Inspection on 03/09/09 for Margaret Allen House

This inspection was carried out on 3rd September 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Margaret Allen House 22/05/08

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Margaret Allen House 8 Bartows Causeway Tiverton Devon EX16 6RH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gail Richardson     Date: 0 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 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 acknowledged as CQC 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 32 Information about the care home Name of care home: Address: Margaret Allen House 8 Bartows Causeway Tiverton Devon EX16 6RH 01884243169 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Margaret.Allen@Guinness.org.uk Guinness Care and Support Ltd care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 15. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Margaret Allen House is a purpose built care home, comprising part of the original property and two newer extensions to the building. The home provides accommodation and personal care for up to 15 older people in single rooms. In October 2007 Devon Community Housing Society and Guinness Care and Support amalgamated with Guinness Care and Support being registered as the providers of this service in December 2007. Margaret Allen House is situated within level walking distance of the shopping centre of the market town of Tiverton and close to the public park. There is a communal lounge Care Homes for Older People Page 4 of 32 Over 65 15 0 Brief description of the care home with a conservatory attached. Meals are taken in a separate dining room or may be served in individual rooms. One staircase is equipped with a stair lift and a passenger lift is also provided for access to the first floor. A call bell system operates throughout the home. At the rear of the building there is a small raised garden and limited car parking area. The cost of care ranges from £ 378.00 to £ 425.00 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Current information about the service, including CQC reports, The Service Users Guide and Statement of Purpose, are available to prospective residents and all documents can be found in reception. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place over one day on the 3rd September 2009 by Regulation Inspector Gail Richardson. For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. The last key inspection took place on the 22nd May 2008. No visits to the home have taken place in the interim period. A tour of the home took place and some of the bedrooms and all communal areas were seen. There were 15 people currently residing at the home. We spoke to 7 of the people using the service and 5 members of staff, the Registered Manager was available throughout the inspection. Care Homes for Older People Page 6 of 32 As part of this inspection we surveyed the opinions of staff members and people using the service.At the time of this report no responses have been received. We looked at records relating to care including four care plans, finances and health and safety records. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The registered manager must ensure that care plans are developed to include changes in peoples needs and more detail to support staff to provide updated care. All risks identified must also have a plan of care to support that risk. It is also recommended that people or their representative are regularly involved in the care planning and indicated their agreement with the plan in place. The management of medications is required to be reviewed to ensure that safe Care Homes for Older People Page 8 of 32 practices are in place. This will mean that correct procedures are followed for the receipt, administration and disposal of all medications to ensure the safety of people using the service and staff. The environment of the home is of a good standard but issues relating to health and safety must be reviewed. These include unsecured free standing units and the management of unrestricted windows. Further review of the provision of hand wash, paper towels and foot operated bins is needed to promote a good level of infection control. Suitable signage is needed to inform people of the use and hazards of oxygen within the home. Furthermore staff need to be aware of the safety requirements of using substances which are hazardous to health to ensure the safety of people using the service. The replacement of some carpets is needed to improve the environment and infection control of the home. Some further updates of staff training are needed to ensure safe and good practices are maintained. These include fire training and abuse awareness training. It is also recommended that the fire risk assessment be updated to include the hazards created by the use and storage of oxygen. Further supervision of staff is needed to support good practice. This will also provide staff with the opportunity for one to one time with a senior member of staff to discuss issues arising and any training needs. 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 9 of 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that people who are thinking about using the service, and/or their representatives, have the information they need to enable them to make an informed decision about moving to the home. The home has assessment procedures in place to ensure that it only offers a service to people whose needs can be met by the home and people are given the opportunity to test-drive the home prior to admission Evidence: The home provides a Statement of Purpose and Service User Guide to ensure that people considering using the service have sufficient information prior to admission, to make an informed decision. We examined 3 pre admission assessments at this inspection and all contained evidence that people thinking about using the service had been appropriately assessed Care Homes for Older People Page 11 of 32 Evidence: by the home before a placement was offered. We were also able to see that the home had obtained additional assessments from appropriate health care professionals where available. People are able to test run the home and the manager explained that people can visit the home and spend time with other people using the service. People told us that they or their families had chosen the home. They also told us that visits prior to admission had taken place to see which room and what facilities were available. One person told us couldnt be better here, I chose to live here and I have never regretted it. Maggie and the girls as so thoughtful and helpful, nothing is too much trouble. Contracts were examined and were seen to contain sufficient detail of the terms and conditions of residency. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff at the home provide a good standard of care because they know people so well. The care plans do not provide sufficient detail to inform staff of changes in peoples conditions and a plan of care to meet those needs. The homes procedures for the management and administration of peoples medication require some improvements to ensure the safety of people using the service. People are treated with dignity and respect by the staff at the home and people value the staff members kindness. Evidence: During this inspection we examined four care plans in detail and followed the care of these people through examination of other records such as accidents, medication and contacts with health care professionals. Each of the care plans identified the persons needs but there was insufficient detail in the plan of care to inform staff of how to meet those needs. This was in reference to Care Homes for Older People Page 13 of 32 Evidence: both physical and mental health needs. Whilst it was evident from observation of staff that they are fully aware of people needs and how to meet them this was not documented to support any new or temporary staff to the home. This may place people using the service and staff at risk. Some people had specific health care needs relating to diabetes, skin care and oxygen therapy. There were no details for staff to identify and signs and symptoms of changes in these needs and there were no ranges of measurement for example blood sugar levels and oxygen doses to enable staff to be sure that the care was being correctly provided. It was also identified that when peoples needs changed the care plan was not updated to reflect those changes. The home undertakes a monthly review and those changes are recorded there. However staff would have to read back over a period of months to identify changes and actions taken. This does not create a clear evidence trail of changes in conditions and provide staff with an overview of peoples changing needs. No staff has had training in writing and updating care plans. Risk assessments are undertaken for people with areas which may present a risk to the person or others at the home. Care plans were not always implemented to support the risk and ensure the safety of people using the service. Care plans contained evidence that people have access to appropriate health care professionals. Each person is registered with a local GP. The home maintains detailed records relating to the persons contact with health care professionals. People told us They monitor my weight and tell me if I need to eat more. This place is wonderful, I have been unwell and the girls could not have done more for me, Maggie was here for a long time to help me. There is no evidence that people using the service or their relative/ representative have any input into their plan of care or have agreed to the care plans content. The manager is recommended to ensure that people evidence their agreement of the homes plan of care. Care plans also contained information as to the individuals preferences with regard to preferred times for waking, retiring to bed, dietary preferences and bathing. People who had specific needs relating to wound care had the regular input of the visiting District Nurse and records were maintained at the home. Throughout the day we were able to observe staff interactions with the people living at the home. These were noted to be kind and respectful. People looked clean and well attired. People told us that staff were always kind and thoughtful. People told us, You Care Homes for Older People Page 14 of 32 Evidence: cant fault it, I wouldnt want to be anywhere else. Staff are so kind and they always come when you call. I am content with the care I receive, I cannot fault anything here, and I am very well looked after. They are very good at noticing what I need and so thoughtful in ensuing that I always get what I need, they are kindness itself . The home does not employ any male staff but the manager explained that the choice of gender of carer had never been a problem and would be addressed if it occurred. The medication systems appeared to be mostly managed to a good standard; some areas require further review to ensure that systems safely support people using the service. The home uses a pre packed blister pack system. People using the service have the option to self medicate should they want to and risk assessments are in place to ensure safe practice is maintained. Some improvements in practice are required. These include that the staff must ensure that prescribed creams are named and dated when opened for use. This will ensure that the creams shelf live is not exceeded. The staff must ensure that all hand transcribed medications are signed by two staff to ensure that there is no risk of error in transcribing. Furthermore the staff must ensure that when recording variable doses the dose administered is recorded. This will enable a clear audit trail of medications given. It was observed that the staff had left out half a tablet in the locked treatment room for either disposal or use. This is poor practice and places both staff and people at risk. This was discussed at inspection and the practice changed immediately to ensure that staff record the dose given and any medications disposed of. The Medication Administration Records must ensure that coded indicators used to state the reason for any omissions must include the reason for the omission to ensure a clear audit trail of medications given. All staff have received medication training appropriate to dispensing medication and a further plan is in place to provide staff with a three step training program from the local dispensing pharmacist. The home uses two oxygen concentrators and has storage for cylinder oxygen. The home must ensure that appropriate signage is in place to advise where oxygen is being used and the hazards of its storage and use. Care Homes for Older People Page 15 of 32 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. The home ensures that people are given the opportunity for social stimulation and community contact. People are offered a wholesome and varied diet and the home has created a pleasant dining environment. Evidence: People told us that there are sufficient activities provided by the home. They told us that they could choose to join in or not. The home provides in house entertainment which includes visiting musicians, manicures and classes in Tia Chi. People told us that the hairdresser visits the home or people can be assisted to a local hairdresser. On the day of inspection the visiting library service were undertaking the fortnightly visit and a local clergy was attending the home to attend to someones specific spiritual needs. People told us that a monthly multi denominational service takes place at the home. Care plans gave some indications into peoples preferences but most people were able to say what they liked and wanted to do. Several people told us that they visit family or walk into the town to do shopping or meet friends. People also told us that they had made friendships in the home and visited each other there. Mini bus trips are also Care Homes for Older People Page 16 of 32 Evidence: provided. A notice board shows activities both in the home and wider community. The home has a cat Bubbles who wanders freely through the home and is very much enjoyed by people using the service. A residents meeting in February 2009 suggested more ideas for activities. Peoples comments would support that these suggestions were actioned. People told us There is plenty to keep me busy, we had a pianist yesterday which was lovely. I can get out into the community to visit family and do a bit of shopping. I walk into town everyday. Visitors were seen throughout the day of inspection and people using the service confirmed that they are always made welcome. Visitors arrangements are found on a public notice board and include that visitors must leave by 10pm, the home would appreciate if visitors would avoid mealtimes and if visiting for the day to provide at least 24 hours notice. Meals can be provided at a nominal charge of £2.50. We spoke with people about the quality and choice of meals at the home. Everybody spoken with was complementary about the standard of food. Menus are set by the manger and the input of people using the service is sought at residents meetings. People can eat in either the dining room or have meals delivered to their rooms. People told us that if they did not like the menu choice staff would provide a suitable alternative. One person told us. Food is lovely, I can eat in my room or downstairs, I am a fussy eater and if I dont like whats on they keep going until they find something I want. We observed lunch being served people said the meals were always served hot and were of a consistently good standard. The atmosphere was calm and sociable, people said that there was vegetarian option and that staff would ask for your choice option before you were served. Gravy and sauces are served separately to enable personal choice to be maintained. Currently nobody requires assistance with eating and drinking but staff have completed training in both basic food hygiene and assisting in feeding to support this need. The menu for the evening meal was assorted sandwiches, light supper and cakes. Supper was served around 7pm and included milky drinks, cheese and biscuits and crisps. Staff have access to the kitchen overnight to supply snacks as needed. Care Homes for Older People Page 17 of 32 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. The home has appropriate systems in place to enable people to raise concerns. People using the service and staff are confident in the management of the home to address any concerns The home takes appropriate steps to reduce the risk of harm or abuse to people living at the home. Evidence: The home displays a complaints procedure within the home, a copy is available in the Statement of Purpose /Service User Guide. The home has received one complaint which was handled within the stated timescale. CQC has not received any complaints about this service. Staff confirmed that they would feel confident in raising concerns, if they had any, with the manager. People using the service who spoke with us, all told us that they would talk with the manager and had absolute confidence that the appropriate action would be taken. People told us, Any problems I would speak to Maggie and she will sort it out. Any problems my family talk to Maggie. and I can talk to Maggie about anything I need. The home has a range of policies and procedures available to staff to ensure that people are protected from the risk of harm or abuse. The home has a copy of Safeguarding Vulnerable Adults Multi Agency Alert Pathway for Devon and training records indicated that all staff have received appropriate training in abuse awareness. Care Homes for Older People Page 18 of 32 Evidence: Some of this training was last undertaken in 2004 and the manager is required to ensure that all staff training is updated to ensure that staff are aware of current best practice. Some policies were seen to contain previous contact details for the previous regulatory body. It was discussed with the manager that the old policies should be replaced to provide clear directions. The home has not recruited any staff since the last key inspection. However the manager confirmed that staff recruitment procedures reduce the risk of harm or abuse to the people living there. The home has registered all people using the service to vote in any forthcoming electoral process. Currently all people using the service are able to manage their affairs independently or have family/ representative support. The home has access to independent advocacy support should this be needed. Care Homes for Older People Page 19 of 32 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 provides a clean, homely and pleasant environment for people to live in. People are supported to decorate and furnish the room to their personal tastes. Some areas require some development to ensure the safety of people using the service. Evidence: The home is a converted building which comprises of 15 single bedrooms over two floors accessible by stair lift and shaft lift. There are nine single rooms upstairs and 6 single rooms downstairs. The lounge and dining rooms are on the ground floor. There is a patio garden area accessible via a small conservatory off the lounge. There are assisted bathrooms available on both floors. The home is a No Smoking home. A wide selection of bedrooms and all communal areas were viewed during this inspection. It was apparent that people are encouraged to personalise their rooms and small pieces of personal furniture were evident. All rooms have en suite facilities and no rooms are shared. The standard of furnishings, fixtures and decor in bedrooms and en suites were of a very good standard. Carpets were seen to be in need of replacement in one bedroom and conservatory as they appeared stained and worn. It was observed that freestanding wardrobes had not been secured to the wall, this may create a tip hazard, this was discussed with the manager who will organise them to be Care Homes for Older People Page 20 of 32 Evidence: secured as a matter of priority. There is a range of bathrooms and toilet facilities with equipment for bathing either assisted or unassisted available to support people with personal hygiene. Hot water outlets are fitted with thermostats to ensure that they do not exceed the Health & Safety Executive recommended upper limits. Outlets checked at this inspection were within recommended limits. Records of these routine checks are maintained but were not available for the previous month. Specialist equipment was seen where there was an assessed need and this was reflected within each persons care plan. The home takes some steps to reduce the risk of the spread of infection. Liquid soap and paper towels are provided in some areas and staff have access to a good supply of disposable gloves and aprons. It was observed that not all areas have hand wash or bins which were foot operated; this is recommended to reduce the risk of cross infection. The home employs one domestic staff each day and the home appeared to have a very good standard of hygiene and was fresh smelling. People using the service told us that the home is always clean. Care Homes for Older People Page 21 of 32 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. The home benefits from a stable staff team who know and understand the needs of the people using the service. Staff training is provided to support staff to provide a good standard of care. Evidence: People told us that there were enough staff working at the home and staff were always available when you needed them. One person told us I am very please with the care here, staff are always busy and seem to have to work very hard. Staff members also told us that they felt there was enough staff to meet peoples needs. The manager told us that the level of staff provided is reviewed on a daily basis and that more staff can be provided if the level of dependency increases. One person told us that you can ring anytime and they will come. The home uses some agency staff as needed. All people using the service who spoke with us were complementary about the care provided and about the kindness and thoughtfulness of the staff. People told us that they felt safe and well cared for. The home provides a consistent staff team. No new staff have been employed since the previous key inspection and so recruitment and induction standards cannot be assessed at this inspection. Care Homes for Older People Page 22 of 32 Evidence: We were informed that over 50 of staff has achieved a minimum of an NVQ Level 2 in Care. This exceeds the recommendation of the National Minimum Standards. Records confirmed that mandatory training is maintained for all staff and that further training is encouraged. All staff have completed training in moving and handling and fire safety and the home has a qualified first aid staff member on each shift. Care Homes for Older People Page 23 of 32 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. People benefit from effective management systems where an open and inclusive style of management is promoted. The home reviews the quality of the care provided and uses the views and findings to change care practices. Supervision of staff is not currently undertaken and is recommended to be reviewed to promote current best practice. The home follows correct procedures to ensure the health and safety of people at the home. Evidence: There have been no changes to the management structure since the last inspection. The registered manager Maggie Parfect is an experienced and appropriately trained manager. She has 21 years of experience of caring for older people and she promotes an open, positive and inclusive style of management. Both staff and people using the service told us that she was very supportive and approachable. Care Homes for Older People Page 24 of 32 Evidence: Annual Quality Assurance questionnaires were sent out in January 2009. The results have been collated and the views and opinions has been used to form the homes 2009/2010 development plan. People told us that they are encouraged to express their views at any time. Documents within the home are stored securely and maintain the confidentiality of people using the service. The manager has not yet undertaken the supervision of staff at the home. However all staff have received an annual performance review. The registered manager confirmed that further work is needed to ensure that supervision of all staff takes place regularly. All staff should be supervised at least 6 times a year to ensure that any areas of concern can be discussed and any training needs identified. The home maintains records for all accidents. Records were examined and were found to contain appropriate action taken and any follow up action. Systems for managing personal monies were examined and found to be satisfactory, with clear records maintained of all transactions and receipts retained. All monies are audited regularly to ensure a clear audit path is available. Health and Safety records are maintained to ensure the safety of people using the service. Some areas of health and safety require attention. These include there securing of free standing units which may present a tip hazard. These include tall book stands in communal areas and wardrobes in bedrooms. The manager must also ensure that all doors which are signed to say keep locked are secured to prevent entry. In two instances unsecured doors led to access rooms with unrestricted windows which may provide a risk of falls to people using the service who have a reduced understanding of danger. The manager must also ensure that staff have a good understanding of the risks of leaving accessible substances which are hazardous to health. These include cleaning solutions and detergents and also include the accessibility of dental tablets to people who may not have a good understanding of their risks. The fire risk assessments in place for each bedroom and store room must include the risk created by the use and storage of oxygen within the home. Care Homes for Older People Page 25 of 32 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 26 of 32 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 The registered person must ensure that all areas of identified risk are assessed and an appropriate plan of care put in place to meet that risk. The risk assessment and care plan are needed to support staff to provide care and ensure that risks are identified and supported appropriately. 22/10/2009 2 7 15 The registered manager must ensure that people are involved and agree with the plan of care and any subsequent changes. This will support people to be included and in agreement with any plan of care implemented. 22/10/2009 Care Homes for Older People Page 27 of 32 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 3 7 15 The registered manager 22/10/2009 must ensure that care plans include all areas of identified need and include changes in health and welfare. The plan must include clear directions for staff on how to meet these needs to ensure people receive the care they require. 4 9 13 The registered manager must ensure that all hand transcribed medications are signed as checked by two staff. This will promote safe practice by reducing the risk of error in transcribing. 09/10/2009 5 9 13 The registered manager 30/09/2009 must ensure that all variable doses of prescribed medications are recorded. Furthermore medication administration practices must be reviewed to include the recording of disposal of variable doses not given. This is with reference to half tablets. This will ensure a clear audit trail of medication prescribed and administered and ensure that safe Care Homes for Older People Page 28 of 32 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 administration practices are maintained. 6 24 12 The registered manager is 30/09/2009 required to ensure that all free standing large units which may have a tip hazard are secured to the wall. This includes wardrobes and large book units. This is required to ensure that there is no hazard to people using the service 7 26 12 The registered manager is required to ensure that suitable hand wash, paper towels and hands free bins are available in all bathrooms and bedrooms where personal care is provided. This is required to ensure that staff and people using the service are protected from the risk of cross infection. 8 38 11 The registered manager 25/09/2009 must ensure that substances hazardous to health are not accessible to people using the service. These include cleaning solutions and dental tablets. 30/09/2009 Care Homes for Older People Page 29 of 32 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 This is required to ensure that people who do recognise danger are not at risk of accidental ingestion. 9 38 12 The registered manager 25/09/2009 must ensure that any rooms which are signed to be kept locked are secured. This was observed to be needed to prevent access to un restricted windows. All unrestricted windows must be secured. This is required to ensure there is no risk of falls and injury to people using the service. 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 7 The registered manager is recommended to ensure that all medical equipment and devises used in the home are checked and serviced regularly to ensure their safety. The registered manager is recommended to implement staff training in the writing and ongoing use of care plans to support people using the service. The registered manager is recommended to ensure that all prescribed creams are named and dated when opened to ensure they do not exceed their shelf life. The registered manager is recommended to ensure that when medication is ommitted the coded indicator used on the medication Administration Record is completed to 2 7 3 9 4 9 Care Homes for Older People Page 30 of 32 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 provide a documented reason for the ommission. 5 9 The registered manager is recommended to develop the signage used to advise of the use of oxygen in the home. This is recommended to include all rooms where oxygen is stored and used and to include the hazards involved. The registered manager is recommended to ensure that the correct name and contact details are included in the homes complaints policy. This will enable anybody wishing to to contact an external body. The registered manager is recommended to ensure that all staff training in the protection of vulnerable adults is updated to reflect current best practice for the safety of people using the service. The registered manager is recommended to ensure the repair/replacement of carpets identified at inspection which are stained or malodorous. The registered manager is recommeded to ensure that all staff recieve the opportunity for one to one or group supervision up to six times per year. This is needed to support and develop of good practice. The registered manager is recommended to ensure that the homes fire risk assesment is updated to include the risks assosiated with the storage and use of oxygen. 6 16 7 18 8 24 9 36 10 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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