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Inspection on 22/03/10 for Maris Stella Wing

Also see our care home review for Maris Stella Wing for more information

This inspection was carried out on 22nd March 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 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

One of the two main strengths of the home remain the provision of food and the activities programme. Residents were provided with a wide selection of food and a varied daily menu. All residents we spoke with were very complementary about this aspect of care. The dining areas were attractive and welcoming. The second main strength was the social and recreational activity programme within the home. The programme we saw was varied and interesting. During the morning we noted a very lively activity taking place in the main hall. During the afternoon, the residents we spoke with indicated that they were very satisfied with the current activity and social programme. We noted that the grounds to the front of the home were most pleasant. Two residents told us they were able to use the gardens in good weather and staffing levels permitting. Car parking facilities at the home were good and due to the location of the home, there was very good and easy access to Southend town centre. All staff on duty including the administration and support staff, were very helpful and co-operative. This enabled us to undertake the inspection process with ease. The home provided warm and welcoming hospitality to us throughout the day.

What has improved since the last inspection?

There had been some significant improvements. These included a review of the medicines administration and recording system. Staff had received further training to ensure safe medicines practices within the home. The general manager advised that since the last inspection, the assessment process prior to an admission taking place had been reviewed. As no new residents had been admitted since the last inspection, we were unable to assess this. We noted at this inspection that there were less physical obstacles round the home. This meant that residents could move around the home with less risk of tripping or falling over trailing electrical leads and wires. The laundry area had improved. We noted that the area was tidier and more orderly.The storage of personal information was much better, but there was room for further improvement as referred to within this report. We noted that records recording the amount of fluids given to identified residents had improved. This meant that those residents who required monitoring in this way could be reassured that their fluid intake was being monitored. Staff advised us that they had received some training sessions. However, the records pertaining to this were inadequate.

What the care home could do better:

Following the last inspection, the provider sent us an Improvement Plan. In addition, the provider had been sending to us copies of their monthly visit report entitled `Nazareth Care - Regional Directors Audit Review Visit Regulation 26 Visit`. These reports had been completed by the area manager and accepted (in signature) by the general manager. Personal resident`s records we viewed at this inspection were not compliant with regulation as they did not reflect residents known health and social care needs. Residents were at risk of not having their needs met because staff had differing views of those needs and the recording methods used within the home were at variance. It was recorded in the monthly audit report that the home had a current staff rota in place. This was not in keeping with our findings during the inspection. This meant that there was no record at the time of our inspection to demonstrate which staff were on duty in the laundry area and the duty hours to be undertaken. It was recorded on the Improvement Plan that `service user monies had not been checked on this occasion`. On our inspection, we were unable to gain access to these records or check the monies as the member of staff who took responsibility for this was not on duty. Within the Improvement Plan, it was recorded that staff induction programme was compliant. These records were not made available to us upon request at the inspection, neither was there a record produced of what the home covers during staff induction. Within the home`s report it was recorded that `monthly supervision notes are completed and include objectives...detailed notes now being recorded, congratulations`. These were not made available to us at our inspection. Within the home`s report it was recorded that `individual training profiles...(comment) Underway Skills analysis being undertaken`. The report stated `90% of staff records checked are present, up to date, correct and understood by staff`. There was no evidence of a current staff training record in place or evidence of a structured staff induction programme at our inspection. Details of our findings are within this report. The general manager advised that they manage the home and receive a daily report from the senior member of staff responsible for each shift. We asked the general manager how the information sent to them on a daily basis is audited, monitored and reviewed. We were advised that there were no management audit monitoring tools in place. Three weeks before the inspection took place, a new computer system was installed in the home. The area manager acknowledged that there were a number of issues which had impacted significantly on the outcome of this inspection. The general manager advised that no care plans had been put on the system until they had reviewed them in person. We noted that there were two recording systems in place. There was a hard copy and a computerised copy. The information on these two records for the same resident often differed. Staff told us that their training for the computerised system was inadequate. Staff told us that the computer network system failed consistently on a daily basis, so two sets of records were being completed. There was no management monitoring tool in place to ensure that records were subsequently made current and updated. The outcome of our findings meant that the care plan and associated documentation system for recording residents` care needs was inadequate. This placed residents at risk because the information held on them was at variance, out of date, not always available when on the computer system, there was no management monitoring tool in place to monitor the systems and staff were not competent or skilled to use the computer system. Staff told us that the situation was a daily occurrence and that the general manager of the home was aware of the difficulties. The general manager advised us that they were not aware of the situation and the area manager stated that this had not been brought to their attention. By the end of the inspection the area manager had addressed the computer networking difficulties which meant that staff had consistent access to the computer. The area manager arranged for a training team to come to the home within seven days to train staff enabling them to be competent and efficient in using the IT system. The area manager advised that they would take responsibility for reviewing all care plans and ensuring the information was correctly placed on the computer system. They were also going to dispose of all hard copies as they were of the understanding that this had already been undertaken. Following the inspection, we were advised by the area manager that a new manager would be in post by 26th March 2009. The home lacks clear leadership and management on a day-to-day basis. Systems and processes used within the home must be reviewed, monitored and managed in such a way as to ensure that residents health, welfare and wel

Key inspection report Care homes for older people Name: Address: Maris Stella Wing 111 London Road Nazareth House Southend On Sea Essex SS1 1PP     The quality rating for this care home is:   zero star poor 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: Ann Davey     Date: 2 2 0 3 2 0 1 0 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 41 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 41 Information about the care home Name of care home: Address: Maris Stella Wing 111 London Road Nazareth House Southend On Sea Essex SS1 1PP 01702345627 01702430352 robert.york@nazarethcare.com www.sistersofnazareth.com The Congregation of the Sisters of Nazareth 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: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Maris Stella is registered to provide personal care and accommodation for 32 older people. It is one of two separately registered care facilities sited at Nazareth House. The home is near the Southend town centre, the railway station, bus routes and all local amenities. The grounds include well-maintained gardens and ample car parking facilities. The premises are older in style and retain many of the characteristics including a large main hall, which is used for activities and entertainment. Accommodation is sited on three floors and there are two shaft lifts. Most bedrooms are single, some have ensuite facilities. There are three lounges, which retain a family home-style environment. Additional seating areas are available around the home. Care Homes for Older People Page 4 of 41 0 Over 65 32 Brief description of the care home Kitchenettes are available on each floor where residents and visitors can make drinks and snacks. There is a Statement of Purpose and Service Users Guide available. A copy of the last inspection report is available upon request from the home. The general manager advised that the weekly charges range from £383.18 - £580.00. The exact fee depends on the type of accommodation available or requested, assessed care needs and the source of funding i.e. private or local authority. There are additional charges for items of a personal nature. Care Homes for Older People Page 5 of 41 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection took place on 13th October 2009. This inspection took place over approximately nine hours. The visit started around 9.15am and finished approximately 6.15pm. The registered manager left the home a month before this inspection. Following the departure of the registered manager, the general manager had taken responsibility for the day-to-day management. Prior to that and following the inspection in October 2009, the general manager undertook the responsibility of monitoring the overall management of the home. The homes current Annual Quality Assurance Assessment (AQAA) which is required by law was dated 24th September 2009. The document provided the home with the opportunity of recording what it does well, what it could do better, what had improved in the previous twelve months and its plans for the future. The area manager acknowledged that this document was not a fair or accurate refection of practices and procedures within the home as it had been completed prior to the last inspection. Care Homes for Older People Page 6 of 41 For the purposes of this inspection, we assessed our findings against the homes Improvement Plan dated 19th November 2009 and also the information provided by the area manager within their monthly Regulation 26 reports. These reports are required to be undertaken by law following a monthly visit to the home by the owner or their representative. The area manager is the representative of the registered provider We sent questionnaires to the home on 21st January 2010 asking that they be distributed to stakeholders and returned to us so that we could have an understanding of how residents, staff and health/social care staff felt about the provision. The area manager and general manager told us that they knew nothing about these surveys as they would have been dealt with by the registered manager who had since left the home. During the day we spoke with the area manager, general manager, residents, staff and a visitor. We looked around the home, viewed aspects of various records and observed care practices. We discussed all our findings in detail with both the area manager and the general manager. This was undertaken with regular updates and clarification sessions during the day with the general manager and a full and detailed summary at the end of the inspection with the area and general manager. Opportunity was provided through the day and at the conclusion of the inspection for clarification and confirmation of the accuracy of information we obtained as part of the inspection process from all parties present. We asked that they took notes so that immediate development work could be started where necessary. We appreciated the co-operation and assistance given to us by the management, staff and residents throughout the day. Records sampled by us were selected at random and were numerically proportionate to the number of residents accommodated and the number of staff working in the home. We spent nine hours undertaking the inspection during which an appropriate amount of time was spent observing practice and speaking with stakeholders. Care Homes for Older People Page 7 of 41 What the care home does well: What has improved since the last inspection? What they could do better: Following the last inspection, the provider sent us an Improvement Plan. In addition, the provider had been sending to us copies of their monthly visit report entitled Nazareth Care - Regional Directors Audit Review Visit Regulation 26 Visit. These reports had been completed by the area manager and accepted (in signature) by the Care Homes for Older People Page 8 of 41 general manager. Personal residents records we viewed at this inspection were not compliant with regulation as they did not reflect residents known health and social care needs. Residents were at risk of not having their needs met because staff had differing views of those needs and the recording methods used within the home were at variance. It was recorded in the monthly audit report that the home had a current staff rota in place. This was not in keeping with our findings during the inspection. This meant that there was no record at the time of our inspection to demonstrate which staff were on duty in the laundry area and the duty hours to be undertaken. It was recorded on the Improvement Plan that service user monies had not been checked on this occasion. On our inspection, we were unable to gain access to these records or check the monies as the member of staff who took responsibility for this was not on duty. Within the Improvement Plan, it was recorded that staff induction programme was compliant. These records were not made available to us upon request at the inspection, neither was there a record produced of what the home covers during staff induction. Within the homes report it was recorded that monthly supervision notes are completed and include objectives...detailed notes now being recorded, congratulations. These were not made available to us at our inspection. Within the homes report it was recorded that individual training profiles...(comment) Underway Skills analysis being undertaken. The report stated 90 of staff records checked are present, up to date, correct and understood by staff. There was no evidence of a current staff training record in place or evidence of a structured staff induction programme at our inspection. Details of our findings are within this report. The general manager advised that they manage the home and receive a daily report from the senior member of staff responsible for each shift. We asked the general manager how the information sent to them on a daily basis is audited, monitored and reviewed. We were advised that there were no management audit monitoring tools in place. Three weeks before the inspection took place, a new computer system was installed in the home. The area manager acknowledged that there were a number of issues which had impacted significantly on the outcome of this inspection. The general manager advised that no care plans had been put on the system until they had reviewed them in person. We noted that there were two recording systems in place. There was a hard copy and a computerised copy. The information on these two records for the same resident often differed. Staff told us that their training for the computerised system was inadequate. Staff told us that the computer network system failed consistently on a daily basis, so two sets of records were being completed. There was no management monitoring tool in place to ensure that records were subsequently made current and updated. The outcome of our findings meant that the care plan and associated documentation system for recording residents care needs was inadequate. This placed residents at risk because the information held on them was at variance, out of date, not always available when on the computer system, there was no management monitoring tool in place to monitor the systems and staff were not competent or skilled to use the computer system. Staff told us that the situation was a daily occurrence and that the Care Homes for Older People Page 9 of 41 general manager of the home was aware of the difficulties. The general manager advised us that they were not aware of the situation and the area manager stated that this had not been brought to their attention. By the end of the inspection the area manager had addressed the computer networking difficulties which meant that staff had consistent access to the computer. The area manager arranged for a training team to come to the home within seven days to train staff enabling them to be competent and efficient in using the IT system. The area manager advised that they would take responsibility for reviewing all care plans and ensuring the information was correctly placed on the computer system. They were also going to dispose of all hard copies as they were of the understanding that this had already been undertaken. Following the inspection, we were advised by the area manager that a new manager would be in post by 26th March 2009. The home lacks clear leadership and management on a day-to-day basis. Systems and processes used within the home must be reviewed, monitored and managed in such a way as to ensure that residents health, welfare and wellbeing is paramount and in line with regulatory requirements. 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 41 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 41 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can expect that their needs would be assessed or identified to ensure that their admission would be appropriate. Evidence: The general manager advised us that since the last inspection, there had been no new admissions to the home. They advised us that following the last inspection, the preadmission process and been revised and all needs would be assessed prior to making a decision as to whether to admit a future resident. The process would include a written assurance that the home could meet the identified and assessed needs of residents. The general manager showed us the homes Statement of Purpose and Service Users Guide which they advised had been updated following the last inspection. The registered manager left the home at the end of February 2010 and we advised the general manager that the documents should be further amended to reflect the Care Homes for Older People Page 12 of 41 Evidence: change. This would ensure that people reading the documents would have current information about the home. The above judgment was made based on the information available at the time of the inspection and based on the understanding that no residents had been admitted to the home since the last inspection. Care Homes for Older People Page 13 of 41 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot expect to have their known health and social care needs recorded in a way that would promote a safe and competent delivery of care. Evidence: Following the last inspection in October 2009, we required the home to ensure all aspects of every residents personal care and health care needs were assessed and documented in the care plan. Risk assessments were also to be put in place to support the consistent delivery of person centered support to each resident. Information was required to be current. We received an Improvement Plan dated November 2009 from the area manager advising us this that this action would be competed by the end of December 2009. The Improvement plan advised us that this process would be undertaken by the registered manager and overseen and reviewed on a regular basis by the general manager. At this inspection we looked at and assessed various elements of case records selected at random belonging to five residents. We also looked at various aspects of associated Care Homes for Older People Page 14 of 41 Evidence: risk assessment documents and health care professional visits. For ease of reference these records have been referred to as A, B, C, D and E within this report. We spoke to a visitor, residents and staff members within the home. We also observed care practice. The home was using a computer system and also a handwritten manual recording system for maintaining care records. The general manager told us that before care plans had been transfered to the computer system they had been updated and reflected residents current assessed health and social care needs. The general manager told us that they had taken responsibility for this. During the morning of the inspection, for a period of nearly four hours, staff did not have access to the computer records. It was established later in the day that since the system had been put in at the beginning of March, there had been down times of many hours at a time when staff had been unable to access records. Staff had made a log of these incidents. Staff told us it doesnt work...we cant operate it...were confused...Im really worried about it...its caused so much frustration. The general manager should have been aware of the difficulty as they had the responsibility of overseeing the work. There was significant confusion about what records were current and which records had been put on the computer. The confusion was shared by staff members and us. There were boxes of manual records with gaps in where information had successfully been transferred on to the computer system, but there were later entries where the computer system had failed and staff had recommenced manual recording again. We noted that there were gaps in some of the daily record reports for residents. We were told that this was because some days records had been put on the computer and when this wasnt accessible staff wrote them manually. We asked what tracking process was in place to ensure that the computer records were updated at a later stage and we were told by the senior carer and the general manager that there was not a system in place. The general manager told us that the day of the inspection had been the only day when there had been computer difficulties. Staff told us otherwise. Resident A - the general manager told us that the records on the computer had been reviewed and were current. We noted on the manual record that the resident had been diagnosed with a condition which required specialist infection control measures. This was not recorded on the computer records. The general manager had not referred to this when we were speaking to them about this resident. We noted from another record that this resident also had a further condition which required specialist attention on a regular basis from the community nurse. This had not been mentioned to us as we entered the bedroom and was not recorded. Care Homes for Older People Page 15 of 41 Evidence: Within this residents bedroom there were inadequate infection control measures. For example there were no paper towels or reciprocals for soiled washing. The senior member of staff stated that they were aware of the condition, the housekeeper told us that they thought it had cleared up and the member of staff who was undertaking laundry duties for that day advised us that they knew nothing about it. The general manager was unable to provide an explanation for this unacceptable practice which placed residents and staff at risk. No risk assessments were made available to us. In addition, the resident A was at further risk because their required treatment for the second identified medical condition had been inadequately recorded. Resident B - on this residents (undated) social history there was reference to a diagnoses of epilepsy and depression. There was no reference to this on their care plans. We were advised by the general manager that this resident had been distressed by a recent incident within the home which had resulted in this resident requiring support and medication to assist them. The general manager was unaware that there was reference to depression on the residents file. Resident C - Information about this resident care needs was noted to be manual documentation and on the computerised system. However, the information on the systems was at variance with each other. Within the care plan it was recorded monitor pain, if severe remove catheter and bladder washout once a week There was no reference as to whom would undertake this. We were told that it would be the community nurse, but this was not recorded in the documentation. We noted that there were significant gaps in the resident Cs records. We were told there will be gaps when we cant get on to the computer we have to write notes. We noted from other documentation on the file that the resident had recently been in hospital. We asked the general manager about this as they had previously told us that when they put the care plans on the computer they had reviewed them to ensure that they reflected current care needs. The general manager was unable to explain why they had transferred the information to the computer system with no reference or update in the care plans to the hospital admission. We noted that on the manual record there had been an entry about the medical intervention required but there was no reference to this on the computer entry. Resident D - this residents care plan had been transferred to the new computer system as reviewed and updated by the general manager. It was acknowledged by the general manager that the residents care plans did not cover all aspects of assessed care needs. For example, this resident required one-two-one social stimulation and interaction and this was not clear on the revised care records. Care Homes for Older People Page 16 of 41 Evidence: Resident E - the general manager was unable to provide any clarification about the accuracy of the information on this residents care plan and supporting documentation. This resident had been affected by an incident within the home. On the residents care plan we noted three entries black out, eating and drinking, communication and personal hygiene and dressing. From our findings and from what staff advised us, our view was that residents were at risk. There were two incomplete recording systems in operation. The computer system was unreliable, incomplete and staff were not confident in operating it. The manual system was incomplete and on occasions at variance with the information on the computer system. There was no tracking or monitoring system to ensure that records were current or up to date. Staff told us that they did not have written guidance on how to use the computer recording system. We were advised by the general manager that no care plans had been transferred to the computer system until they had been updated. We noted that training on care planning had been provided by the general manager. There was no process in place to ascertain that staff were competent following the training. Known and assessed care needs of residents had not been recorded. We were advised by the area and regional manager that the home was at that time, totally reliant on agency staff to maintain minimum staffing levels. Late in the afternoon we asked a member of staff for access to the office where residents records were stored. The member of staff told us that they were agency staff and did not have access to this information and could not let me into the room because they didnt know the code. This meant that staff on duty and caring for residents did not have access to any information about residents in their care. Our findings around the care planning and associated documentation recording system were not consistent with the providers statement within their improvement plan dated November 2009. At the last inspection we advised the general manager that information about individual residents should be kept in a secure area. On this inspection we noted a daily record reporting book with a list of all residents together with personal information about them had been left in an area accessible to the general public and other residents. Information the home held on residents remains insecure. It was positive to note that following the last inspection fluid intake records were noted to be current. It was further positive to note that when a resident had been taken to the lounge area by a member of staff, the record had accompanied them. Whilst we acknowledge this improved and good practice, consideration should be Care Homes for Older People Page 17 of 41 Evidence: given to how this can be better managed for the dignity of each resident. In the ground floor lounge, we noted that six residents were sitting there with their fluid charts beside them clearly visible to other residents and visitors to the home. Staff we spoke with which included the general manager who was responsible for overseeing the management of the home, a senior carer, housekeeping staff, laundry staff, care staff and agency staff, gave a variety and differing accounts of residents specific care needs. On occasions, these accounts were at variance with the information recorded on either the computerised record or manual records system. There was no clear system in place for individual residents care needs having been identified to be recorded in one place, for staff to have access to them and for a clear record to be kept of how the care needs were being met. The general manager and a senior member of staff told us that the home had a good working relationship with all health and social care professionals. We saw various records on residents care notes where social and medical intervention had occurred. As noted previously within this section of the report, the quality of the records relating to these matter was at variance. Some records were adequate, whilst others were inadequate or non existent. This situation placed residents at risk and they cannot be confident that their health needs and the steps required to meet them would be adequately recorded. It was positive to note that the system whereby records had been maintained of medicines administered. We noted no anomalies or gaps within the records we selected at random to view. The medicines stage system was orderly and there was no undue overstocking. We noted that there were self administration risk assessments in place. We noted that there were a significant number of handwritten entries made by staff concerning changed doses, changed medication and of new medicines prescribed. There was a risk that if a member of staff wrongly recorded an element, there was potential for the error to be repeated in the future. It is good practice for a second member of staff to double check any handwritten entries. the general manager was unable to provide any clarification about the accuracy of the information on residents care plans and supporting documentation. Within the providers improvement plan it was stated that the general manager would undertake a monthly audit of the medicines system. There was nothing in place to demonstrate that this had taken place. During the course of the day we observed members of staff supporting residents in a variety of ways. We noted that staff assisted residents at meal times with dignity. We observed residents who required assistance with mobility being assisted by staff in a Care Homes for Older People Page 18 of 41 Evidence: safe manner. We noted that on occasions a member of staff was sitting with a resident speaking with them on a one to one basis. A visitor told us that they were satisfied with the care provided to the relative. They confirmed that the family had been involved in the care planning process. They told us that they visit the home on a regular basis and although staff are around, they do not usually sit in the lounge with the residents. We were in a lounge area for over fifteen minutes and in that time one member of staff came in to complete a fluid intake record chart before leaving again. There were six residents in the lounge. There was a television on but we noted that nobody was watching it. Two residents sitting together told us its normally like this, staffing I suppose. We asked if they needed anything but intimated that they were content. Care Homes for Older People Page 19 of 41 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. Residents benefit from a varied, balanced diet and are able to participate in a wide range of social activities. Evidence: The social activity programme and the provision of food remain the main strengths of the home. We assessed this group of key standards in detail during the last inspection in October 2009. Our findings at that time were fully recorded in the subsequent report. We noted during the morning that there was an activity under way in the main hall. We observed a large number of residents enjoying a lively session of bingo. We overheard a lot of laughter and good interaction. We spoke with two residents in the afternoon who had been there in the morning and they told us yes, its good...lots of things to do...I really like what is put on for us...always something to do every day...never get bored here you know. We spoke with two residents who told us that they prefer to stay in their bedrooms watching television, reading and pursing personal interests. They told us that this was their personal choice and confirmed that they had a call bell if help was required and Care Homes for Older People Page 20 of 41 Evidence: staff popped in to see me. The menu for the day was displayed on notice boards in the corridors and on dining room tables. We could see that there was choice and variety. All those residents we spoke with were very positive about the quality, variety and quantity of food. Two residents told us that they had particular preferences and although the dish may not be on the menu, staff always oblige and provide it for them. One resident told us and its always done with a smile of the face, nothing is too much trouble for them and Im so grateful, theyre absolute dears with my funny ways. We noted that some residents were enjoying the morning service which was being relayed from the homes chapel to their respective bedroom. We noted that the home had maintained detailed records of food eaten by individual residents following each meal. It was positive to note that residents who required to have their fluid intake monitored had detailed records to demonstrate that their care needs around this particular issue had been met. Care Homes for Older People Page 21 of 41 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. Residents can be confident that their concerns will be managed appropriately and their care provided in a safe way. Evidence: The homes complaints procedure was displayed in the home and also detailed in the Statement of Purpose and Service Users Guide. Residents we spoke with knew that they could raise a concern at any time and intimated that they would feel confident to speak with a senior member of staff. They said that they would feel confident that a matter would be dealt with properly. The visitor we spoke with confirmed that they would feel happy to raise any concern and feel confident that their concerns would be taken seriously. Following the last inspection, the home now has a formal complaint record system in place. The general manager told us that since the last inspection in October 2009, there had been no formal complaints received. We were advised of a matter which to our knowledge at least two residents had raised concerns about with the general manager. These had not been recorded in the complaints records. The general manager felt that these were not formal complaints. In our view based on the elements of the concerns raised, these matters should have been formally recorded by the general manager. The general manager expressed the view that these matters were were not formal complaints and had dealt with them as they felt appropriate. Care Homes for Older People Page 22 of 41 Evidence: Our view was that there was no clear audit trail of the concern details, how the matter was looked into and by who, the outcome and review of any monitoring process which there would have taken place in this instance. Although we have assessed the outcome of these key standards as good, there was room for further development. We asked four members of staff about their understanding of the term safeguarding adults from harm and what they would do should an incident come to their attention. All provided us with appropriate responses and confirmed that following the last inspection they had received training. Care Homes for Older People Page 23 of 41 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. Residents live in a comfortable and clean environment. Evidence: During the late morning we looked around various aspects of this large home with the general manager. During the afternoon and early evening, we had a further look around on our own. Residents accommodation was on three floors. The bedrooms we saw were functional and contained items of personal belongings. Some of the bedrooms we saw were very homely and had private telephone lines installed. As on the previous inspection we noted that some bedrooms were not carpeted and had washable floor surfaces. We also noted a relatively large number of beds were hospital style beds. We raised both these issues with the general manager at the last inspection. Maris Stella is a residential home and therefore the environment must be as homely as possible. Where washable floor surfaces or hospital style beds are in use, there should be a clear explanation about it within individual care notes or records. The general manager was unable to demonstrate that records were in place. Communal areas were clean, practical and functional. On the ground floor during the afternoon we noted that a group of eight residents were seated in the lounge with no staff member present for considerable periods of time. There was a television on, but nobody at that time appeared to be interested in watching it. We raised this issue at Care Homes for Older People Page 24 of 41 Evidence: the last inspection. It was positive to note that following the last inspection we observed less physical obstacles and hazards in the corridors. For example, trailing leads and cleaning trolleys. We did note that where bathrooms had been cleaned, a safety notice had been placed in the doorway advising people of wet floor. We noted that these signs were still in place several hours later. We asked the general manager about this as there did not seem to be any system by which a member of staff removes them after a suitable period of the floor being allowed to dry. The general manager said that they would address this. At the last inspection, we noted that there were a number of unresolved issues following the homes decision to close the laundry facility on Maris Stella and use the main laundry area which is shared with St Josephs which is a registered provision sharing the same site. At this inspection we received mixed views from residents and the visitor about the ongoing situation. Comments we received were my clothes come back beautiful...no trouble at all to things get lost...come back late and I dont know what happens. During the last inspection we noted several concerns within the main laundry area. At this inspection it was positive to note that the laundry area was adequately equipped for its purpose. Within an earlier section of this report we recorded that there was no evidence that the home had adequate infection control measures in place to safely manage a known medical condition. There were no guidance instructions within the laundry area about how staff should manage the situation and the member of staff who undertook laundry duties was not aware of the condition. This has been referred to within the management section of this report. Residents we spoke with were very positive about their environment and those we spoken to within their bedrooms expressed complete satisfaction. One resident said I love my room and have everything here I need. Another resident said its not home but its nice. One resident told us that there had been some changes in the dining room and felt things are much better now and I enjoy the company of those I sit with. Care Homes for Older People Page 25 of 41 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are looked after by caring staff but may be at risk because of an inadequate day to day line management system. Evidence: Following the last inspection we were advised that the overall management of staffing matters was to be overseen by the general manager. We were advised by the area manager that this arrangement had commenced the day following the inspection in October 2009, although the registered manager was in post until the end of February 2010. Within the homes Improvement Plan it was recorded that matters such as staff induction, staff training and staff supervision would be overseen and monitored by the general manager. A clear staff rota was on display in the homes office. The senior member of staff advised us that the information on the rota reflected the staff on duty. The home was registered to provide care for thirty two residents with twenty six residents being accommodated and cared for on the day of our visit. On the morning of the inspection there was a senior member of staff, two care staff and two agency staff on duty together with supporting ancillary staff. During the afternoon there was a senior member of staff, one carer and three agency staff on duty. The rota recorded that there would be three staff on duty that night. The senior Care Homes for Older People Page 26 of 41 Evidence: member of staff advised us that the number of staff on duty throughout the week remains the same. It was positive to note that following the last inspection, night staffing levels had been increased from two to three. We noted within the laundry area, there was no staff rota on display for staff who routinely work in this area. The general manager told us that one of the member of staff who worked in that area had probably taken it home to copy. The general manager advised that in order to maintain these staffing levels, the home is totally reliant on agency staff. We were advised that six employment applications were in the process of being processed. The senior member of staff advised us that the same agency staff work in the home in order to provide some degree of continuity for residents. We spoke with residents about their experience of staff within the home. We received comments such as nice girls...somtimes, I dont understand them...rushed at times...kind...pleasant...so busy...friendly...change about a bit...fine...always talk to me...usually someone around...ok...some you see, some you dont. When speaking with staff we found them to be friendly, helpful and cooperative. The general manager advised us that since the last inspection there had been one member of staff recruited and we asked to see their records. The member of staff had started work in February 2010. We viewed various elements of this record and those seen, were in order. We asked to see the induction record for this member of staff. We were advised that this wasnt available and the general manager could not evidence that this process was in place or the elements of it. Following the last inspection we required the home to implement and maintain adequate staff training and supervision records. The Improvement Plan stated that this was to be overseen by the general manager. The staff training programme given to us remained out of date with the last entry being September 2009, a month before the last inspection. The general manager showed us a disorderly pile of assorted certificates and documentation regarding attended staff training going back to before the last inspection. There were no current staff training records available. We asked the general manager to demonstrate that following the last inspection, staff supervision sessions had been taking place. There were no records available to demonstrate any progress on this matter. When we asked staff about this and they intimated that they were unsure about what was meant by a formal supervision session. We asked the general manager about our findings as the Improvement Plan was clear that they would be overseeing this matter and monitoring progress. Their response was at variance to the explanation we received from the area manager about Care Homes for Older People Page 27 of 41 Evidence: these sessions. We asked the general manager about the process by which individual staff training needs were being identified. We were advised that they met with staff and get from them what they express or desire to do. There was no documentation evidence of these conversations and staff seemed unclear about the process when we spoke with them. The general manager advised us that now the registered manager had left, they would assume responsibilities for these matters. We reaffirmed that the Improvement Plan was quite clear in stating that the general manager took responsibility for the overview of these matters as from November 2009. We asked for evidence to demonstrate that the registered manager had received regular supervision from the general manager following the last inspection until they left. No record could be produced. We asked to see records to demonstrate that staff meetings had taken place since the last inspection. The general manager appeared unsure about this issues and produced a record of a meeting that had taken place on 16th November 2009 between themselves, the registered manager and a senior member of staff. We asked about other staff meetings and was advised dont get a chance to do these records. We remained unclear about what meetings had taken place as there was no robust records to support this issue. Our overall assessment of the management of staffing matters has been reflected within the management section of this report. Care Homes for Older People Page 28 of 41 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are at some risk because the day-to-day management within the home is not robust. Evidence: Following the inspection that took place in October 2009, we were advised that the management of the home would be directly overseen, monitored and managed by the general manager. Within the Improvement Plan dated November 2010, we were advised of the management structure in place from that date to improve the identified where systems were stated in that document to have been put in place but there was little or no evidence to support some of the claims made. At the inspection in October 2009, we recorded that there were weaknesses in the management structure. At that time there was a registered manager in post who had been supervised by the general manager. The overall outcome of that inspection for residents was assessed as poor. Following that inspection, the general manager continued to directly oversee the day to day management of the home. Care Homes for Older People Page 29 of 41 Evidence: Following the October 2009 inspection, the home was placed by the provider on a Regional Team Special Measures Program (as spelt in the document) authored by Robert York, Area Manager. The aims of this programme were: 1- Whilst the home is within special measures a member of staff will visit the house a minimum of three times per calender month 2- The home will be monitored at every level 3- CQC will be kept informed of all changes and plans 4- The manager of the home has a duty to report daily to the regional team and overview of the activities of the operation with specific reference to the items contained within the action plan 5- If deemed necessary the Regional Team will allocate a support manager to take control of the environment and support the manager on a day to day basis 6- The regulation 26 visit will be an extended visit using a special measures monthly report tool 7- During the period of special measures the Regional Team takes responsibility as the Responsible Individual and this process responsibility will not be delegated to the house superior Within the providers Improvement Plan beside every regulation noted in the October 2009 inspection there was the requirement, the action to be taken, the named person responsible, the timescale and the monitoring criteria. In the main, the day to day management supervision was delegated to the general manager with the area manager taking responsibility for reviewing the process during the monthly regulatory visits. Our findings at this inspection were not in line with all the declarations made within the Improvement Plan. This has been detailed within our report. We asked the general manager for evidence of any management audit monitoring tools used since the last inspection. We were advised that there were not any. We asked how implementation and progress of shortfalls identified at the last inspection had been monitored and audited on a day to day basis. There was no clear structure or process in place. We asked to see the record audit trail of residents monies kept by the home. The Care Homes for Older People Page 30 of 41 Evidence: general manager advised us that the member of staff who had responsibility for this was not on duty and there was no access to monies or records. The general manager advised us that they had raised this before. At the last inspection we viewed a number of general maintenance contracts and service agreements. They were noted to be in order and therefore we did not ask to see them again on this occasion. It was positive to note that following the last inspection, records were now being held when fire drills had taken place. We asked the general manager about the homes quality assurance programme and was informed that there had been no stakeholder surveys returned since the last inspection and the quality assurance report due at the end of 2009 had not been produced. This information was at variance with the information provided by the area manager. The day-to-day management of the care planning recording system was not robust and placed residents at risk because there were two sets of records which on occasions as evidenced within this report were at variance with each other. In addition, on one occasion the general manager, the senior carer, a housekeeping member of staff, and a laundry member of staff demonstrated a different understanding of a residents specific care requirement. The care plans for this particular resident had two differing sets of care plans. It was evident that the management of the care planning system was poor. There was no evidence that the process was being managed on a day-to day-basis to ensure that care required had been recorded, reviewed and known to staff who were undertaking the care. Care Homes for Older People Page 31 of 41 Are there any outstanding requirements from the last inspection? Yes R 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 1 7 15 Every resident in the home 30/11/2009 must have a current care plan and associated risk assessments in place. These records must be reviewed and updated either when changes in the care are required or at a period of no less that one month. This process will make sure that the information is up to date. This is to ensure that all staff are aware of the current care needs of residents, how they are to be met, who by and the regularity. This requirement was made at the previous inspection and remains outstanding. 2 29 30 Arrangements must be made 15/12/2009 for a full review of staff training needs and requirements to be undertaken and recorded. This information should be known to the registered manager. During the inspection process it was clear that training was required in a number of areas. These have been detailed within the report. Care Homes for Older People Page 32 of 41 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 All staff providing care for residents must have received suitable and adequate training so that residents can be cared for in a safe and knowledgeable way. A process by which the competence of all staff is assessed should be put in place. The timescale reflects the period of time by which a full review must have taken place and the training needs of all staff have been identified and arrangements put in place for the training to be provided. 3 30 18 All staff must undertake a 14/10/2009 period of induction training which meets with current requirements. There must be records in place to evidence that the training has been given. This is to ensure that new staff to the home understand the homes philosophy, the polices and practices and good working practices. No further staff whether agency or permanent staff should start working in the home until the registered manager is satisfied that this requirement is met. This is reflected within the Care Homes for Older People Page 33 of 41 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 timescale. 4 31 9 Arrangements must be made 31/12/2009 by the owner of the home to ensure that the designated responsible person for the day to day management of a registered care home is suitably qualified, trained, competent and experienced to meet the homes Statement of Purpose. This is to ensure that residents live in a home where there is clear leadership and direction. 5 38 12 Systems must be reviewed, 31/12/2009 assessed and be put in place to ensure that the health, safety and welfare of residents and staff are safeguarded. This is to ensure that everything that is practically possible through robust safe working practices and procedures are in place to keep residents and staff safe. Care Homes for Older People Page 34 of 41 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 Every resident must have a 30/04/2010 current plan of care and associated risk assessment in place. These records must be reviewed and updated either when changes in the care are required or at a period of reasonable time. This process will ensure that the information held on residents is up to date This requirement was been made at the two previous inspections and remains outstanding. Following the inspection, action was to be taken by the area manager and this is reflected within the timescale for compliance. This is to ensure that all staff are aware of the current assessed needs of every resident, how they are Care Homes for Older People Page 35 of 41 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 to be met in a safe way, who by and the regularity. 2 27 17 There must be a staff rota available at all times. The timescale for compliance reflects the action to be taken by the general manager. This is to evidence that adequate and sufficient numbers staff are planned to be on duty or were on duty to meet the needs of all residents. 3 30 18 The home must demonstrate 22/04/2010 that staff employed have undertaken a period of induction training which meets with current requirements. There must be records in place to evidence that training has been given. This requirement was made at the last inspection and remains outstanding. This is to ensure that new staff to the home understand the homes philosophy, the polices, practices and good working conditions. 23/03/2010 Care Homes for Older People Page 36 of 41 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 4 30 18 Arrangement must be made for a systematic review of staff training needs and requirements to be undertaken and recorded. During the inspection process it was unclear what training was required or had been completed because of the inadequate process by which staff training is identified and recorded as undertaken. There was no process in place by which staff competencies had been assessed. This requirement made made at the last inspection and has not been addressed. The timescale reflects the period of time by which a full review must have taken place and the training needs of all staff have been identified and arrangements put in place for the training to have been provided and adequate records kept. All staff providing care must receive adequate training and demonstrate competence suitable for the tasks they are responsible for so that residents can be 31/05/2010 Care Homes for Older People Page 37 of 41 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 cared for in a safe and knowledgeable way. 5 31 9 Arrangements must be 22/04/2010 made by the owner of the home to ensure that the designated responsible person for the day-to-day management of a registered care home is suitably qualified, trained, competent and experienced to meet the homes Statement of Purpose. This requirement was made at the previous inspection and remains outstanding. Following the inspection, action was to be taken by the area manager and this is reflected within the timescale for compliance. This is to ensure that residents can live in the home where there is clear leadership and direction. 6 33 17 Where the registered home safe keeps personal monies on residents behalf, there must be a transparent and accountable system in place and available. The timescale given for compliance reflects the 24/03/2010 Care Homes for Older People Page 38 of 41 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 action agreed to be taken by the area manager. This is to demonstrate that monies held on behalf of residents is safe, available and robust. 7 36 18 There must be a process in 22/04/2010 place by which all staff working within the home receive regular and structured supervision which is documented. This includes those staff within a day to day management role. This is to ensure that the practice, knowledge, competence and expertise of all staff is sufficient and adequate to meet the assessed care needs of residents and to ensure that the home is managed in the best interests of residents. 8 38 12 Systems must be reviewed, assessed and put in place to ensure that the health, safety and welfare of residents (and staff) are safeguarded. This is to ensure that everything that is practically possible through robust practices and procedures are put in place and monitored 22/04/2010 Care Homes for Older People Page 39 of 41 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 to make sure that staff and residents are safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 It is good practice to ensure that handwritten entries made in a record pertaining to any changes of medicines to be administered by staff are checked and endorsed by a second member of staff to minimise any error in recording. At the last inspection, a requirement was made to ensure that all information held on residents was kept in a secure place. The daily report book as referred to within this report should also be subject to this requirement. It is good practice to ensure that all concerns are formally noted together with the process describing how they were addressed Unless it has been assessed and recorded as being absolutely necessary, it is not good practice for there to be washable floor surfaces and hospital style beds in bedrooms. This was referred to within the last inspection report. It is good practice to remove all obstacles such as warning signs from the entrances to rooms used by residents as soon as practicable to minimise any risk of accidents. The provider of the home must review and monitor the process by which their requirements and recommendations made within Regulation 26 reports(monthly visit reports) are implemented. These visits are being undertaken and recorded but the monitoring and validation process was not robust. 2 10 3 16 4 19 5 26 6 33 Care Homes for Older People Page 40 of 41 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. 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