consider the whole mealtime experience to ensure meals are served correctly and timely. (It was also noted that residents were anxious to leave as they had to wait for the puddings to arrive from the kitchen). Care Homes for Older People Page 16 of 29 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. Complaints will be acted upon and residents are safeguarded with a more thorough procedure now being followed. Evidence: The home has a complaints procedures that is generic for all Southern Cross homes. The way to complain is on display in the entrance to the home and in all service users guides. The Manager tells us in the AQAA that one complaint has been received since she has been in post that was acted upon straight away and was resolved within 24 hours. The Commission has not received a complaint since this Manager has been in post in the last 4 months, although complaints had been received prior to this. The staff team are aware of the Protection Of Vulnerable Adults procedures and the training matrix in the home shows a high number of staff (78 ) have been trained. The two staff spoken to during this visit were able to give good examples of when they would report on any concerns to the Manager. In the past few months a number of referrals from the Manager to the Safeguarding team have resulted in strategy meetings being attended and positive action taken by the home following these meetings to ensure the residents are safeguarded. Previous to this Manager being in post some concerns had been received by the Commission over the incorrect procedures taking place and safeguarding concerns not being addressed correctly. Besides the training taking place all new staff complete a CRB disclosure application Care Homes for Older People Page 17 of 29 Evidence: and will not commence work unsupervised until that clearance has been received. This was confirmed by the Manager in the AQAA and by the Administrator during personnel file checks on the day of this visit. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is having major snagging problems with the new building but areas that can be used are safe, clean and suitable for the residents Evidence: On arrival at Iceni House we were shown around the home by the new Manager. At present the home is only caring for 21 residents all with bedrooms on the ground floor. This building has only been running as a home for the past 18 months and is a large purpose built 74 bedded home. There are a large amount of snagging problems that have caused concern with the whole of the upstairs area being taken over by contractors due to coving falling, large cracks appearing and fire doors that had been fitted incorrectly and would not all close. The immediate risk of the fire doors has been rectified after the new manager took photographs of the problem. Contractors are now in the building repairing cracks and replacing many metres of coving. The families tell us the home is attractive, clean and comfortable. This home is clean, bright and well furnished is one comment. Another states the ambience of Iceni House welcomes everyone as the reception is entered and of which is also apparent in all other areas. Care Homes for Older People Page 19 of 29 Evidence: The fire alarm and emergency lighting records, seen, are up to date with all maintenance areas fully checked and recorded in the Southern Cross maintenance manuals. The home has a number of hoists and specialist handling equipment that is stored in the one bathroom due to lack of storage in the building. This may cause a problem when the home is full and the bathroom required for more use. The family members also tell us that the Manager is trying to make the rooms as homely as possible with residents own colour schemes with bed linen to match. This was observed in one persons room who had a wall full of photographs, grand childrens drawings and own personal belongings around the room. The furniture in all the bedrooms are robust with solid wardrobe, drawers and specialist beds. There is ample room to move about the bedrooms and each one has its own en-suite with walk in shower. A concern within the en-suites is the lack of a lockable bathroom cabinet. This is required due to the amount of creams and denture tablets that are within easy reach of residents and present a potential risk. The home has a lounge and dining room in each unit with the unit for people with dementia having access to the inner courtyard garden that is safe and secure for walking and activities. One concern shared with the Manager was the lack of space in the lounge if every resident wished to sit in there. There is a large flat screen television for residents but the chairs have to be placed in a line if the television is to watched with a passage running at the back of the chairs from the entrance of the lounge to the patio doors for people to get to the garden. The room is well furnished as is the dining room with large windows that let in plenty of light. The Manager is in the process of placing net curtains at the downstairs windows that face out to the courtyard to ensure privacy for the residents who are in these rooms. Throughout the building it was noted how clean all areas were and there were no unpleasant odour detected. Care Homes for Older People Page 20 of 29 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 home has been through a difficult time with personnel which is now being rectified with the Manager working on recruiting more staff. The shortfall has been filled with agency staff, and residents have been cared for by staff who may not have the full understanding of the role of a carer for people with dementia. Evidence: On the day of this unannounced inspection there were 21 residents who needed care and support. 12 in the unit caring for people with dementia and 9 in the nursing unit. On duty during the inspection was 1 nurse, 5 carers, 1 Activities Co-ordinator, 2 Kitchen staff, 1 Housekeeper, 1 Manager, 1 Receptionist, 1 Administrator and 1 Maintenance Officer. All residents appeared to be cared for. The atmosphere was calm and residents were smiling. People who appeared anxious were being attended to and those who needed occupying were being supported with activities. The home has struggled recently to find the correct staff to care for the residents and a number of Agency staff have been used. According to the staff team this has not been a problem and the same faces have been in the home working well and alongside the permanent staff team. The AQAA tells us that 17 staff members already are qualified or are in the process of completing their NVQ qualification. The Manager tells us that all staff will commence this qualification training on successful completion of their probationary period. Care Homes for Older People Page 21 of 29 Evidence: The Manager informed us that a big recruitment drive has resulted in a number of staff being recruited who will commence their employment on the receipt of all relevant documentation. The home has been struggling to staff the home due to a number of personnel going through the homes disciplinary procedures. The Manager informs us that the home will always fill a vacancy with an agency staff member while recruitment procedures are taking place. Two personnel files were looked at which are stored for safe keeping in the locked front office. Both had a tracking form at the front of the folder. All the relevant paperwork was seen as were the two CRBs received. The recruitment of personnel was discussed with the homes Administrator who now has a robust procedure to ensure all documentation is collated and in the personnel files. The staff training files are all in the training/meeting room and were looked at. It was noted that there was not a record of moving and handling on these files front check list. The training matrix tells us that moving and handling has taken place. There needs to be a true record of what is in the training file to what is recorded on the individual staff training file. A concern that has been raised throughout some safeguarding strategy meetings has been the lack of understanding by staff of dementia care. This has been slightly addressed with a recent 2 hour training session for staff. There is still a need for indepth training and knowledge building to ensure the right skills are in the home to meet all the needs of the care service. Care Homes for Older People Page 22 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is now carried out correctly with a fit person being in charge of the day to day running of the home. Evidence: The home has been through problems of recruiting and retaining a Manager for this service with a total of three Managers being employed since the building was completed nearly 2 years ago. The present Manager, who is yet to be registered with the Commission, has been in post since November 2009 and has experience of managing a care service over a number of years. She is a qualified RGN and RMN and also holds the Registered Managers Award with a recently completed NVQ 4 in Leadership and Management (certificate pending). Since being in post she has spent time with staff, residents and families who have commented on the support and management style that has seen some changes. One such comment was the Manager is very good and the home is improving. The AQAA, completed by the Manager tells us of concerns that have been identified and what Care Homes for Older People Page 23 of 29 Evidence: action has taken place, such as audits now carried out regularly on medication management and staff personnel files. Both these audits were discussed on the day and evidence was seen of this process. The home is still to develop a robust quality monitoring system that will take into account the views of all stakeholders of this service. As mentioned, audit systems are being introduced that will measure some quality outcomes. To fully action, review, develop and plan forward with aims and objectives for the service, an effective quality assurance system needs to be introduced. The home has now introduced a safe and easy system that enables residents to have access to their own money as and when they wish to. Previously, no money could be issued at the weekends or bank holidays when Administrators were not in the building. We now see a safe locked in the nurses area where a float can be left for the weekends and receipts can be issued for any money received in and a record of money going out. In the AQAA the Manager tells us that the staff 1 to 1 supervision has been difficult to establish to date. Now a timetable has been introduced to ensure that all staff will have planned sessions with their senior staff member. In the AQAA, under the section Our plans for improvement over the next 12 months it states, appraisals and supervision will take place regularly. Throughout the tour of the building it was noted that safe practices were in place. Fire records were seen and up to date. (The recent concern regarding poorly fitted fire doors has now been rectified). All areas of the home were clean and tidy with no unpleasant odours. Staff training folders and the training matrix show that staff are trained in all subjects that protect the safety and welfare of residents and staff. In discussion it was identified that a number of staff had not complete the full Skills For Care induction and with the folders now found this process is to begin. The Manager told us that she intends to start all staff on the process over the next few weeks. Care Homes for Older People Page 24 of 29 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 25 of 29 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 2 The care plan reviews must be written and updated on the main care plan. To ensure all staff are aware of the change and new care support required. 01/06/2010 2 9 13 The cabinet used to store controlled drugs must be secured in line with the Misuse of Drugs (Safe Custody) Regulations. To ensure safe storage of medication is upheld. 01/06/2010 3 15 13 The hot trolley used in the nursing unit should not be left unattended when on. To ensure residents are not at risk of burning. 01/05/2010 4 24 13 All creams/lotions/denture 01/07/2010 tablets must be locked away in bathroom cabinets. Care Homes for Older People Page 26 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure residents are not at risk of ingesting inappropriate items. 5 30 18 The Manager must employ suitably competent and experienced personnel. To ensure the correct skill mix on each shift can meet the different needs of residents especially those who suffer with dementia. 6 33 24 The Manager needs to introduce a quality monitoring system To review and improve the delivery of the service in the best interests 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 01/10/2010 01/08/2010 1 7 When completing care plans staff should look at the strengths the person has and ensure this is recorded as part of their day to day care support. The care plans, especially for people who suffer with dementia, should include the support required to help them with their memory loss/disorientation etc. It is recommended that action is taken to ensure all medicines requiring refrigeration are stored at correct temperatures It is recommended that action is taken to synchronise Page 27 of 29 2 7 3 9 4 9 Care Homes for Older People 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 medicine monitored dosage containers with medication chart records to assist with their safe administration. 5 9 It is recommended that written information placed alongside medication charts to assist with the safe administration of medicines is reviewed to ensure accuracy. Further improvements to the meal time experience could be made to ensure all needs and choices are available and timely. The manager needs to continue to ensure that all personnel in the home are fully compliant with the safeguarding procedures. Consideration needs to take place on the shared space (lounge of Pickenham) where residents sit due to the shape and size of this room being limited. The Manager needs to monitor the regular supervision and appraisals and ensure they are up and running as soon as possible. The identified need to introduce the Skills for Care to the staff team should be introduced as soon as possible. 6 15 7 18 8 20 9 36 10 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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