Inspection on 23/09/08 for Magnolia House

This inspection was carried out on 23rd September 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Magnolia House 08/09/09

Magnolia House 04/10/07

Magnolia House 08/08/06

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Magnolia House 42 Hull Road Cottingham Hull East Yorkshire HU16 4PX     The quality rating for this care home is:   two star good 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: Diane Wilkinson     Date: 2 3 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Magnolia House 42 Hull Road Cottingham Hull East Yorkshire HU16 4PX 01482845038 01482848271 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Bottomley Type of registration: Number of places registered: Park Lane Healthcare (Magnolia House) Limited care home 82 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 82 The registered person may provide the following category of service only: Care Home only - Code PC 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 82 Dementia Code DE, maximum number of places 82 Date of last inspection Brief description of the care home Magnolia House is a care home that is operated by Park Lane Healthcare Limited, a privately owned company. The home has been adapted and extended to provide accommodation and care for up to 82 older people, including those with dementia Care Homes for Older People Page 4 of 30 Over 65 0 82 82 0 Brief description of the care home related conditions. It is situated in Cottingham, close to the border between the East Riding of Yorkshire and the city of Hull. The home stands in extensive landscaped grounds that include mature trees, flowerbeds and various seating areas. Information about the home is provided to service users and others in the homes Statement of Purpose and Service Users guide. Private and communal accommodation is located over two floors, both in the east wing and the west wing. Most private accommodation is provided in single bedrooms and many of these have en-suite facilities. There are various lounge and dining areas, some overlooking the landscaped gardens. All areas of the home, including the garden, are accessible to residents via the provision of passenger lifts and ramps. The home is on a bus route and is easily accessed via road; there is ample car parking space for visitors and staff. Care Homes for Older People Page 5 of 30 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: two star good 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 inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last Key inspection of the home on the 4th October 2007. The unannounced site visit was undertaken by one inspector over one day; it began at 9.45 am and finished at 5.15 pm. On the day of the site visit the inspector spoke on a one to one basis with residents and relatives as well as staff and the registered manager. Inspection of the premises and close examination of a range of documentation, including four care plans, were also undertaken. The registered provider and manager submitted information about the service in advance of the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self assessment that focuses on how well Care Homes for Older People Page 6 of 30 outcomes are being met for people using the service. As part of the inspection process surveys were sent out to eight health and social care professionals as well as residents; two surveys were handed to relatives on the day of the site visit. Surveys were returned from seven residents, two health and social care professionals and two relatives. Comments were mainly positive, such as, the choice of meals has improved recently and the staff at Magnolia House are very dedicated and seem to do everything they can to keep dad as comfortable as possible. Anonymised comments from surveys and from discussions on the day of the site visit will be included throughout the report. The registered manager informed us that accommodation fees at the home range from 350.00 to 590.00 per week. At the end of this site visit, feedback was given to the registered manager on our findings, including requirements and recommendations that would be made in the key inspection report. What the care home does well: What has improved since the last inspection? Furniture, decoration and furnishings in the east wing have been upgraded and this provides pleasant surroundings for residents. The alterations to the dining room have created a light and bright area for residents to enjoy their meals. Recruitment and selection practices are more robust and protect residents from harm by ensuring that only people that are considered safe to work with vulnerable people are employed. Most staff have now attended training on safeguarding adults from abuse; this offers extra protection to residents living at the home. A new medication room has been created in one wing and medication trolleys have been fixed to the wall to offer additional security. There are specimen signatures held Care Homes for Older People Page 8 of 30 for staff that have completed medication training to enable medication administration records to be checked for authenticity. 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. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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. Prospective residents are assessed prior to their admission to the home and only offered a placement if their individual care needs can be met. Evidence: We checked the care plans for two people who had lived in the home for a short time. Both included admission information, a full care needs assessment and various risk assessments, including one for moving and handling and a general risk assessment that covered mobility, medication, tissue viability and nutrition. People told us that they or their family had visited the home to look around before they decided to move in, and some people said that they had respite care at the home before they made a decision about permanency. When the placement is funded by a local authority, a copy of the community care assessment and care plan is obtained from care management. In addition to this, an assessment is always undertaken by the home. Information is also requested from Care Homes for Older People Page 11 of 30 Evidence: family and friends and health and social care professionals so that the home has as much information as possible about the prospective resident prior to their admission. All of the information gathered at the time of admission is collated and used to develop an individual care plan for each resident. Care Homes for Older People Page 12 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health care needs are met in a way that respects a persons privacy and dignity; this is supported by well-maintained care planning documentation. Some changes to the administration, recording and storage of medication would improve accuracy and security. Evidence: We examined the care records for a further three residents; these included an individual care plan that was based on the care needs assessment and other information gathered at the time of admission. Care plans include risk assessments that have been undertaken by a senior member of staff - these include information on mobility, nutrition, tissue viability and medication. Care plans record information on the areas where people are able to self care as well as any assistance needed by staff. We saw evidence that care plans and risk assessments are reviewed on a regular basis, both in house and formally. Daily records are very thorough and reflect any assistance offered with personal care, diet, how people spend their day and any visitors seen. In addition to these, a recording sheet is kept in the rooms of all Care Homes for Older People Page 13 of 30 Evidence: residents who choose to remain in their room throughout the day to evidence that there have been hourly checks on their welfare. Key workers complete a monthly report that records a summary of a persons care provision that month, including all inputs from GPs and district nurses. Residents and relatives told us in surveys and on the day of the site visit that they are happy with the care provided by the home. One relative said, The staff at Magnolia House are very dedicated and seem to do everything they can to keep dad as comfortable as possible. The registered manager told us that they intend to introduce new care plans following a series of planning meetings with all managers in the organisation. All visits from health care professionals are recorded, including the outcome of the contact. We saw evidence that residents are weighed on a regular basis as part of nutritional screening; new chair scales have been purchased to facilitate this. Pressure care and continence care is reviewed on a regular basis and any equipment needed is provided - there is evidence that advice is sought from others where necessary. All of the residents that returned a survey to the Commission told us that they receive the medical support they need. One resident told us, If the staff are in any doubt about my condition they call for a second opinion. There is now a dedicated medication room in both wings of the home and this has improved both storage and security. On the day of the site visit we observed the administration of medication. We noted that two staff are involved in this process; one person takes the medication from the container and puts it into a medication pot, and the other person gives the medication to the resident. This could lead to mistakes being made either in the administration of medication or the recording. We noted that medication administration records are not signed until the person has been seen to take their medication. Staff that have responsibility for the administration of medication have undertaken appropriate training and there is a list of sample signatures for this group of staff so that medication administration records can be checked for authenticity. Some residents have been prescribed controlled drugs; we observed that these were stored securely. We checked a sample of controlled drugs and found that both the records and the actual drugs held were accurate. We were told by a senior carer that controlled drugs are counted both before and after administration; this is good practice. Medication administration records for other medication administered were also checked - there is a photograph of each resident filed with their individual medication record - this assists staff in identifying residents and helps to ensure the safe administration of medication. There were some minor errors in recording, mainly in the administration of as required medication. We noted that, when handwritten entries are made on medication administration records, only one member of staff is involved. Two members of staff should be involved in this process and both should sign the written entries made on the records. We observed that unused medication is returned to the pharmacy safely. There is a medication fridge at the home but on the day of the site visit the fridge was full, so someones Care Homes for Older People Page 14 of 30 Evidence: antibiotic medication was stored in the fridge in the serving area of the dining room. This fridge does not lock and can be accessed by residents and others; this places residents at the risk of harm and should be avoided. We observed on the day of the site visit that residents are spoken to sensitively about personal care issues and that staff knock on doors before entering. We observed that residents are treated as individuals, with consideration given to their personal lifestyle choices. Residents and visitors that we spoke to confirmed this, and all residents that returned a survey to the Commission told us that staff listen to them and act on what they say. Care Homes for Older People Page 15 of 30 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. People are supported and encouraged to retain their chosen lifestyle, to be as independent as possible and to remain in contact with family and friends. Meal provision at the home is good. Evidence: We saw in the care plans that we examined on the day of the site visit that there is a record of a persons life history and personal relationships, plus details of their hobbies and interests; we noted that these were reflected in daily records made by staff. People told us that staff always listen to them and act upon what they say, and that they are able to choose how and where they spend their day; this was observed on the day of the site visit. An activities coordinator is employed on five days per week, three days on one wing of the home and two days in the other wing. The registered manager told us that the activities coordinator spends one to one time with people in their own room as well as organising communal activities. There are details of forthcoming activities, including entertainers and special events, displayed on the notice board and the registered manager recorded in the AQAA form returned to the Commission that residents are now given a sheet to keep in their bedroom to remind them of forthcoming events; this is good practice. Care Homes for Older People Page 16 of 30 Evidence: There are large, landscaped gardens at the rear of the home and we observed that there are various seating areas for residents and visitors; we saw these being used on the day of the site visit. The registered manager told us that the garden has now been fully enclosed so that it is a safe area for residents to walk around without any fear of them going missing. The hairdresser visits the home twice a week. There is a dedicated hairdressing room and waiting area, where people sit with friends waiting for their appointment time; this encourages socialisation. The registered manager told us in the AQAA form that residents that are capable are encouraged to make their own appointments with the hairdresser, and the hairdresser now offers beauty treatments as well as hairdressing. When asked about available activities, one resident told us, Unfortunately I am partially sighted so cannot always participate but enjoy the exercises to music and another said that they enjoyed, card games, domino tables, singers and entertainers. The registered manager told us that they are going to purchase a loop system to enable those with a hearing problem to participate more fully in activities. Care plans record regular visits from family and friends and residents told us that they are encouraged and supported to maintain contact with their family. Some residents have their own telephone and they told us that this helps them to keep in touch with family and friends. We noted on the day of the site visit that visitors were in and out of the home throughout the day, and that they appeared to have a good rapport with staff. The registered manager told us about the plans they have in place to increase social stimulation for those people who do not have regular contact with family and friends, for example, to encourage them to visit the local pub with staff for morning coffee or an afternoon sherry. We saw residents rooms when we looked around the premises and noted that they have been able to personalise their rooms and to bring in small items of furniture. Residents are encouraged to handle their own financial affairs, although the registered manager told us that most people have assistance from their family to do so. There was previously information on display about available advocacy services, but the registered manager told us that this had been misplaced; she agreed to obtain new information. This would enable people to contact advocacy services without asking for assistance, and would promote privacy and independence. We saw a daily menu, a weekly menu and a menu specifically designed for those with diabetes displayed on the notice board. We observed the serving of lunch and saw that residents were offered a choice of two main meals and two desserts. The registered manager told us that menu choice was discussed at the last residents meeting and, as a result, some new food choices have been added to the menu. One resident told us, the choice of meals has improved recently. Someone is now employed to work in the servery; they assist with the serving of lunch but are also available to provide drinks for residents and visitors throughout the day. Catering staff are undertaking National Vocational Qualification (NVQ) Level 2 in food Care Homes for Older People Page 17 of 30 Evidence: preparation and it is hoped that this will further improve meal provision at the home. We observed that people receive appropriate assistance to eat and drink, and that mealtimes were encouraged as social occasions; we observed that some residents remained at the dining table after lunch chatting with other residents. Care Homes for Older People Page 18 of 30 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. There are appropriate policies and procedures in place on complaints and safeguarding adults from abuse. People tell us that they know how to use the complaints procedure and any allegations or incidents of abuse are dealt with appropriately by the home. Evidence: There are appropriate policies and procedures in place on how to make a complaint and how it will be dealt with, and these and a complaints form are displayed in the entrance hall. All of the residents that returned a survey reported that they know how to make a complaint and they also said that they know who to speak to if they are unhappy. One resident said, I usually approach the manager or office staff. The CSCI have received one complaint since the last key inspection; we asked to see this information and noted that a record had been kept of the complaint details, the investigation undertaken and the outcome. There is a complaints log in place and this records minor complaints from residents with details of how they have been dealt with. There have been four issues at the home that have resulted in safeguarding referrals being made to the local authority. Three have been investigated by the local authority (one remains outstanding) and the findings were that no abuse has taken place; the home has taken any action that has been recommended by the investigator. There are appropriate policies and procedures in place on safeguarding adults from abuse, including a whistle blowing policy. The registered manager told us that safeguarding adults is now considered as mandatory training by the organisation and Care Homes for Older People Page 19 of 30 Evidence: training records evidenced that most staff have now completed training on this topic. In addition to this, the registered manager has attended Managers Awareness training on safeguarding adults from abuse. Care Homes for Older People Page 20 of 30 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 well maintained, well decorated, well furnished and maintained in a clean and hygienic condition. The extensive well kept gardens provide a safe area for residents and others to sit out or take a walk. Evidence: We toured the premises on the day of the site visit and observed that they are well maintained, well decorated, well furnished and clean. We noted that several areas of the home, including communal accommodation and bedroom accommodation, look out over the landscaped gardens. On the day of the site visit we saw that people were taking advantage of the good weather and sat outside with visitors or took a walk around the garden. The lounge and dining room at the rear of the premises has a full wall of windows and this provides ample access to sunlight. The two dining areas in the west wing have been made into one and now provide a brighter and more spacious environment for residents to enjoy. The registered manager told us in the AQAA form that the west wing has been fully refurbished, including new lounge furniture, new dining room chairs, carpets, curtains and bedding; this was observed on the day of the site visit. A care manager commented in a survey that the west wing was not as pleasant as the east wing; this is no longer the case due to the refurbishment that has taken place. A resident told us in a survey, The care home has had to go through a difficult period due to the building Care Homes for Older People Page 21 of 30 Evidence: work. The staff have worked extemely hard to minimise the effects and though tired have gone the extra mile to ensure the comfort of residents. On the day of the site visit work was being undertaken to repair a hole in the ceiling that had been caused by a leak in the roof; care had been taken to make this area safe. There is a handyman employed at the home for five days per week and they are responsible for day to day repairs and health and safety issues, such as in-house fire tests, water temperature tests and a weekly health and safety audit. We saw the newly built bedroom extension. There was a strong odour in one of these bedrooms but it was evident that every effort is being made to alleviate this. Information was received that a room used by a respite resident had a strong odour and that the replacement mattress put on the bed was not new. We observed that this room was quite pleasant although no personalisation had taken place, as the room was used for respite care. We detected no unpleasant odours in this room. There is a seperate building to the front of the premises; this was previously registered as a partially independent unit called Willow Court. This registration was eventually cancelled and the property was incorporated into the registration for Magnolia House. The registered manager told us that this building is no longer used by residents. Laundry facilities at the home are very good; a laundry manager has been appointed and there are also laundry assistants in post. We noted that most staff have undertaken training on infection control and observed good hygiene practices being used by staff throughout the day. Liquid gel has been placed at the entrance of the home and visitors as well as staff are encouraged to use it. This strengthens infection control arrangements in place at the home. Care Homes for Older People Page 22 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by staff that are recruited safely (for the most part), that are well qualified and who receive the training needed to equip them to carry out their role. Evidence: There are separate rotas in place for day staff, night staff, catering staff and domestic staff; all were seen to record the role of each member of staff. The registered manager told us that every effort is made to ensure that the staff rota is covered during periods of staff sickness or annual leave. An administrator has recently been employed and this releases the registered manager and senior staff from some administration tasks and allows them to concentrate on personal care tasks. All new staff complete an application form that includes information about their employment history and a criminal conviction declaration. We noted that recruitment processes at the home had improved although one written reference for a new employee could not be located and one written reference was not dated; employment records for a third person included two written references. A Protection of Vulnerable Adults (POVA) first check had been received for all new employees prior to them commencing work. The registered manager was reminded that a POVA first check should only be used in exceptional circumstances, not routinely. Under normal circumstances a satisfactory Criminal Records Bureau (CRB) check should be in place Care Homes for Older People Page 23 of 30 Evidence: prior to staff commencing work at the home; this would evidence that staff have no criminal convictions that would prevent them from working with vulnerable people. Training records evidence that good progress is being made towards NVQ achievement, that staff undertake appropriate induction training and that all staff are required to undertake mandatory training. The registered manager told us that two senior staff are now undertaking Training for Trainers courses; this will equip them to faciliate in-house training on mandatory topics, and will lead to new employees receiving mandatory training promptly instead of having to wait for the next planned course; this is good practice. We noted that staff undertake mandatory training on a regular basis but that more specialised training courses are made available for those that are interested, such as dementia awareness and challenging behaviour. Care Homes for Older People Page 24 of 30 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 home is well managed and the health, safety and welfare of residents and others is protected by the systems in place, including effective quality assurance systems. Evidence: The registered manager has the experience and skills required to carry out her role effectively. She has achieved the NVQ Level 4 Registered Managers award and is working towards NVQ Level 4 in Care. She has recently been attending meetings with managers from other homes within the organisation; they have been amending policies and procedures and have devised new care planning documentation that is to be used throughout the organisation. The registered manager also attends some inhouse training alongside staff; she has recently attended refresher training on fire safety. The staffing structure within the home clearly defines the role of the registered manager and other senior staff. There are systems in place to measure the quality of the service provided by the home, including monthly quality audits, staff meetings, resident meetings (relatives Care Homes for Older People Page 25 of 30 Evidence: are also invited to attend) and reviews of residents care plans. Survey forms have been sent to residents and other stakeholders and the home has recently introduced resident and visitor comment cards. Surveys and comment cards for this year still have to be analysed but when all of the information has been collated, residents and others will be informed of the outcome, both at meetings and via the twice yearly newsletter. The quality assurance systems in place give residents and others the opportunity to comment on the way in which the home is operated, and there is evidence that changes are made at the home in response to residents comments, for example, the daily menu. Monies are not held or managed on behalf of residents. Some residents handle their own financial affairs, mostly with assistance from family and friends, and every bedroom has a lockable drawer to enable residents to hold money safely. Any expenditure made on behalf of residents, such as hairdressing and chiropody, is added to monthly accommodation fee accounts. We examined the health and safety arrangements and associated documentation that have been produced by the home. Equipment such as stairlifts and passenger lifts have been serviced on a regular basis, although the annual service for hoists has been delayed due to a change in contractor; the registered manager acknowledged that this work needed to be undertaken as soon as possible and agreed that it would take place within 28 days. There are maintenance certificates in place for the fire alarm system, electrical equipment and gas appliances. In house checks of the fire alarm system, including weekly fire tests and monthly fire drills, are undertaken consistently. There is a written statement in place for maintaining safe working practices, including risk assessments, and staff receive appropriate training on health and safety topics. Care Homes for Older People Page 26 of 30 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 30 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 9 13 Medication should be administered by one member of staff. Two members of staff being involved in the administration of medication increases the risk of mistakes being made in recording or administration. 21/10/2008 2 9 13 Two staff members should 21/10/2008 sign written entries made on medication administration records This is needed to ensure accuracy on medication records and the actual medication given to residents 3 29 19 There must be two written references in place for new employees before they commence work at the home. 21/10/2008 Care Homes for Older People Page 28 of 30 This would provide evidence that they are suitable people to work with vulnerable adults. 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 9 More care should be taken with completing medication administration records to ensure that they are an accurate record of medication taken and not taken. Medication that requires to be stored at a cool temperature should be stored in a medications fridge and not in a fridge that is for general use, to ensure that it is stored safely and securely. Information about advocacy services should be made available to residents and others. This would enable them to contact advocacy services without asking for assistance and promote privacy and independence. A POVA first check should only be used in exceptional circumstances, not routinely. Under normal circumstances a satisfactory CRB check should be in place to evidence that the applicant is suitable to work with vulnerable adults. All health and safety equipment should be maintained on an annual basis, or as recommended by the manufacturer. 2 9 3 14 4 29 5 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) 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. 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