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Please note that the information on this website is now out of date.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 15/04/09 for Mandalay Residential Home

Also see our care home review for Mandalay Residential Home for more information

This inspection was carried out on 15th April 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 3 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

Feedback from the postal surveys was positive, and the people who use the service comment: `We are given a choice of meal`. `The food is getting better, I have no complaints now`. `The staff are lovely, very good, they always come quickly when I call them`. A relative`s comment: `The staff are always nice and patient. I have looked at other places and this home is always clean and tidy, it is a very good place. The staff are very attentive`. A health care professional comments: `Excellent communication from both the Manager and Deputy Manager`. `They care for my client who has complex health needs. They interpret management plans well and take all appropriate action to maintain the client`s health and well being`. `Staff at the home are always courteous and welcoming. They always find time to talk never appearing flustered. Very professional attitude`. When asked what the service does well, staff comment: `We look after, care and entertain the residents`. `We provide a happy environment for the residents, we also have a good relationship with their relatives`. `We make sure that the residents are given the care that they require`. `The home has a good atmosphere, the residents feel at home`.

What has improved since the last inspection?

All bedrooms have been fitted with locks and facilities have been made for the people to make private telephone calls. After consultation with the fire and rescue authority appropriate fire risk assessments are now in place. The banister situated on the front stairs by the entrance of the home has been adjusted and risk assessments are in place for people using the stairs. Additional domestic staff have been employed and the laundry procedures have improved since the previous inspection.

What the care home could do better:

The people who use the service comment: `Sometimes it takes a little while to understand the overseas workers, but once you get used to their accents it is fine`. `Sometimes the overseas workers speak to each other in their own language and this isnot acceptable`. `Sometimes my meal is not hot enough`. Staff comment: `It would be good if we could rearrange the lounge and dining room space`. `There is a lot less light in the lounge area compared to the dining room`. `It would be nice to have the conservatory built`. The Statement of Purpose requires additional information on the qualifications and experience of the Registered Provider, Manager and staff. Although it is planned to implement new care plans the current plans do not fully ensure that the people`s needs will be fully met. The record in the daily logs does not fully reflect the care given and who is providing the care at that time. Dignity and respect is not always being upheld if members of staff speak in their own language in front of the people. Improvements are required in the medication storage. Written entries on the medical administration sheets are not consistently countersigned. There are shortfalls in the training programme and not all staff have received the protection of vulnerable adult training. A qualified first aider must be on duty at all times in the home. A formal activity programme is not in place to ensure that all of the people receive social stimulation.

Key inspection report Care homes for older people Name: Address: Mandalay Residential Home 10 Julian Road Folkestone Kent CT19 5HB The quality rating for this care home is: 1 star adequate A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Penny McMullan Date: 1 5 0 4 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. things that people have said are important to them: 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: They reflect the Care Homes for Older People Page 2 of 31 This box describes the information we used to come to our judgement We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 Page 3 of 31 Care Homes for Older People acknowledged as CQC copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Care Homes for Older People Page 4 of 31 Information about the care home Name of care home: Address: Mandalay Residential Home 10 Julian Road Folkestone Kent CT19 5HB Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): old age, not falling within any other category Number of places (if applicable): Under 65 0 Over 65 40 care home 40 Stargate Partnership Ltd 01303258095 F/P01303258095 mandalayresidential@hotmail.co.uk Additional conditions: Date of last inspection: Brief description of the care home: 2 8 0 4 2 0 0 8 Mandalay is registered to provide residential care to 40 older people. The home has recently been extended and the whole of the premises has been refurbished and redecorated. All bedrooms are single and have en-suite facilities. Communal space Care Homes for Older People Page 5 of 31 consists of a dining room and lounge and there are plans to build a conservatory in the future. Accommodation is over 3 floors and there are 2 shaft lifts. There are local shops and the main bus route into Folkestone runs close to the home. Care Homes for Older People Page 6 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: 1 star adequate How we did our inspection: This was a key inspection carried out over a period of time and concluded with an unannounced visit to the home on 15 April 2009. The new Manager and Deputy Manager assisted throughout the inspection. Surveys were sent to the home for the owners to distribute to people that use the service, staff and professionals who have contact with the service. All comments received are positive and have been included throughout this report. The care of three people was tracked to help gain evidence as to what it is like to live in the home. Various records were viewed during the inspection. The home returned the Annual Quality Assurance Assessment (AQAA) within the required timescale. Information within the AQAA was not detailed enough to provide information about what the home has achieved and improved on since the last inspection. Substantial improvements are therefore required when submitting the next AQAA. The last inspection on this service was completed on 28 April 2008. The rating of this service remains as one star adequate. Although a new Manager has been appointed, the management of the home has been unstable over the last three years. Some of the requirements from the last inspection have not been fully met and Care Homes for Older People Page 7 of 31 further improvements in the service are required. They have appointed a new manager and in the two weeks since her appointment, action has been taken to address many of the areas of concern. We are confident that the home will continue to improve because the new Manager is taking steps to address the issues, therefore no further action will be taken at this time. However an improvement plan will be required to monitor the progress of the home and if the requirements are not met within the agreed timescales, the Commission will consider enforcement action. Care Homes for Older People Page 8 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The people who use the service comment: Sometimes it takes a little while to understand the overseas workers, but once you get used to their accents it is fine. Sometimes the overseas workers speak to each other in their own language and this is Care Homes for Older People Page 9 of 31 not acceptable. Sometimes my meal is not hot enough. Staff comment: It would be good if we could rearrange the lounge and dining room space. There is a lot less light in the lounge area compared to the dining room. It would be nice to have the conservatory built. The Statement of Purpose requires additional information on the qualifications and experience of the Registered Provider, Manager and staff. Although it is planned to implement new care plans the current plans do not fully ensure that the peoples needs will be fully met. The record in the daily logs does not fully reflect the care given and who is providing the care at that time. Dignity and respect is not always being upheld if members of staff speak in their own language in front of the people. Improvements are required in the medication storage. Written entries on the medical administration sheets are not consistently countersigned. There are shortfalls in the training programme and not all staff have received the protection of vulnerable adult training. A qualified first aider must be on duty at all times in the home. A formal activity programme is not in place to ensure that all of the people receive social stimulation. 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 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 10 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 11 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 the 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 people who use the service are provided with the information they need before making a decision to move into the home. Care needs assessments are carried out to make sure the home can meet individual needs. Evidence: The Statement of Purpose has been updated to include the details of the new manager, however the qualifications and experience of the registered provider, manager and staff have not been included. People in the home told us that they did receive lots of information when they moved into the home to help them make a decision to live there. Each person has a care needs assessment before moving into the home. The Manager of the home carries out the assessment with the person or their representative to make sure that the home can provide the care the individual needs. Information is also taken into account from the care plan or joint assessment from the placing authority. This information is then used to form part of the care plan. A relative of a person recently admitted to the home comments: My relative has been here a few weeks, so far so good, in fact very good. Care Homes for Older People Page 12 of 31 Standard 6 is not applicable to this home. Care Homes for Older People Page 13 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvement in the care plans is required to provide the staff with the information they need to meet the full care needs of the people using the service. The health care needs of the people is well supported, however there are shortfalls in the storage and recording of medication. Improvements are required to ensure that the people using the service have their privacy and dignity upheld at all times. Evidence: A care plan is in place for each person. A requirement was made at the previous inspection for the plans to include further details of how to meet peoples needs and risk assessments to provide clear guidelines for staff to follow. Although in some areas the plans have more information some shortfalls still remain. For example the plans use the words monitor and assistance but do not clarify what these mean to the individual. Moving and handling risk assessments identify that a carer needs to be with a person at all times when using a zimmer frame but it does not indicate why or what the carer must do to support the person in a safe way. All of the carers have received Care Homes for Older People Page 14 of 31 moving and handling training and demonstrated their understanding of a safe practice but this is not reflected in the risk assessments. Although the Manager has only been in post for two weeks, she has already recognised the shortfalls. She is currently introducing a new format of care planning and risk assessments, which will address all of the issues. We saw that this format covers all aspects of health and personal care with more detailed information. As the Manager has already started to introduce this format, the previous requirement will not be brought forward, however a new requirement will be made to ensure that each person receives the new format of care plan. The Manager has also introduced a key worker system and a detailed record of personal care given. This enables her to monitor that all care needs are being met. The plans have been updated to record the changing needs of the people and in some cases have been signed to say they agree with the contents. Some of the entries in the daily records do not describe the care being provided. For example one record was not completed, and the use of such entries as his usual self, or had a good day does not detail the care provided to that person. Carers should also sign their full name to confirm that they have provided care at that time. Health care needs are monitored through the care plan and there is a separate page to record all health related appointments. People spoken to told us that the staff respond well to their health care needs. A visitor told us that they make sure her relative sees the optician, dentist and attends out patients appointments. When required the carers have received individual training to meet peoples individual needs. The medication storage has not changed since the previous inspection. The last two inspection reports recorded that the home planned further improvements to the storage of medication. The current facilities are very small and when the home is fully occupied there may not be enough space to store the medication appropriately. Although the plans included installing a hand washbasin this has not happened. A new dedicated medication refrigerator is now in place. The Manager told us that the storage of medication is still under review and further discussions will take place to improve the storage. Care Homes for Older People Page 15 of 31 The home uses the monitored dosage system to administer medication. There has recently been a medication error, which was not identified through the regular audit process. Although the incident was investigated further no full written record of the outcome was in place. This incident occurred before the new manager took up post. She told us that she would be reviewing the audit system to make sure that the risk of errors is minimised and in future a full and written account of any incident will be in place. Only senior staff administer the medication and all have received training, some of the staff are also completing additional training. In some cases the hand written entries on the medication record sheets have not been countersigned to ensure that the information is correct. Medication keys should be kept separately from the keys in the home. We found that medication, which should have been kept in the refrigerator, was stored in the medication trolley. One tube of cream, which should be stored separately, was also in the trolley with other medication. Both items were removed for correct storage and a requirement will be made in this report to ensure that correct storage of medication is in place at all times. The manager told us that she has written to individual GPs to ensure the use of homely remedies is safe. The home supports some individuals with complex care needs and preferences. There are examples of good practice when promoting diversity and supporting people to live the life of their choice. For example people are supported to take responsibility for their medication and health care needs. Carers were observed talking and supporting the people, respecting their privacy and dignity. However, two people comment: Sometimes it takes a little while to understand the overseas workers, but once you get used to their accents it is fine. The girls are nice but two of the overseas workers speak in their own language in front of me. The Manager told us that she would be addressing these issues with the staff. When asked if carers respect their privacy a relative comments: My relative is a very private person and the carers are sensitive to his needs and respect his privacy and dignity well. Care Homes for Older People Page 16 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are being provided in the home and visitors are welcome. The people using the service are supported to live the daily life of their choice. People are able to influence the meals provided in the home to ensure they have their choice and preferences. Evidence: The home does not have a dedicated activity co-ordinator, however the care staff are providing some activities. The Manager told us that the full activity programme would be reviewed in line with preferences recorded in the care plans. At the time of the inspection some of the residents were playing bingo and the people who use the service confirm that other activities take place. There are exercise sessions and musical entertainment. The home receives visits from the local various churches on a regular basis. Recently some of the people went on an outing and had a cream tea and on occasions the staff are able to take some of them shopping to the local supermarket. Care Homes for Older People Page 17 of 31 The people using the service were seen enjoying the bingo session, however not all of the people are able to join in. An activity programme for all of the people is required to ensure that everyone in the home, including the more dependent people, have some social stimulation. A relatives comments: They do have lots of activities here; there was a lovely Easter party. They have bingo every week, outside entertainment and regular church visitors. The people told us that they could choose to join in the activities or plan their day as they please. One person told us how he prefers to stay in his room and watch television and is not interested in the activities. Others confirm they get up and go to bed when they wish and feel they have choice over their daily lives. The people spoken to say their visitors are always made welcome and can stay for a meal if they wish. One visitor comments: The daily life in the home is good and the staff are always attentive. The people are encouraged to keep in contact with their family and friends, and one person told us how pleased she was to receive telephone calls from her friends. The people who use the service told us that the food had improved. Recently they completed a questionnaire about the food being provided. Feedback indicated that some of the vegetables were hard and they wanted them cooked more. The cook listened to the people and they say the vegetables are fine now. The four weekly menus are also being reviewed to include the suggestions made. The Manager has identified further training for the cook to ensure that the needs of the people will be met. Feedback from the people also indicated that the food was not hot enough and action was taken to address this issue by warming and covering the plates. The Manager has also introduced cleaning schedules for the kitchen and monitoring forms to ensure that the peoples nutritional needs are being met. On person comments: I would like more choice of juice. The Manager told us that this was being addressed and more choice of drinks would be made available during the day. The meal served at the time of the inspection looked appetising with good portions and choices were available. Care Homes for Older People Page 18 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 the 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 can feel confident that any concerns or complaints will be listened to and acted upon. Improvements in staff training is required to ensure that the people are fully protected from abuse. Evidence: As a result of a quality assurance questionnaire, when three of the people said they did not know how to complain, the Manager wrote a letter to every individual explaining the process. One relative comments: I have no complaints, I have never had to complain, I only have to tell the Deputy Manager of any concerns and it is resolved there and then. One person says she has lived in the home for several years and has never had any complaints. Any concerns are logged and appropriate action is taken. Staff told us that they are aware of safeguarding procedures, however only eight members of staff have received the protection of vulnerable adults training. Improvements are required in the recruitment process to make sure application forms have the complete employment history of the person to ensure that they are safe to provide care. A requirement will be made in this report. 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 the 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 people benefit from a home which is comfortable and well maintained. Laundry facilities and systems have improved to reduce the risk of infection. Evidence: The home has been extensively refurbished and is well maintained with furnishings and fittings to a high standard. There is a garden at the rear of the home with a base for a conservatory to be erected. At the previous inspection we were told that a conservatory would be added in the near future but this has not been completed at this time. Since the previous inspection the Manager has consulted with the fire office and environmental health with regard to the stair banister and stair gates to confirm that the home complies with the requirements and is safe. Since the appointment of the Manager two weeks ago she has implemented a deep clean of the kitchen. As a result new cleaning schedules have been introduced, together with a monitoring system, to ensure that the cleanliness of the kitchen is sustained. She has requested new carpets for the lounge and in the meantime arranged for cleaning of the whole of the downstairs carpets to be carried out. New locks have been put on all of the bedroom doors and some of the people are able to have their own keys. The people who use the service have personalised their rooms Care Homes for Older People Page 20 of 31 to their own choice. One person says that she was not happy with her room and has since moved to room where she is more comfortable. The Manager has revised the transportation of the laundry to reduce the risk of infection. This means that the laundry is not taken through the dining room and appropriate trolleys and bags are now in full use. The laundry facilities are situated in a separate building outside of the main home. The storage areas have been reviewed and are being tidied to improve the overall laundry systems in place. At the time of the visit the home was clean and tidy with a pleasant smell throughout. 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff on duty to meet the needs of the people. A full training programme is not in place to ensure that staff have the skills to do their job well. Improvements are required in the recruiting process to ensure that staff are safe to provide the care to the people. Evidence: Since the previous inspection the service has recruited additional ancillary staff to ensure the home is clean and tidy. At the time of the inspection the home was appropriately staffed to meet the needs of the people. Feedback from relatives and staff indicate there is always enough staff on duty and the home copes well in times of sickness or annual leave. The people using the service told us that the staff are responsive to their calls, including night staff. One carer told us that since the appointment of the Manager the staffing routines have improved. The Manager told us that she has implemented new systems of working, for example, allocation of staff to individual people and the key worker system. Care Homes for Older People Page 22 of 31 Staff files seen did not all have completed application forms to confirm the applicants full employment history. Further evidence is also required to record that overseas workers documents are checked to make sure they have the paperwork in place to work in this country. When staff transfer from another home in the organisation, full documentation is still required on file to evidence that the required checks have been made, including references or work reports. A requirement will be made in this report. The home has a programme of NVQ in place and over seventy five percent of staff have achieved this award. It is the intention that all staff have access to NVQ and eventually all staff will hold the award. Although the service can be commended for providing their staff with NVQ training, there are major shortfalls in mandatory training, for example moving and handling, fire awareness, health and safety, food hygiene, infection control and first aid. The new Manager is aware of these shortfalls and has already booked some training courses for food hygiene and fire awareness. She told us that she would be addressing all of the shortfalls to bring the training up to date. A requirement will be made in this report. A new member of staff told us that she completed her induction, which is linked to NVQ, and she will be commencing this award in May. She told us that she felt supported by her colleagues when she started and also shadowed other carers until she was confident to do her job well. She confirmed that all mandatory training has been provided and her competency was tested throughout her induction. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using the 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 Manager has recognised what needs to be improved in the home. The health and safety systems in the home ensure that the people and staff are safe. Evidence: The new Manager has been in post for two weeks and is in the process of applying to the Commission to be considered as the Registered Manager. She is qualified and experienced and has worked in other residential settings as a Registered Manger. Since her appointment she had recognised the improvements required in the home and has already implemented systems and started to review care plans and risk assessments. Further examples of the changes are included throughout this report. She demonstrated her understanding of what needs to improve in the home and has already started to implement systems to address these issues. We feel confident that she is committed to improving the service. Care Homes for Older People Page 24 of 31 There is evidence that a quality assurance programme is in place, however this needs further development. The last quality assurance questionnaire was sent to the people using the service in January 2009. It was highlighted that improvements with regard to the food was required. Action was taken to address the issues and feedback from this inspection indicates that the food has improved. There is a quality assurance audit system in place but this had not been completed at the time of this inspection. The last full quality assurance questionnaire was carried out in July 2008, and this had been analysed and action taken. However this information is not linked to the development plan for the home and people were not formally advised of the outcome. A recommendation will be made in this report to fully implement the quality assurance system. The Manager told us that the Area Manager has been completing the Regulation 26 visits, however the last record on file was August 2008. We requested copies of the visits during the last three months and were sent inadequate and repetitive information. The Registered Provider must ensure that Regulation 26 visits are carried out, recorded appropriately and a copy given to the Manager and the Commission. This was a requirement from the previous inspection and although some information has been provided it does not fully evidence that the visits are being carried out in line with this regulation. It is the Registered Providers responsibility to monitor the service being provided through regular monthly visits. In order that we can monitor this a copy of the report for the next three visits will be forwarded to the Commission. There are good financial systems in place to make sure the people who use the service can access their money. Relevant records are in place and where possible, the people sign to say they have received their cash. Some of the residents are supported to manage their own finances or assisted by their relatives or representatives. The Manager has a planned supervision programme in place and staff providing the supervision have been trained to do so. Staff told us that they are receiving supervision and feel supported by the management team. The home is providing some mandatory and induction training for all staff. There are also shortfalls in First Aid at Work training and the home must ensure that a first aid Care Homes for Older People Page 25 of 31 appointed person is on duty at all times. A requirement will be made in this report. Further information on the lack of mandatory training is recorded previously in the staffing section of this report. All safety checks are carried out and temperatures and monitoring safety records are in place. The fire book is in good order and a fire risk assessment in place. Full names of staff must be recorded when fire drills take place to ensure that all staff are aware of what to do in the event of a fire. Health and safety checks are carried out on a regular basis and environmental risk assessments are in place. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1. 7 15 To implement the new format of care plans to include further details of individual care and clear guidelines for staff when moving and handling the people who use the service To ensure that individual care needs are met and staff have written guidelines to move people safely. 17/07/2009 2. 9 13 To ensure that the correct storage of medication is provided at all times To make sure the person is given their medication at the required temperature stated. 30/04/2009 3. 18 12 To ensure that all staff receive the protection of vulnerable adult training. 31/07/2001 Care Homes for Older People Page 28 of 31 To make sure staff are aware of how to deal with any safeguarding issues 4. 29 19 To make sure that application 31/05/2009 forms show a full history of employment To make sure staff are appropriately vetted To implement a full training programme To give the staff the training and skills to do their job well To record Regulation 26 visits and ensure that a copy is given to the manager of the home To make sure that the Registered Provider is aware of the quality of the care being provided in the home To ensure that First Aid at Work training is provided and a qualified person is on duty in the home at all times. To ensure that staff are competent and trained to provide first aid if required. 5. 30 18 31/05/2009 6. 33 26 31/05/2009 7. 38 13 31/05/2009 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. 1 To amend the Statement of Purpose to include the qualifications and experience of the Registered Provider, Manager and staff. 2. 7 Entries in the daily logs to fully reflect the care given that day and the full signature of the staff providing that care to Care Homes for Older People Page 29 of 31 be recorded. 3. 4. 9 10 To consistently countersign hand written entries on the medication administration sheets. Staff to respect the dignity of the people who use the service by ensuring that they speak in the appropriate language at all times. 5. 12 To implement a formal activity programme to include all of the people using the service to ensure that they receive social stimulation. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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!