Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 21/05/09 for Jansondean Nursing Home

Also see our care home review for Jansondean Nursing Home for more information

This inspection was carried out on 21st May 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

During the inspection all staff were helpful and courteous. The administrator was helpful and able to evidence well organised files particularly those relating to health and safety service certificates, and staff personnel files. Information was easily accessible and to hand when it was requested. There was evidence that recruitment checks were undertaken prior to employment to ensure staff are safe to work in the home. Many of the staff team have been in post for some considerable amount of time, which ensures that residents are provided with consistent care from staff that are fully conversant with their needs and the workings of the home. The staff we met had a working knowledge of dealing with adult protection issues and more importantly the reporting of such matters.

What has improved since the last inspection?

It was evident that money had been invested in the building, with the new extension completed and ongoing upgrading of individual bedroom areas. New furniture has been purchased along with curtains and soft furnishings providing great improvements in the communal and individual bedroom areas. Work is still underway in the grounds of the building although the internal work has been completed . The kitchen has been relocated and some new equipment has been installed. The kitchen is now located adjacent to the dining area hence food can be served more directly to residents. The kitchen was awarded a four star rating by the Environmental Health Officer in April 2009. A qualified staff member has completed the manual handling trainers course and is now able to provide manual handling updates to staff working in the home.

What the care home could do better:

Information obtained from the assessments needs to be fully explored to ensure that residents are appropriately placed and that their needs can be met by the staff team. There needs to be a review of the staffing levels including numbers on duty and skill mix,in light of the home`s lay out and resident`s dependency. The home needs to ensure that when risks are identified then action must be taken especially during periods where works are underway. Social activities and choice need to be improved upon to maximise resident`s sense of well being.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Jansondean Nursing Home 56 Oakwood Avenue Beckenham Kent BR3 6PJ     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: Rosemary Blenkinsopp     Date: 2 1 0 5 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: Jansondean Nursing Home 56 Oakwood Avenue Beckenham Kent BR3 6PJ 02086507810 02083258008 jansondean@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Sage Care Homes Limited care home 32 Number of places (if applicable): Under 65 Over 65 32 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category of service only: Care home with nursing (CRH - 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 Date of last inspection Brief description of the care home Jansondean is a large, detached, older building, situated in a pleasant residential area of Beckenham. It is near to local facilities and shops, and is close to a main road, bus routes and train stations. Parking is to the front of the building. The Providers (Sage Care Homes) have several other homes for the care of older people at different locations around the country. Accommodation is provided on 4 floors (lower ground, ground, first and second), and a passenger lift facilitates access to all floors. Care Homes for Older People Page 4 of 31 Brief description of the care home A new build extension was completed at the end of 2007, and this has extended the lounge/dining room on the lower ground floor, which leads out into a large garden. Disabled access has been provided into the garden. Extensive refurbishment of individual bedrooms, to incorporate en suite facilities and develop all single bedroom accomadation continues . Fees range between £605.00 for Local Authority beds ,The Primary Care Trust fees are £750, private fees are £ 670.00 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 site visit was undertaken, unannounced over a one day period. Prior to the inspection the Manager had completed the AQAA and forwarded this to the CQC. Comment cards were provided and returned during the inspection. During the visit we met with two relatives, several residents and observed staff interaction and engagement with residents. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. Care Homes for Older People Page 6 of 31 A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the person in charge at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. 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 following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 31 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 pre-admissions procedures provide residents with some of the information they require prior to any decision regarding placement being made, to establish whether the service is right for them. The homes pre admission assessment enables the home to ensure the residents needs can be met. Evidence: Nineteen residents were on site during the key site visit and one person was on two weeks respite care. Those files inspected had an assessment conducted by the home prior to admission. In those seen it was the manager who had conducted the assessment. Personal information including details of next of kin was recorded. We selected assessment information to view, including that from recently admitted residents. The Care Homes for Older People Page 11 of 31 Evidence: home uses a standard assessment form for all prospective residents. In the first file, there was information relating to the residents mental health condition this was further compounded by sensory impairment which indicated that they had complex needs. Further assessment information included a letter from Bromley hospital and the Local Authority Community Care Assessment. This resident was seen, and it was obvious that there was some mental impairment present and the information in the assessment should have led the home to further investigate the issues around the residents mental state. It may have resulted in the home finding that they could insufficiently meet the residents needs. The other files viewed contained similar assessment details and additional information from health professionals such as an occupational therapy assessment. This report provided good information about the residents needs and abilities. In addition, files contained an initial enquiry form which provided brief details of the residents needs and a property checklist which is completed on admission. We were able to view contracts which are located in the administration office. The two viewed were signed and dated. They detailed the fees payable; clearly stated the room to be occupied and the circumstances plus any payment due, if the agreement should be terminated. We were unable to find records relating to trial visits or visits made to the home by families of prospective residents in the care plans we viewed . There was little evidence relating to what other information had been provided to the family pre admission. All of this information would be beneficial in ensuring that the home was able to meet the residents needs and that they had sampled the service prior to any permanent decision on placement being made. If this were located in the care plan it would provide staff with some initial information on which to provide care . The manager did advise us that this information was available to view. The home produces a Statement of Purpose and a Service Users Guide, which is made available to each resident. These documents will need to be updated to reflect the new regulatory body the CQC. 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. Residents physical health care needs are met by staff in the home supported by members of the multidisciplinary team. Psychological and social care are less well provided for. Care plans are not fully reflective of residents needs and provide limited information on which staff can deliver the care. Medications are safely managed and residents can be assured that they will receive medications correctly. Evidence: We were advised that there were two residents in the home, who had pressures sores, one which was a chronic grade three, and the other a diabetic foot ulcer grade 4. The Tissue Viability nurse is involved with the pressure sores and one is under the care of the hospital. These files were included as part of case tracking when care plans were sampled. Those care plans viewed were in a standard typed format, they included activities of Care Homes for Older People Page 13 of 31 Evidence: daily living. It was evident in the care plans, that not all of the care needs were either identified or updated. One resident whom we met told was in bed all of the time, did no have this essential information included in their plan of care. This would impact on a lot of physical, social and physical care and should have been recorded. Another resident who we met, was confused and making accusatory comments. In their care plan under the daily records, there were many references about their confusion and aggressive behavior, but there was no care plan to deal with these issues. Other issues were also identified in the daily records including agitation, restlessness and confusion. There was little other information to indicate what staff were doing about these presenting problems. All of these need to be individually managed by staff and may require specialist input from psychiatric services. The staff need to have a clear consistent approach when delivering care and this needs to be identified in the care plan. Risk assessments were in place to cover manual handling skin integrity falls and oral hygiene. It was apparent that when high risks were identified the routine re-evaluation continued usually monthly, when more frequent monitoring may have been required. Manual handling assessments did not have the type or size of sling to be used included. Generally the residents or their advocates signature was omitted from care plans. It is important that where possible care plans include signatures of the resident or their advocate to evidence that they have had input into the development of the care plan. The dentist and his assistant were in visiting and they relayed to us, that in their opinion staff were helpful and always had been. Medications are via the MDS system . They were safely stored in a clinical room which was very tidy. The records were well completed. Charts had photographs for identification purposes and allergies recored . Those medications received into the home were recorded. Only qualified staff administer medications. There is a medication policy which sets out how medications need to be managed. The controlled drugs had accurate records for auditing and were safely stored . In one health professionals comment card the following comment was included There has been a history of a very caring staff team in the home. Several comment cards referred to the need for more staff and in particular the need to increase qualified Care Homes for Older People Page 14 of 31 Evidence: nurse cover. Another comment card provided good comments including the following I am very happy with the care the residents received. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Organised activities are limited in the main they are passive such as watching TV. More stimulation would benefit residents whilst promoting and enhancing individuals well being. The menu provides a choice of food and a balanced diet. Evidence: Residents were seen sending time in their own bedrooms until just before lunch when several were assisted into the communal areas where lunch was served . We observed the lunch being served We were advised that lunch was running late and serving started at 12:45 pm. Two hot choices were available. The dining tables were laid up in preparation with cutlery, condiments, serviettes and table clothes. There appeared to be four residents who required assistance with eating and others that needed supervising, although only two staff were in the vicinity. There were insufficient staff to supervise and assist residents with their meal and this needs to be reviewed. Care Homes for Older People Page 16 of 31 Evidence: There was an incident we observed of a resident who was having difficulty eating and when attempting to eat was unable to do so successfully. We observed that the food was becoming cold and asked staff to intervene. The resident was not assisted or supervised with their meal. Whilst it is accepted that the home should encourage residents to be as independent as possible and make choices staff need to ensure that dignity issues are considered. It was apparent that this resident also had mental health issues, talking to themselves, making very unusual comments and they seemed distressed. They appeared to be quite deaf and they were not wearing any dentures. It was difficult to converse with this resident and we were unable to illicit much from them. In relation to the food , one relative made the following comment The meals always look nice my aunt eats well . There was little in the way of activities during the day of the site visit . The home does not employ an activities organiser and it is left to staff , when they have time to conduct these. On occasions external entrainer are brought in, and special occasions such as birthdays and Christmas are celebrated. In relation to activities the following comments were made by residents activities have been provided twice in as many months, and more activities needed. Visiting is flexible and we met with 2 visitors during the site visit. They expressed their satisfaction with the care that their mother received and the way staff welcomed them to the home. The following was stated in a returned comment card , Patients not put to bed until night staff on duty, even though they are not able to communicate, it was further stated that residents were left in their chairs even if it was not what they wanted and they were sitting in hard chairs. These comments need to be investigated to ensure that residents choices and preferences in relation to their rising and retiring times is respected. 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. Complaints information is provided to residents, relatives and visitors, which provides opportunities to raise issues. Staff demonstrated a working knowledge of adult abuse procedures, which affords protection to residents. Evidence: The complaints information is available and on display in each of the bedrooms.This will need to be revised to reflect the new regulatory body the CQC. The complaints file is retained in the office and this is where all complaints are retained. The file had no correspondence in it, as the manager stated no complaints had been received. Complaints information is also available in other documents supplied to residents including the Statement of Purpose. Staff were interviewed about the action they would take if there was suspected abuse and how they might action whistle blowing. Staff said that they had received training on protection of vulnerable adults. This topic had also been covered during the induction period. All staff had a good knowledge of what action they should take in abuse or circumstances where whistle blowing is appropriate, and knew the importance of reporting this on in a timely manner. Residents said they would raise concerns with staff or members of their families. Care Homes for Older People Page 18 of 31 Evidence: 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. Improvements to the environment provide residents with a better home to live in. The absence of risk assessments and safety precautions in the home introduce risks and potential hazards to residents. Evidence: The home is still undergoing major refurbishment. Bedrooms are in the process of being upgraded and work on these areas was taking place. The carpets to the hall and ground floor looked new although we were advised these were four years old. Several bedroom had been upgraded with new furniture and fittings, this provided more comfortable accommodation for residents. In one bedroom which was easily accessible, and close to other residents bedrooms, work was being done. The door to this area was not locked. Once inside the room it was very hazardous as it was being completely refurbished, the window was out, the floor was bare and uneven floor boards obvious,and there were power tools on the floor. There were no workman in the room, although one did arrive shortly afterwards. We were concerned about the relatively easy access to the area, and that residents could enter this area and may have an accident. Care Homes for Older People Page 20 of 31 Evidence: We asked for the risk assessment in relation to the building work and the fire risk assessments, which need to be in place and reviewed when there is any change to the service particularly during building works. There was one document headed Risk Assessment ,however this referred to general risks and not those specifically related to fire and the risk of building works. The manager was unable to locate these and was unsure if these had been reviewed in light of the work. Some documentation was received after the site visit, including risk assessments. Immediate requirements were issued at the site visit. Other areas of potential risk were also identified. The fire door, that provided access to the laundry area, was wedged open with a wooden wedge. This was pointed out and rectified immediately. The top floor sluice door was open as was the corridor door which may pose a risk if resident should wander in to these areas. The fire exit to the first floor was also open, as was the fire exit on the lower ground floor in the lounge area. All of these pose risks to residents who live in the home and must be looked into. We received information regarding an incident where the lift had broken down and visitors were stuck in it until the fire brigade arrived. During the site visit we requested information on this and supporting risk assessments in light of the potential for further occurrences of such a nature. The manager advised that there were no records of the incident nor had a Regulation 37 been received by us, or a specific risk assessment for this incident been developed in respect of a further breakdown. This needs to be looked into and actioned. Another comment card received, referred to a health professional visiting a resident whose bedroom was cold. On querying this, she was told that there was a problem generally with the central heating. It was January 2009, when the incident occurred and it was evident that problems with the plumbing and heating had occurred. Whilst breakdowns in services do occur - every effort should be made to ensure residents comfort is maintained, and additional heating should have been sourced. 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. Staff are provided in adequate numbers although with the lay out of this building and dependency of residents, the skill mix and number of staff should be reviewed. The provision of one qualified nurse per shift allows little staff supervision or input into residents care. Robust recruitment procedures ensure that staff working in the home are subject to appropriate checks which affords protection to residents. Evidence: The home operates on one qualified nurse, one senior health care worker and four health care assistants. On the day of the key inspection the senior carer was a trained nurse in the Philippines, although has not registers with the NMC in the UK. The home has in recent years had a fairly stable staff team which provides consistency in the care provided. Comment cards received by us in the main were less than favourable about staffing in the home. Staffing levels were referred to in several of the comment cards in particular the lack of staff was brought up. Issues such as the trained nurses being over stretched at weekends and working long days was indicated. The off duty Care Homes for Older People Page 22 of 31 Evidence: confirmed that long days were worked and on occasions a night duty had been worked by staff who had also worked a morning shift. Staff who work long hours may become fatigued and this must be carefully monitored. Another comment card said the following, more training for night staff so that they can be aware that bullying in the workplace is unacceptable. This is a issue which must be addressed by the manager to ensure that staff are not subject to bullying in any form and that staff feel supported in their role. In addition the homes policy on Bullying must be put into practice and staff made aware of its content and the action to take if it occurs. Another staff comment card indicated that staff cut backs had led there to be not enough staff. Another comment was that one patient missed an appointment because of low staff numbers, and that there was low staff moral. Staff whom we met had different opinions on the staffing levels and ratios of qualified to unqualified, some feeling there was sufficient others not so satisfied and feeling quite under pressure. There have been five new staff that he started working the home including three care staff and one part time administrator. We selected two newly recruited staff files for inspection. They contained evidence of those checks made prior to employment and included evidence of CRB clearance two references identity checks and a self declaration in respect of their health. Staff are issued with Terms and Conditions of employment and job descriptions. We met with several staff throughout the course of the day . The domestic had been in post for 5 years and had completed the NVQ in house keeping some 18 months ago. She confirmed updates in statutory topics including those for fire health and safety although none for manual handling. Manual handling should be incorporated into all staff training as this involves not only managing residents but also lifting loads. A qualified nurse was spoken to, she had worked in the home for some time. She confirmed that she received supervision through one of the qualified staff nurses. She also confirmed that she had received statutory updates in topics including fire, health and safety, abuse and manual handling. In addition she had had some instruction on Advocacy and the Deprivation of Liberty Act . We met care staff as well during the site visit they to confirmed that they received supervision and training. One NVQ level 3 care staff talked to us. She confirmed that she received supervision and felt that there were enough time to get the work done. Care Homes for Older People Page 23 of 31 Evidence: She had received training that included POVA, health and safety, manual handling and catheter care. The manager stated, that she had since taking up the post, audited all of the training and in particular identified the gaps in the mandatory training and identified those staff who required updating, this must include ancillary staff as previously referred to. There is an RGN working in the home, who has completed the training to become a manual handling trainer this must include ancillary staff as previously referred to. The home is a member of the Bromley training consortium and this provides valuable and regular training to care staff working in care homes. Care Homes for Older People Page 24 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. The home is managed by a trained nurse with experience in care of the elderly. Health and safety procedures are in place to ensure the home is safely maintained for residents,although identified risks are not always actioned and pose potential harm to those living in the home. Quality assurance measures are limited and do not fully allow feedback from all parties involved in the home to further input into the service Evidence: Ms Clarke is the manager of the home although has not yet been registered despite the fact that she applied late 2008. Ms Clarke took up post around September 2008 and is currently working 32 hours a week in her role as manager. She has experience in this type of work previously managing a similar facility in Bromley. Delays have occurred in her process to become the registered manager as her paper work was lost Care Homes for Older People Page 25 of 31 Evidence: by the CQC. A selection of health and safety certificates were inspected, they were retained in the administrators office They were easily accessible and well organised. Those records relating to fire drills had the date of the training and a list of those attending . Signatures of the staff attending should be obtained to confirm their attendance. There was long gap between fire drills of approximately a year . It is essential particularly during building work that fire precautions are paramount with extra vigilance around all aspects of fire safety. The fire risk assessment was dated November 2008 although there was no reference to the building work and this needs to be revised to include the additional risks. Fire alarms had been serviced April 2009 . The weekly fire alarm testing had a gap of ten days in the period 24 April 2009 - 4 May 2009 and the last record was dated 11 May 2009 - ten days previous. Other records indicated the emergency lights and fire door were addressed monthly. On two occasions 6/4/09 and 11/5/09, the records showed that the emergency lights had a fault and it had not been rectified. Again it is important that action is taken especially during the period when work is being undertaken. Action needs to be taken. Other service certificates sampled indicated gas, electrical and lift maintaining were current. Quality assurance documentation was inspected. Minutes of staff meetings were available for a meeting November 2008 and a carer meting April 09. The document headed Jansonden client audit which was conducted 2008, was inspected. This was a survey to obtain residents views on the service they received. The graph showed positive results in particular the areas relating to staff and care, although less so in relation to the food. There was little in respect of other quality control measures to evidence input from all those involved with the service. We were advised that the manager has an open or policy and therefore relatives can see her at any time so specific meetings and forums ahead not been organised. Regulation 26 visits were not on site as these are retained at Head office. Sue Clarke said that although she does not receive a cope these are discussed with her by the owner . All valuables are stored safely including residents money. Residents money was checked and found to be correct with supporting records completed. Receipts are retained and the balance sheet itemises all transactions. In the main one signature Care Homes for Older People Page 26 of 31 Evidence: was recorded it is recommended two staff sign for all transactions to offer greater safeguards in case of discrepancies. The home has a RGN who has completed the manual handling training for trainers course. Care Homes for Older People Page 27 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 28 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 7 15 Care plans and supporting documents need to fully reflect the care to be provided. The care plans are the basis on which staff deliver the care hence must be comprehensive. 30/09/2009 2 19 23 All areas of the home must be maintained in a safe and hazard free manner . Residents need to live in a well maintained and safe home. 30/07/2009 3 27 18 The manager must ensure that the skill mix and numbers of staff are sufficient to meet residents needs. Staff need to have sufficient time to provide care and complete required records under appropriate supervision levels . 30/09/2009 Care Homes for Older People Page 29 of 31 4 33 35 Quality assurance measures 30/09/2009 must include the views of all stakeholders. To ensure that there views are taken in to consideration in any future developments in the service. 5 38 23 All health and safety measures and precaution must be in place. To ensure that the home is safe for residents to live in. 30/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 More detailed assessment information should be obtained to ensure that the home is able to meet all of the residents needs including their psychological care. 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!