Inspection on 10/06/09 for Meadows Sands Care Home

This inspection was carried out on 10th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadows Sands Care Home 08/12/09

Meadows Sands Care Home 02/08/07

Meadows Sands Care Home 03/08/06

Meadows Sands Care Home 05/04/06

Meadows Sands Care Home 19/12/05

Meadows Sands Care Home 24/08/05

Meadows Sands Care Home 14/12/04

Meadows Sands Care Home 23/08/04

Meadows Sands Care Home 10/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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: Meadows Sands Care Home 98 South Parade Skegness Lincs PE25 3HR     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: Elisabeth Pinder     Date: 1 0 0 6 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 29 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 29 Information about the care home Name of care home: Address: Meadows Sands Care Home 98 South Parade Skegness Lincs PE25 3HR 01754762712 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: marina@meadowssands.co.uk Accredited Care Limited care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories:- Old age, not falling within any other category (OP) (26) Dementia - over 65 years of age (DE[E]) (26) The maximum number of service users to be accommodated is 26. Date of last inspection Brief description of the care home Meadow Sands Care Home is situated on the sea front at the Southern end of Skegness. There are public car parking facilities to the front of the home and three car park spaces to the rear of the home for staff. The home has no garden but seating is available at the front of the building and there is a park across the road. The bedrooms are situated on three floors accessible by stairs or a passenger lift. There are communal lounges and dining facilities on the ground floor. The current weekly fee is £366.00 - £466.00. Additional charges are made for chiropody, hairdressing, newspapers and personal toiletries. Care Homes for Older People Page 4 of 29 Over 65 26 26 0 0 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: This was an unannounced visit and it formed part of a key inspection, focusing on key standards which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to the Care Quality Commission (CQC). The visit lasted approximately six hours and was carried out by two inspectors. We took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since our last visit. This inspection was brought forward due to concerns about the staffing levels and management of the home, therefore there was insufficient time to request surveys from people using the service. However, the providers had returned their Annual Quality Assurance Assessment (AQAA) which gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. The main method used to carry out the inspection is called case tracking, this includes Care Homes for Older People Page 5 of 29 following the care of a sample of people through their care records and assessing their care. We spoke to people who use the service, members of staff, the providers and temporary manager. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide must tell people how they can access our reports and be given to people to make sure they have sufficient information about the service. Information must include the complaints procedure, the current fees rates and additional costs and people must be given a contract/terms and conditions of residency. Assessment of needs undertaken before people are admitted into the service must contain more detail to make sure all their needs are identified and that care can be provided to meet their needs. Written confirmation must be sent to them assuring them that their needs will be met. Care records need to be improved, care plans need to include all the identified needs of people and give clear instructions to staff how these are to be met. Care plans must be person centred and include details of how peoples privacy and dignity will be met. Care plan reviews must include any changes required and show people have the opportunity to be involved and express their views. Care plans should include reference to the Mental Capacity Act and the effects it has upon peoples lives and clearly tell staff what to do if the person does not have the capacity to make decisions. Risk assessments must be written to advise staff how to minimise or remove risk when providing care. Staff must follow correct procedures to ensure medication is given safely. All policies and procedures must be specific to the service and contain local contact addresses and telephone numbers where applicable. All staff should have training relevant to the specific needs of people living at the home, this should include; induction, dementia training, medication training, equality and diversity and mental capacity and safeguarding adults. Staff must also be adequately supervised. Attention should be given to the environment of the home, this should include re-siting the toilets near the dining room, fitting restrictors to all windows above the ground floor and the cleaning of the stained carpet. The providers must seek advice from their fire officer regarding the mortice lock on the front door. A fire risk assessment must be Care Homes for Older People Page 7 of 29 written. A system must be in place for evaluating the quality of the services provided and quality monitoring should include obtaining the views of all stakeholders involved with the service. The providers must visit the home at least once a month, unannounced, and prepare a written report on the conduct of the home and send a copy to CQC. 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 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know about the service before they move in, however, they are not assurred their needs will be met. Evidence: A comprehensive service user guide was in place detailing the philosophy of the home and its aims and objectives. The service user guide and statement of purpose were available and both referred to CQC but people could not acess these as they were stored in a large policy and procedure file in the office. People spoken to could not remember if they had received any information prior to their admission and were unsure how they would be able to obtain a copy of our report. However, people told us they liked living here. The files of two people admitted since the previous inspection and records showed that information gathered was very brief and did not give enough information about peoples needs to make sure they could be met. For example, one assessment read, Care Homes for Older People Page 10 of 29 Evidence: high risk of falls, but did not give any information about the management for this, and another gave no indication about the persons wishes or choices in respect of personal preference, privacy and dignity, social activities or diet. Although both assessments identified peoples religion they gave no indication whether the person wished to practice. Records did not record who was involved in providing the information and were not signed or dated. Records seen did not contain letters confirming that after their initial assessment the service could/could not meet their needs and the provider told us these had not been sent. He also told us these people had not received a written statement of terms and conditions or a contract. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are happy with the support they receive, however, shortfalls in record keeping put them at risk. Evidence: Care plans looked at lacked detail to make sure staff had clear guidance on how to meet peoples needs. They were not person centred and did not promote the dignity or respect of the person. A care plan had not been written for one person who had been admitted in May 2009. Care plans seen gave very basic details about physical health care needs and did not include religious wishes, social stimulation or end of life wishes. Some care plans contained an assessment about how people are helped to make decisions for themselves, however, these did not tell staff what to do if the person was unable to make a decision, they referred to their relatives dealing with their affairs. A book about the laws around decision making was available in the office, however, staff told us they had little understanding of this or of how peoples differing needs such as culture and lifestyle are recognised. The temporary manager confirmed that training had been arranged for three staff to attend training on these subjects in July of this year. Care plans looked at did not tell staff whether people had Care Homes for Older People Page 12 of 29 Evidence: a preference to a male of female carer providing their personal care. We found some risk assessments in a separate folder in the office but the information was out of date and contained information for eleven people who were no longer living in the home and no risk assessments for six people currently living in the home. Risk assessments written mainly related to falls and the locked front door. One of the files looked at contained some life history about the person but it was also very limited. Dates were recorded for care plan evaluations but did not show if the person was involved or if they were in agreement with their plan of care. However, we spoke to nine people living in the home and they were all positive about their care. They told us I like being here, and nothing is too much for the staff. Throughout our visit we saw members of staff talking and laughing with people and attending to their needs in a calm manner. Staff told us we provide fabulous care and I have time to care and spend time with the residents. A medication policy was in the policy file kept in the office and receipts of medication received were also kept. We had been told that regular medication audits by a local pharmacy take place, however, during our visit we could not find any details to support there had been a pharmacy inspection. We looked at the medication records for one person and noticed it had not always been signed to show that medication had been given. We also noted that one care plan told staff to give night medication on a spoon of jam for one person and there was no evidence to show this had been discussed and agreed with the person or advocate, GP or pharmacist and no risk assessment had been written. Another record was unclear as to the date a course of medication stopped, other records looked at and showed on the whole clear instructions with a photograph of the person, although occasional gaps were in the records. We were told that there were three named staff who gave medication. One person said she had received medication training three months ago, however, there was no evidence to show what training had been provided by the home to show that staff knew what to do and had been considered safe. Care Homes for Older People Page 13 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in various recreational activities and maintain contact with family and friends as they wish. Meals provided are well balanced and take into account personal preferences and special dietary requirements. Evidence: In the entrance hall there was a notice board with clear details in large print and pictures about the activities provided in the home. These were also referred to in both the service users guide and statement of purpose. The activities were over a four week period with each week giving details of the activities available. Activities gave choices including self care, outings, in house activities, entertainment and home activities. We spoke to the activities person who had considerable experience concerning activities she told us that she would try to spend time with a person when they came into the home asking them what they like to do and what their interests were. The activity co-ordinator showed us a file she kept called getting to know you and the majority of these gave clear information regarding peoples choices. The provider agreed to make sure this information was kept in peoples individual files. We looked at activities folders giving examples of the type of activities and reminiscence as well as another folder with a request for staff to please complete daily activity sheets for all people. The last record was completed on the 23/04/09. We saw an Care Homes for Older People Page 14 of 29 Evidence: activity taking place organised by the activities person, six people in the lounge were listening to music, talking to one another and shaking their hands to the beat of the music and smiling. Two staff were having a dance with two of the people and we heard staff asking did you enjoy that, did you want to dance, are you alright and what ever you choose in response to questions. We observed meals being served in the separate dining room which had tables laid with clean table cloths and we noticed that peoples art work was displayed on the walls. During the meal staff sat by the side of people who needed assistance helping them in a quiet, friendly and calm manner. People told us I love the food and the food is the way I like it to be. They told us that the menus were varied and a choice offered. Alternatives and specialist diets, such as a diabetic diet were also available. East Lindsey District Council awarded the home 3 stars excellent following their last inspection in recognition of the homes catering standards for 2008/2009 and we saw that the kitchen was clean and well organised. A cleaning schedule was being followed and tasks signed and dated when completed. Care Homes for Older People Page 15 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies are in place for handling complaints and allegations of abuse but people are at risk of not being protected due to a lack of staff knowledge of the subjects. Evidence: There was an up to date complaints procedure in both the statement of purpose and service users guide, however, people did not know if they had been given a copy of this but told us they would raise any issues with care staff should they arise. None of the people spoken to including staff had any complaints about the home. We saw a copy of Lincolnshires County Council Safeguarding Adults policy and there was a separate policy on adult protection. However, these did not give details of addresses or contact numbers to tell staff how to refer an allegation to their local safeguarding adults team. We spoke with two new members of staff who knew what abuse was and told us they felt confident to report any suspected abuse to a senior person, however, they both confirmed that their induction had not covered safeguarding adults and their knowledge was obtained from working in other care homes. We looked at their files and both showed a check by the Criminal Records Bureau. Within the last twelve months there has been four safeguarding referrals made to the Lincolnshire County Council team and these are currently being investigated. Care Homes for Older People Page 16 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well-maintained, clean, comfortable and homely environment. Evidence: People we spoke with were satisfied with the cleanliness and the accommodation in the home. The home was odour free, although we noticed a stain on part of the carpet in the dining room. A partial tour of the building was carried out and we looked at some bedrooms of people whose care was being followed with their permission. These were clean, individualised with pictures, momentoes and ornaments. There were on some doors signs indicating the number of the bedroom and a picture of the person. None of the bedrooms had locks to their door but had a lockable item of furniture, shared bedrooms had portable privacy screens. Most first floor windows had been fitted with restrictors, however, no restrictor was fitted on the window of the bathroom next to the staff toilet or on the window in bedroom 12. The provider told us he would make sure this was actioned as soon as possible. Door sensors had been fitted to the outside of two bedrooms on the 2nd floor and we were told they had been put on to alert staff if a person came out of their room at night, however, there was nothing about this in the peoples care records. We also noticed a slide bolt on the outside of one bedroom, the providers told us they did not know that it was there and agreed to take it off. During our visit we were told that the commercial dryer was out of action and the Care Homes for Older People Page 17 of 29 Evidence: providers had arranged for a domestic dryer to be provided whilst a replacement was arranged and this was delivered whilst we were in the home. We spoke to the person responsible for laundry and ironing who was ironing in an empty bedroom and they told us they had suitable equipment to carry out their role. We also looked at the linen storage and saw bed linen was of a good standard and of different colours to give choice. People told us I have a very comfortable bedroom, I have a nice bedroom and my clothes are looked after well but I note the dryer is not working. We also saw various mobile hoists being used with slings of differing sizes and other specialist equipment which was on loan to the home for individual needs of people. A discussion was held with the providers regarding the two small toilets next to the dining room as these do not give sufficient room for people using wheelchairs to close the door and curtains were being used to protect the privacy and dignity of people using these facilities. We were told that plans are currently being drawn up for the toilets to be re-sited to where the office is and the office will then be re-sited, the providers told us this work should commence within the next three months. Care Homes for Older People Page 18 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by staff recruitment procedures and there are enough staff on duty, however, people are placed at risk due to a lack of staff knowledge. Evidence: In May of this year the providers sought advice from Lincolnshire County Council regarding staffing and management difficulties. Lincolnshire County Council provided staff and a manager to support them throughout this period and other staff were bought in from local agencies. The providers also agreed to a voluntary suspension of any new placements until staffing levels stabilised. During our visit agency staff were still being used but this was minimal and there was enough staff on duty to meet the needs of people currently living in the home. Rotas for the week beginning 8th June were looked at and these showed that there were three care staff from 07:00 - 21:00 and two care staff throughout the night. In addition to this a temporary manager had commenced on 08 June 2009 and told us he planned to work from 08:00 - 18:30 Monday - Friday and 08:00 - 13:00 Saturdays. He also told us he would be available on call 24 hours each day and his contact numbers were displayed in the office. There was also a cook, a domestic and a laundry person on duty. Rotas showed that only two staff were agency staff. We spoke to people living in the home and they told us they felt there was enough staff on duty, their comments included, I find the staff are very nice, Sometimes I dont sleep very well but I only have to call and they will come to see me and nothing is too much for the staff. Care Homes for Older People Page 19 of 29 Evidence: We spoke to five members of staff, two of whom had been working in the home since February 2009 and June 2009. They told us when I came here I received a very warm welcome, the atmosphere in the home is lovely and I really enjoy working here. Their files were looked and showed that safe recruitment procedures had been followed. However, they told us they had only been given very brief information about the home, one said they were told, these are the rooms and these are the people. Both said they shadowed about five shifts with another member of staff. They also told us they had worked in other care homes and had previous care experience and felt their induction would have been totally inadequate if they had not had some experience. One person told us they had received no training since their appointment in February 2009, when they had been shown the hoist and given a brief talk about adult protection. Training records were not up to date and the providers acknowledge that training had slipped since the manager left, the most recent records were dated 14 May 2008, however, most were dated 2006. The temporary manager told us he was in the process of arranging training and had booked two consultants for the following week to discuss care planning, admission assessment and nationally recognised vocational award training. Care Homes for Older People Page 20 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service is not being managed satisfactorily, people are placed at risk due to a lack of actions relating to risk and a lack of up to date records. Evidence: As previously highlighted the providers sought advice from Lincolnshire County Council regarding staffing and management difficulties. The providers have responded to our requests to be kept informed of the present and future management arrangements for this service. Since our visit we have received written confirmation that three care staff have been promoted to team leaders and they will take charge of the shift when working. A care manager has also been recruited and will commence as soon as recruitment checks are cleared and interviews are taking place to recruit a care home manager. The service uses an external consultancy organisation to provide their policies and procedures and whilst these covered numerous topics such as health and safety, risk assessments, infection control guidance from the Department of Health and safeguarding adults they had not been tailored specifically to the service. The providers agreed to address this. Since our visit we have also been informed that the Care Homes for Older People Page 21 of 29 Evidence: providers have received confirmation of their hygiene and investors in people awards. In addition to the policy file, information and training guidance was available on dementia but there was no evidence that the procedures and records had been put into use and no quality audits to monitor that procedures were being followed. Risk assessments regarding fire, building and general risk and health and safety policies had not been completed, however, the providers acknowledged these issues and told us they were to contact the fire officer to arrange a visit to discuss fire safety and carry out a risk assessment. They told us they also plan to complete a health and safety audit. The front door to the home has a mortice lock fitted which affects people wishing to go outside as they have to ask a member of staff to let them out and back in again, it was also noted that this is a fire exit and the providers agreed to discuss this with their fire officer to look at an alternative locking system. A visitors book was available in the entrance area with suggestion slips by the book inviting comments. The last quality audit was dated May 2008 and a report had been written to analyse the returned surveys. Minutes of the last staff meeting were available and these were dated 03/06/09, topics of discussion included, the management structure within the home. No resident meetings have taken place but the temporary manager told us he was in the process of setting up a meeting for relatives and residents and letters are to be sent to all relatives/advocates with questionnaires seeking their views of the service. We found the office and records disorganised with a lot of duplication and records either missing, incomplete or out of date. Records of maintenance were not up to date, for example the last record showing portable electrical appliance safety test was carried out in 2007. Weekly water temperatures were last recorded 03/01/2009 and the last weekly fire alarm test record was dated 17/04/2009. Since January there have been seventeen accidents, some resulting in people needing hospital treatment, none of these have been reported to us and the temporary manager showed us a form he had printed and confirmed this would be used to report any incidents affecting the well being of people living in the home. The providers told us they visited regularly but did not make any report of their findings, staff told us we see the owners regularly and I find them very supportive and receptive to ideas. Financial records of people whose care was being followed were looked at and these were up to date. Care Homes for Older People Page 22 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 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 1 4 A service user guide must be 31/08/2009 given to each person and must inform them how to access our most recent inspection report. They must also be given terms and conditions/contracts of residency. To ensure people have the right information about the service. 2 3 14 People planning to come into 28/07/2009 the home must receive written confirmation that having regard to their assessment the care home is suitable for the purpose of meeting their needs. To ensure people are confident the service can meet their needs and are clear about the service that has been agreed. Care Homes for Older People Page 24 of 29 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 3 14 Pre-admission assessments must contain sufficient information about the person to enable staff to understand and meet their needs. To ensure peoples needs are identified and can be met at the care home. 28/07/2009 4 7 15 Care plans must contain sufficient information about how people want their care providing, as well as their abilities. They must include all areas of need and inform staff of the action needed to meet needs. They must be reviewed and updated regularly. To enable staff to provide the right level of care and support. 28/07/2009 5 9 13 Procedures must be followed 28/07/2009 for the administration of medication. To ensure people receive their medicines safely. 6 16 22 The complaints procedure must be supplied to each person living in the home. 28/07/2009 Care Homes for Older People Page 25 of 29 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 ensure people know how to raise any issues of concern or make a complaint. 7 18 13 All staff must know what to do should they receive an allegation of abuse. To ensure people are protected from harm. 8 19 13 Windows must be made safe. To help to protect people from hazards to their safety. 9 30 18 Staff must have the necessary skills and knowledge relevant to the work they perform. To ensure staff are able to care for people living at the home. 10 30 18 Staff must receive a 31/08/2009 structured induction programme and be appropriately supervised and supported during their induction training. To ensure staff have the necessary skills to care for people living at the care home. 31/08/2009 28/07/2009 28/07/2009 Care Homes for Older People Page 26 of 29 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 11 31 26 The provider must carry out 31/07/2009 monthly visits to the home and a written report must be sent to us to show the service is being monitored. To ensure the health and welfare of people living there are promoted. 12 33 24 Systems must be in place to 31/08/2009 regularly review and monitor the quality of care being provided. To ensure this service is run in the best interests of people living there. 13 38 23 A fire risk assessment must be written in line with current legislation. To ensure people are safe. 31/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 7 19 29 30 Care plans should include reference to the Mental Capacity Act and the effects it has upon peoples lives. Carpets should be stain free. Staff should be given copies of the general Social care Council Code of conduct booklet. Staff should be given training to enable them to have knowledge of the Mental Capacity Act and how it influences how they support people. This will help to ensure that peoples rights and choices are protected. Page 27 of 29 Care Homes for Older People 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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