Inspection on 10/02/09 for Maiden Castle House

This inspection was carried out on 10th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Maiden Castle House 22/02/08

Maiden Castle House 20/08/07

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Maiden Castle House 12-14 Gloucester Road Dorchester Dorset DT1 2NJ     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: Tracey Cockburn     Date: 1 0 0 2 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 29 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 29 Information about the care home Name of care home: Address: Maiden Castle House 12-14 Gloucester Road Dorchester Dorset DT1 2NJ 01305251661 01305251102 maidencastle@care-south.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care South Name of registered manager (if applicable) Mrs Teresa Baldwin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: A maximum of 10 service users may be accommodated for intermediate care in separate ground floor accommodation. A maximum of 5 of these service users may be between the ages of 55 and 64 years. May accommodate up to 10 service users aged between 55 and 64 years on admission and whose primary need on admission relates to their dementia. Date of last inspection Brief description of the care home Maiden Castle House is a purpose built property in a residential area of Dorchester. It is registered to accommodate people under the categories of Old Age, Dementia and Intermediate Care (Rehabilitation) services. Maiden Castle House is registered to Care South; a not-for-profit registered charity, (formerly the Dorset Trust) being an established provider of care services in the south of England. Care Homes for Older People Page 4 of 29 care home 66 Over 65 31 35 10 0 Brief description of the care home There are 66 single person bedrooms each with en suite hygiene facilities. The home comprises two floors divided into separate living units; Maumbury A and B are for physically frail people and the Intermediate Care Unit , providing short term care, is on the ground floor. Each unit has its own facilities, including a communal diningroom/lounge, kitchenette and sluice room. On the first floor are the Eggardon A and B Units; these are specially designed for the care and accommodation of people with dementia. These units include a range of communal areas, enabling residents to readily access their bedrooms and WCs. In the corridors are a number of built-in display cabinets containing household items from earlier years (e.g. the 1940s). Laundering of clothing and household linen is carried out at the home and arrangements can be made for chiropodists, opticians and other health and social care professionals to visit individual residents. On the ground floor there is an enclosed outdoor courtyard/patio area and on the first floor within the Eggardon Units there are balconies with safety glass. The fees at the time of the inspection are;for the dementia unit 700 pounds to 765 pounds per person per week. The fees for other people living in the home range from 595 pounds to 670 pounds per person per week depending on their care needs. Up to date fee information may be obtained from the service. Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained 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: We visited the home unannounced. Two inspectors were involved in the site visit because the home is large and has both a specialist unit for people with dementia as well as a rehabilitation unit for ten people. We reviewed the annual quality assurance assessment sent in by the manager of the service and information in this helped us plan the site visit. We looked at records the home keeps on how people are cared for and we looked at the records the home keeps on how staff are recruited and trained. We spoke to people who live in the service and we spoke to people who work in the service. We also spoke to health care professionals who are involved in the running of the rehabilitation unit. We also observed life in the home during the day we were there. Care Homes for Older People Page 6 of 29 A separate pharmacy inspection took place several weeks after the key inspection and the outcome of this is contained within a separate random inspection report. What the care home does well: What has improved since the last inspection? What they could do better: At the end of this inspection there are five requirements and eight recommendations. One of the requirements was made as an immediate requirement and the registered manager has contacted us to say the information on agency staff is now in the home. It is important that people are aware of their individual plans of care and involved in the details otherwise the care cannot be person centred. To ensure that people living in the home are protected from harm, it is important that all staff complete safeguarding training. To ensure that the care needs and wellbeing of all people living in the home are fully met it is important to staff the home accordingly otherwise vulnerable people are potentially at risk of harm. To ensure that staff working on the dementia unit have all the skills they need to do the job well and fully support and engage with people living on the unit, there must be further specialist training for them. To ensure that peoples individual health needs are fully met there must be a consistent approach to recording otherwise the wellbeing of people living in the home may be compromised. Care Homes for Older People Page 8 of 29 It is important that people living in the home have routines which meet their needs and maintain their dignity. It is important that work continues to meet the recreational expectations of the people living in the home. To maintain good infection control consideration should be given to the use of pedal bins. To ensure that people are in safe hands at all times work needs to continue to encourage staff on to National Vocational Qualifications. To make sure that people living in the home are protected by the homes recruitment policy and practice gaps in employment should be explored during interviews and recorded. there should also be a record of information given to staff such as the General Social Care Council code of conduct. It is important that induction training covers the induction standards provided by skills for Care. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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 10 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. People have their needs assessed before a decision is made about moving into the home so that everyone is clear that the home has the ability to meet an individuals needs. People who are using the intermediate care service have had their needs assessed and are supported to maximise their independence and return home. Evidence: We looked at the care files for five people, they all contained assessments of need. The annual quality assurance assessment says: A key worker for each resident needs to be allocated prior to admission so that they can support the individual moving into the home. Our Quality Assurance Survey suggests that individuals would like more support from staff in the moving in process. Nominated staff members in the form of a key worker would be a move to improve the moving in process. They would then be able to support the individual from the outset to ensure a smoother transition and support Care Homes for Older People Page 11 of 29 Evidence: and guidance during this sometimes stressful experience. The home provides a rehabilitation service for up to ten people. This is provided in a separate but attached building to the main home. This is also staff separately. We spoke to staff from the Primary Care Trust who explained the referral process. The assessment is completed by the social worker who sends it to the manager of the home for agreement. Each week a case conference is held to discuss the care of each person, plans are then discussed with the individual and changes made and agreed. Staff in the rehabilitation service told us that people go on home visits before the end of their stay. Specialist staff such as occupational therapist and physiotherapists are involved and visit the service each day. People told us that the staff are very support and encouraging. We were told that there had been some concerns about the staffing of the unit but this has been resolved. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. To ensure that the principles of respect and dignity are put into practice people should be able to have their personal care needs met at a time which suits them. Evidence: The annual quality assurance assessment states: Maiden Castle House has an holistic approach to the care of its residents ensuring they are treated as individuals, have choices about how they live their lives, have the opportunity to live fulfilling lives and are involved in the care planning process. We found that the home has an aspiration to be holistic but that some people do not find this to be their experience at the moment. We were concerned about one person who was hoisted and told us that they did not have the correct sling and at times felt unsafe. They told us that they had not had the correct sling for some months. We raised this with the deputy manager, who contacted Care Homes for Older People Page 13 of 29 Evidence: us after the inspection to tell us that the occupational therapist had visited on 24/09/08 and reviewed the sling, she advised that a different one should be ordered but the sling they were using was safe and should continue to be used. The OT had advised some changes to the way it was used. We looked at the minutes of staff meetings when issues have been raised about the provision of baths and showers for people living in the home. Previously people living in the home were offered showers or baths on a rota system, this was changed and key workers were responsible for ensuring that the people they supported had baths or showers. One person told us that they had not been offered either in the two weeks that their key worker was away. This key worker system was introduced in October 2008 and discussed at the staff meeting in October 2008. Consideration should be given to whether or not this is a person focused system and whether the needs of the individual are being taken into account. We looked at a number of care plans and found very good level of information for staff. For one person we found that the information about the particular stage of dementia they were in provided good clear information for staff to support them. We found good information on how people might react if they were in pain or discomfort and clear guidance on how they should be supported and the action to be taken. We found information on people seeing health care specialist when they needed to. We found some information in care plans did not translate into care practice, in one situation the persons care plan said they should be supported to eat slowly and reduce the risk of choking however we observed no support being offered during meal time and they were eating very quickly. We found that fluid and food charts were not consistently being completed or signed by staff which means it is difficult for information to be evaluated when reviewing care plans. If people are not being offered the fluids they need this could put them at risk. We also found that care plans are not consistently signed and dated and do not show whether or not the individual or their family have been involved. The annual quality assurance assessment says: The home has a robust medication policy and senior care staff are trained and assessed as competent to administer medication. Only senior members of staff are able to administer medication. They all complete Safe Handling of Medicines training programme. We have a designated senior member of the team who oversees the medication in the home, taking responsibility for ordering, receiving and storing our medication in line with legislation and good practice. The home has just transferred to a new pharmacy system who are providing the home with a comprehensive service, access to a pharmacist, on line support services and training for staff. Residents are able where appropriate and safe to do so self medicate. We were concerned that the medication policy had not been reviewed for four years, we were also concerned that there had been several instances when medication had run out for individuals. As such we felt it was important to arrange for a pharmacy Care Homes for Older People Page 14 of 29 Evidence: inspector to visit the service. People told us that sometimes they are very lonely and do not see many people. We observed people being taken to their rooms for private meetings, we spoke to several people who told us that they always wear their own clothes and are able to see visitors in private if they wish. We found that information on fluid intake for one person was inconsistently recorded, for example one one day the last entry was at 17:00 and the next day was blank. At the last inspection there was a recommendation that guidance is provided to staff on stoma care. We did not look at any specific records relating to stoma care but we did note that staff receive training in this area. People living in the home told us that staff were friendly and cheerful and their privacy maintained. We were concerned that people are not able to have baths when they choose to and are concerned that this does practice is not person centred. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Work needs to continue to ensure that individuals expectations of social and recreational activities are met. Evidence: There are two people employed to undertake activities with people in the home. One person is contracted to ten hours a week and another twenty five hours a week unfortunately when we inspected neither were working. There are activities for the week on each lounge door of the home. These activities include, bingo, board games, quizzes, crafts, afternoon cinema, afternoon tea dance, skittles and nail care. We explained in our feedback that although it might be a nice 1:1 activity for people living in the home we would consider nail care to be personal care not a social activity. We also spoke to several people living in the home who said that the memory boxes are very good and they have a lot of fun discussing the items in the box. One person told us that there had been a lot of laughter when they discussed an undergarment called combinations. The deputy manager told us that all the social histories which we found to be blank in some of the care records are being updated by the activity people and they keep this information separate, we did not see it on the day of the inspection. Care Homes for Older People Page 16 of 29 Evidence: The annual quality assurance assessment says: The new system has a section dedicated to Life History, Who am I, And what I enjoy and dont enjoy. This will ensure that as part of our care planning system equality and diversity will be promoted for each individual, ensuring that all staff are aware of each individuals preferences. We found out that not everyone eats at the same time. People who need support to eat their meals eat at a different time. People told us that their preferred routines are sometimes interrupted because of staffing in the home. The domestic staff make breakfast in the morning because there is no one else to do it as care staff are busy. We saw information in the staff meeting minutes about this. The annual quality assurance assessment says: Prior to my appointment care staff were assisting residents to get up, washed and dressed in the morning then having to change roles to prepare and serve breakfast which was leading to waiting times for residents that they felt was not acceptable. I have recruited and re deployed other staff to ensure that the care staff can mostly concentrate on care giving in the mornings whilst other staff are preparing and serving breakfast. This has improved outcomes for residents in their breakfast experience. At the last inspection a recommendation was made that the activities organiser should be fully integrated with the care team meaning they should be part of reviews and meetings. Work is being completed by the activities organiser on individuals interests, previous work and family life. This has not yet been completed and the information was not available to us as it was locked away. This probably means it is not accessible to staff. Some staff are employed in a social care role and we observed people having one to one time participating in activities such as dominoes or just chatting, this was specifically in the rehabilitation unit. We did not observe any social care staff on the first floor. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a complaints procedure. Further training for staff is necessary to ensure that people are protected from abuse. Evidence: We looked at three complaints and all had been responded to with appropriate letters. There are twelve care assistants who have not completed safeguarding training and nine care team managers and senior care assistant have not done this training. There have been a number of safeguarding referrals made by the home and the commission. We have found that the home make referrals regarding safeguarding themselves are are clear about following their policy and procedure. We found that the home is very open about concerns and how to address them. The annual quality assurance assessment says: All of the staff would benefit from completing the Dorset County Council abuse training package, however this is on a nominated basis and difficult to access for high numbers of staff. Other safeguarding training has not been sourced for staff. 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. People live in clean comfortable surrounding which are well maintained. Evidence: The home was very clean and well maintained. The annual quality assurance assessment makes the following comments about how the dementia unit could be improved: The dementia unit would benefit from more domestic furniture in order to aid daily living skills, or to be used as reminiscence for the residents. Due to the choice in flooring for the unit it can at times feel clinical. The home has a limited outdoor space for the residents, what is available could be better maintained and improved upon to improve outcomes for residents. The 2 main courtyards would benefit from areas of raised beds to aid access for all of the residents. The 2 balconies on the dementia unit are bare and non inviting. These areas would benefit from raised plant pots, foliage of some description and better seating. On the dementia unit all the items which could be used for reminiscence are behind glass cabinets which are locked. There is a mini cooper car in the corridor on the first floor in the dementia unit. The deputy manager told us that sometimes people sit in it with staff and listen to the radio. We found that the bins are all swing bins and should be pedal bins to improve infection control measures. Care Homes for Older People Page 19 of 29 Evidence: We found that the dishwasher on the first floor has not been working for some time. 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. Staff in the home are trained to do the job but there is not sufficient of them to provide a person centred approach to care which leaves people vulnerable to harm. Evidence: The annual quality assurance assessment sent to us states: We have an adequate staff compliment for our residents, with more staff available during our peak times. On the day of the site visit we found there were forty seven people living in the home being supported on the day by one deputy manager, one care team manager, three senior care assistants and six care assistants as well as seven domestic staff, one chef, one kitchen assistant. Morning day shifts are from 7:15 am until 2:45 pm at that time on the ground floor of the home there were three care assistants and one senior. On the first floor there were three care assistants and one senior. The rehabilitation unit was covered in the morning by one care assistant and one senior. The afternoon/evening shift runs from 2:30pm until 10:00pm and is staffed the same as the morning. We found that twelve care assistants have not received safeguarding training, ten care assistants have not had dementia awareness training and sixteen staff have not had challenging behaviour training. We found that there were agency staff working in the home and we found there was Care Homes for Older People Page 21 of 29 Evidence: no information available on their skills, training and satisfactory Criminal Records Bureau (CRB) check. One agency worker told us that she always carries her Criminal Records Bureau (CRB) disclosure with her and has never been asked to produce it at the home. An immediate requirement was made and the operations manager for the provider contacted us the following day to to tell us that the information was being sought from the agency provider and would be in place. We found that agency staff were asked to complete a questionnaire however there was no information as to what action was taken if they responded negatively to a question such as have you had moving and handling training or are you confident to use an assisted bath. We found out from people we talked to that they they find the staff cheerful and helpful but they dont think they see them enough just to talk to. One person told us that it can be very lonely. We observed that during lunch in one part of the home there was only one member of staff on duty and people were having to wait to be supported to go and sit somewhere else after they had finished their meal. The minutes of a senior staff meeting in December 2008 were seen and the issue of the management of shifts was raised. We found that there is a half hour period during the day when the dementia unit is only staffed by one person, when a member of staff goes for a break. We found that there are two people who require the support of two staff. we also found in a care plan for one person that it was advised that they had one to one observation during the day. One the staff files we looked at for new staff we could not find evidence that these staff had completed induction training which met the Skills for Care induction standards. The annual quality assurance assessment says: We have our own NVQ assessment centre, with assessors who come out to the homes to assess our staff, all care staff are given the opportunity to achieve NVQ awards. The training that is offered is comprehensive, any subjects that cannot be covered by our own team are sourced from other providers. There are fifty six care assistants employed to work in the home and only sixteen of them have NVQ at level 2. Of the fourteen Care Team Managers, Senior Care Assistants, eleven have NVQ at level 2 and seven have NVQ at level 2 and 3. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in training, staffing and recruitment suggest the home is not being run in the best interests of the people living there and potentially puts them at risk. The service has quality assurance systems in place. Evidence: The manager has NVQ level 4 and the Registered Managers Award and is currently working towards a BSc at Bradford University in Dementia Studies. The manager is registered with the commission. We looked at information about visits to the home by senior managers ( regulation 26) visits. There were reports for the months up until December and January of 2008/9. The manager had conducted an audit on 22/12/08 as per Care South guidance. The manager stated in the annual quality assurance assessment that there have been some barriers to improvement over the last twelve months; The main barrier to improvement over the last 12 months has been changes in management and senior staff positions. These positions are key changes in the home which takes time and consideration to recruit into, which may deflect time spent Care Homes for Older People Page 23 of 29 Evidence: on improvements. In the last 12 months the home has had 3 managers and as many Deputy Managers which is unsettling for residents and staff. The home has had periods of time with vacant Care Team Manager posts which impacts on important work in the home. Changes in the senior management team at the home has also impacted on the staff team, some staff members have found these changes unsettling and therefore have sought alternative employment. This has resulted in the home having to use a high number of agency staff to fill the vacant care hours. This does result in lack of continuity for the residents. the annual quality assurance assessment says: All residents money is kept in the homes safe and audited regularly. Monies held is recorded and signed in and out by 2 individuals. The money can be accessed by the residents at any time. Only senior members of staff have access to the safe. the home has a quality assurance system in place and the annual quality assurance assessment says: Each year the home conducts its Annual Quality Assurance residents survey which will underpin our plans for this year. We have also surveyed professionals who visit the home regularly to monitor their views of the service. We found the fire records to be up to date. 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 1 29 19 The registered person shall 19/03/2009 not allow a person to work in the care home unless he has obtained in respect of that person information and documents specified in paragraphs 1 to 7 of schedule 2 The registered person must ensure that the people living in the home are safe and to do this they must ensure that any agency staff employed to work in the home have the skills and training to do so as well as a satisfactory Criminal Records Bureau check. 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 The registered manager must consult with the individual or their representative when reviewing the care plan. To develop a person centred approach to care individuals must be involved in the reviewing process so they 29/05/2009 Care Homes for Older People Page 26 of 29 know how their needs will be addressed. 2 18 13 The registered provider must make arrangements, by training staff or by other measures to prevent service suers being harmed or suffering abuse or being placed at risk of harm or abuse. To ensure that people are protected from abuse all staff should have safeguarding training. 3 27 18 The registered provider 31/05/2009 shall, having regards to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered provider must ensure that there are enough staff on duty each day to enable people to have all their care and support needs met fully. 4 27 18 The registered provider must ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform 31/07/2009 16/05/2009 Care Homes for Older People Page 27 of 29 The registered provider must ensure that the staff working in the dementia unit on the first floor are given further training in dementia care so they can meet the needs of the people living on the specialist unit in a person centred way. 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 8 The registered manager should ensure that information is recorded accurately and consistently in fluid charts and other documentation to ensure the wellbeing of people living in the service. The registered provider should ensure that people living in the home are able to have their personal care needs such as bathing at a time which is suitable to them. This will maintain their personal dignity. The registered provider should ensure that activities being offered in the home are based on the leisure and recreational interests of the people living there. The registered manager should consider the use of pedal bins instead of swing bins as part of an effective infection control policy. The registered provider should work towards 50 of care staff achieving national vocational Qualifications at level two or above. The registered provider should ensure that they evidence all staff have been given the General Social Care Council code of conduct. The registered provider should ensure that gaps in employment history are explored and recorded during interview of prospective staff. The registered provider should ensure and evidence that all new staff complete the Skills for Care induction standards. 2 10 3 12 4 26 5 28 6 29 7 29 8 30 Care Homes for Older People Page 28 of 29 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. 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