Inspection on 27/01/09 for Meadway Court

This inspection was carried out on 27th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadway Court 17/01/08

Meadway Court 04/07/06

Meadway Court 08/03/06

Meadway Court 12/05/05

Meadway Court 08/12/04

Meadway Court 24/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Meadway Court Meadway Bramhall Stockport Cheshire SK7 1JZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Fiona Bryan     Date: 2 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Meadway Court Meadway Bramhall Stockport Cheshire SK7 1JZ 0161-4408150 01614395628 meadwaycourt@boroughcare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Borough Care Limited Name of registered manager (if applicable) Miss Tracey Lloyd Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Service users to include up to 42 OP and up to 5 DE(E). Date of last inspection Brief description of the care home Meadway Court provides permanent residential care for up to 36 older people and offers intermediate care facilities for up to six residents. Intermediate care is for people who have been assessed, by health and social care professionals, as being suitable for a short-term placement of rehabilitative care. The length of stay is time limited between one to six weeks. During their stay residents are seen by Physiotherapists, Occupational therapists, Social Workers and district nurses. Meadway Court also offers day care facilities for up to four service users over seven days per week. Care Homes for Older People Page 4 of 31 care home 42 Over 65 5 42 0 0 Brief description of the care home The home is one of 12 care homes owned by Borough Care Limited. The home consists of 40 single bedrooms and one shared bedroom. Bedrooms are situated on the ground and first floor areas of the home, 24 of the rooms have en-suite facilities, which comprises of a wash-hand basin and toilet. There are several communal areas situated throughout the home, including a large conservatory to the rear of the building, which opens onto a large patio area with garden furniture. The gardens are pleasantly landscaped with flowers and shrubs. A lounge is available for residents wishing to smoke. A full passenger lift is in place. The home is situated at the end of a cul-de-sac in the Bramhall area of Stockport. Bramhall village is approximately ten minutes walk away. The village has a wide variety of shops, restaurants, churches and banks. Access to motorway networks, public transport and train station are within a reasonable distance of the home. Fees range from 327 to 436 pounds. The service user guide is displayed in the reception area of the home and is given to prospective residents or their relatives when they visit the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection, which included a visit to the home, took place on Tuesday 27th January 2009. The staff at the home did not know that this visit was going to take place. All the key standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people living at the home, visitors, the manager and other members of the staff team. Key standards refers to those standards we feel are particularly important in ensuring the health, safety, welfare and quality of life of people living at the home. The care and services provided to three people were looked at in detail, looking at their Care Homes for Older People Page 6 of 31 experience of the home from their admission to the present day. A selection of staff and care records was examined, including medication records, training records and staff duty rotas. Before the inspection, we asked for surveys to be sent out to people living at the home and staff asking what they thought about care at the home. One resident and seven staff returned their surveys. We also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager completed the form quite well and we discussed ways in which she could give us further evidence of improvements to the service the next time we request an AQAA. What the care home does well: What has improved since the last inspection? At the last inspection we made 3 requirements and six recommendations. We were satisfied at this inspection that the requirements had been met and the manager had acted on 4 of our recommendations. Since the last inspection the manager has returned from maternity leave and is in the process of registering with us. Staff said the new manager was supportive and felt she was making changes that were improving the service they offered. We spoke to another health care professional visiting the home during our inspection and they felt there had been improvements in the organisation of the home over the past year. They reported that staff followed instructions and advice they gave about the treatment for people living at the home and referred people to them promptly if they needed treatment. Care plans were more detailed and provided good information for staff about peoples abilities and the help they needed. Since the last inspection the use of the large communal room on the ground floor has been reviewed and changed following consultation with people living at the home. This means that staff dont spend as long helping people move from one area of the home to another and people were happier with these arrangements. One of the care supervisors has been given responsibility for coordinating social Care Homes for Older People Page 8 of 31 activities within the home and this area has improved. We discussed accessing training for the care supervisor in providing activities for older people and people with dementia so she can develop this role. Recruitment procedures had improved and we could see that all the proper checks had been made before new staff started working at the home, to make sure they were suitable to work in a care setting. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Care Homes for Older People Page 10 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using 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 given information, and have their needs assessed before deciding to move into the home so they know that their needs can be met. Evidence: A statement of purpose and service user guide were available, which gave good information about the services provided at the home. Borough Care also has a website that gives information about all the homes within the group. One person living at the home returned a survey and said they had received all the information they needed to make a decision to move into the home. We looked in detail at the care received by three people living at the home. Each person had been assessed before coming to live at the home. Pre-admission assessments were kept in the managers office and relevant information was usually transferred to the files that were kept in peoples rooms, for staff to use on a daily Care Homes for Older People Page 12 of 31 Evidence: basis. On occasions some of the information was missing from the records used by the carers, for example it was not highlighted that one person had previously fallen and their falls risk assessment did not therefore reflect this. The home provides six intermediate care beds. People who needed these beds were assessed before admission under the single Assessment Process and were admitted directly from hospital or home. Physiotherapy, occupational therapy and district nursing input were available for these people. Staff were knowledgeable about the people they were caring for and said that changes to the residents needs or information about new residents was provided to them at staff handovers at the beginning of every shift. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff work well with other health care professionals to ensure peoples health care needs are met but some practices in respect of the management of medicines could put people at risk. Evidence: We looked at the care three people were receiving in detail. Each person had a care plan written for them, which generally addressed the needs identified during their assessment. Care plans in the main were very detailed and gave specific information about the abilities of each person and their preferences with regard to their daily routine. A record was kept of when care plans were reviewed but although this sometimes said that changes had been made it was not always clear what the changes were and when they had been made. This is important so staff can monitor any changes to care and check that they are meeting the persons needs. Care Homes for Older People Page 14 of 31 Evidence: Risk assessments had been undertaken for falls and moving and handling. However, as stated in the previous section information from the assessment was not always taken into account, which could mean that staff assessed someone as at lower risk than they actually were. It was recommended at the last inspection that staff started to undertake nutritional risk assessments in line with Department of Health guidelines. Nutritional screening was still not being carried out and this was discussed with the manager. Staff must make sure that a full record is kept of events that happen to people each day, especially when they are unwell. The daily records for one person said that they were feeling poorly on 9/1/09 and the next entry was dated 14/1/09, which said they had returned from hospital. Also staff need to make sure that the information they write in the daily records is an accurate reflection of each persons day. One person said the care file was Aesops fables as it was all stories and another said staff always wrote that they had slept well even though they suffered from insomnia and rarely slept well. Records showed that people had seen GPs physiotherapists, district nurses, occupational therapists and podiatrists. We spoke with a health care professional who was visiting the home to provide treatment to someone and they said they felt organisation in the home had improved over the last year and that staff followed any advice or instructions they gave and kept them informed about any concerns they had regarding individuals. People generally looked well cared for but we saw some people with food stains on their clothing, dirty nails or spectacles that needed cleaning. Records appeared to show that some people did not have very regular baths. The records for one person indicated that they had not had a bath between 31/12/08 and 18/1/09. They had been offered a bath on 6/1/09 but had refused. If people do not want a bath or shower one day staff should ask every day rather than waiting another week before they are asked again. We looked at how medicines were managed for a small number of people. There were some shortfalls, which could put people at risk. Staff had written on the records for one person that they were managing their own medicines but no risk assessment had been undertaken to check that this would be safe. When we asked the person they told us staff were actually administering some of the medication because they had told them they couldnt manage them alone. Care Homes for Older People Page 15 of 31 Evidence: However, the records had not been signed by staff to show that they were giving the medication. The dose of medicine for one person had been changed. We knew this because staff told us but would not have known just by looking at the records because the dose had not been altered on them. This meant that if a member of staff gave out the medicines who did not regularly do so they would give the wrong dose if they followed what was written on the records. Instructions for the administration of some medicines had been handwritten by staff. When they do this they should ask another member of staff to check what they have written and countersign it so any errors are minimised. We spoke to one person who had a medical condition which meant they needed their medicines to be given to them at quite specific times to ensure they could function and maintain some independence as well as possible. This person told us they did not always get their medication as early as they should which affected their mobility and dexterity. Staff must make sure that medicines are administered as prescribed so they work properly. People living at the home said staff were good. One person said staff looked after her reasonably well and another said staff were lovely, excellent and she said staff understood what help she needed and treated her with respect. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using 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. Improvements in the routines of the home are in line with what people living there wanted. Evidence: At the last inspection we had found that many people were not happy that the large communal room on the ground floor was being used solely as a dining room, as there was less room for large group activities and staff were spending a lot of time transporting people around the home, from the first floor to the ground floor for meals. Since then the function of the room has been changed back to a lounge/dining room in accordance with the wishes of most people living at the home. This has meant that more people now socialise in the communal rooms on both floors, although some people still preferred to spend time in their own rooms. Since the last inspection one of the care supervisors has been made responsible for ensuring activities are arranged and carried out. A discussion was held with the manager about accessing training in providing activities for older people and people with dementia for the care supervisor to assist her in this role. Care Homes for Older People Page 17 of 31 Evidence: Activities for the week were displayed on various notice boards around the home. The activities for the week commencing 26th January included a birthday party, movie night, a trip to the local village and chocolate making. People living on the first floor said there were activities going on but they all took place on the ground floor and they sometimes found it difficult to go downstairs or couldnt be bothered to make the effort. Some people told us they liked to read, watch television and chat with other people in the lounges. Several people told us about the mobile shop that goes round twice a week so they can buy toiletries, sweets and magazines. The care files that we looked at contained only very limited information about peoples social interests and did not in the main record how people had spent their day. However, staff had started an activities file, which detailed what events and social occasions had been provided, together with photographs and comments from staff and people living at the home. The comments were useful as the manager could see what activities people had enjoyed and would like to do again. Activities that were recorded included manicures, current affairs discussions, movement to music, board games, bingo, trips to village and Stockport theatre and quizzes. In the AQAA the manager said staff were about to start completing a leisure profile with each person living at the home. One person living at the home said staff were trying hard to get more activities going but felt more could be done. Comments about the food provided at the home were mixed. One person said it was always homemade soup for lunch, which she enjoyed. Another person said the food was quite good and everyone we spoke to confirmed there was a choice at each mealtime, including breakfast when people could have a cooked breakfast if they wished. However, several people said arctic roll was served too often and there were too many sticky, sugary foods and everything has loads of cream on. One person said they tried to eat a sensible diet but found the meals repetitive. One person said sausage rolls had been served the previous weekend that were not heated through and the pastry was inedible. One person was concerned about putting on weight as it was not good for their mobility, but found it hard to refuse food and found the staff served very large portions. At the last inspection some people told us they were not always offered hot drinks between meals, which they thought was dependent on if enough staff were on duty. People repeated this during this inspection. Lunch was served at 12.50pm on the ground floor. Tables were nicely laid with cloths, milk jugs and sugar bowls, crockery and cutlery and condiments and sauces. We saw Care Homes for Older People Page 18 of 31 Evidence: that some people waited quite a long time at lunch to be served and people told us they often had to wait. However, the soup, when it was served smelled appetising and people said it was tasty. People were then offered spaghetti on toast or cheese salad. Staff asked people if they wanted bread and butter to accompany their meals and one staff member noticed that someone was falling asleep at the dining table and went to help them and encourage them to eat. On the first floor we saw the cook asking people if they were enjoying their meal and were told that she often went round and chatted with people to check they were happy with the food. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using 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 living at the home and their relatives are able to complain and action is taken to respond to their concerns. Evidence: In the AQAA the manager said that people living at the home were encouraged to comment on the service they received and the complaints policy was provided to them in the service user guide. The complaints procedure was also displayed on notice boards around the home. People that we spoke to said they would speak to the manager or deputy manager if they had any concerns and most felt they would be addressed. One person who returned a survey said they always knew who to speak to if they were unhappy but they didnt need to complain as they were satisfied with the care they received. A record of complaints had been maintained. The record provided information about what action the manager and staff were going to take or had taken in response to each complaint but did not say whether the complainant was happy with the outcome. The majority of staff had undertaken training in safeguarding adults and were aware of the procedures to follow. Care Homes for Older People Page 20 of 31 Evidence: However, one person living at the home told us about an incident where she had been hit by another person living there. We could find no record of this incident in either persons care file or in the incident records. The manager and deputy manager said they were unaware of the incident and we discussed the actions that should be taken in such circumstances, as peoples challenging behaviour may present a risk to other people and staff need to ensure that systems are in place to protect them. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using 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 suitably adapted, clean, comfortable and pleasant surroundings. Evidence: A tour of the home was conducted. The home was clean, tidy and free from any unpleasant odours. The premises were well maintained, both internally and externally. One person who returned a survey said the home was always fresh and clean. A number of service users rooms were seen, which were furnished and equipped to a comfortable standard. The majority had been personalised by the occupants, with pictures, ornaments and small items of furniture. Since the last inspection one of the bathrooms had been converted to a shower room and two baths had been fitted with hoists. The home has several small lounges, including a room designated for residents wishing to smoke, and a conservatory. Since the last inspection new furniture had been bought for the conservatory, which was bright and airy with books and magazines for people to read. Care Homes for Older People Page 22 of 31 Evidence: The reception area had been redecorated and was welcoming with photographs of staff, thankyou cards, books and a notice board that advertised the days the mobile shop was open and the days people could attend services for Holy Communion. Grab rails were provided along the corridors and other aids such as raised toilet seats were available. It was reported that since the last inspection one of the units (Sycamore) had been redecorated and new carpets, curtains and furniture had been provided. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using 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 receive care and support from staff who have the skills to support them correctly. Evidence: On the day of the inspection three carers were on duty to care for 17 residents on the ground floor and two carers were on duty looking after 25 residents on the first floor. In addition, the deputy manager was on duty and the manager came on duty in the afternoon. One person who returned a survey said there was usually staff available when they were needed. People that we spoke to during our visit said they thought the home was sometimes short staffed. One relative said they had once had to help giving out the meals as there was only 1 carer and the kitchen assistant to serve the lunch. One person said they were sometimes left on the toilet and had to shout to get staff to come and help them. Several people made reference to feeling rushed or harassed by staff. One person said staff rush you when you are not well - we are too old and dont want to be hurried along. Six staff returned surveys before our inspection. Of these, 4 staff said there were usually enough staff and 1 said there was always enough staff whilst 1 person said Care Homes for Older People Page 24 of 31 Evidence: they thought there was only sometimes enough staff. We looked at the staff duty rotas for the weeks beginning 15/1/09 and 22/1/09. These showed that from 8am until 3pm there was often 1 team leader plus 5 or 6 carers, but that from 3pm until 10pm there was often only 1 team leader with 4 carers. This was discussed with the manager and it was recommended that she keeps staffing levels in the afternoons under review as, depending on the amount of care and support people living at the home need, which will vary, these staffing levels may not always be enough for staff to meet peoples needs. We looked at two staff personnel files and these showed that all the information and documents required for new employees, to check their suitability to work in a care home, had been obtained before they started working there. In the AQAA the manager reported that 13 of the 20 care staff had successfully completed NVQ training. Staff also told us they had undertaken training over the past year in a range of topics such as first aid, the management of medicines, audiology, pressure care and dementia care. Training records verified this. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using 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. Some changes had been made as a result of feedback from people living at the home and the return of the manager has improved the daily organisation and running of the home. Evidence: Since the last inspection the manager has returned from maternity leave and is in the process of registering with us. A number of people living at the home said they did not see the manager very much around the home; several people referred to her coming into the dining room about once per week and saying hello and leaving again. People said there were sometimes residents meetings and minutes were available for meetings dated 14/3/08 and 11/10/08. We were told the next meeting was planned for February. The minutes of the last meeting were displayed on the noticeboard in reception but one person said they were too high up for people in wheelchairs to reach or see. The minutes showed Care Homes for Older People Page 26 of 31 Evidence: that people had been asked for and given suggestions about outings they would like to go on and food they would like on the menu. One person commented that it would be useful if the minutes of the previous meeting could be read out at the next one so people could discuss what had been actioned from their suggestions and what had not. Staff said they had staff meetings and felt they were supported by the manager. One staff member said she thought improvements to the service had been made since the manager returned to work. Several people living at the home thought the home was good or above average, although a number commented that it was not like home. Senior managers from Borough Care had visited the home in accordance with Regulation 26 of the Care Homes Regulations 2001 and reports were available of their findings. The manager completes a monthly audit (check) that is sent to the companys head office. The audit covers areas such as medicine management and health and safety records. Procedures for the management and safekeeping of residents money were satisfactory. Records were available to show that health and safety checks had been carried out in the building and equipment had been regularly serviced. Staff were observed using the hoist using safe working practices. As stated in the complaints and protection section of this report, we could not find a record of an incident between 2 people living at the home that we were told about. Staff should make sure that any such incidents are reported so a decision can be made if further action needs to be taken. Care Homes for Older People Page 27 of 31 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Staff must ensure that medicines are given at the times prescribed. This will ensure that medicines work properly 13/03/2009 2 9 13 Medicine administration records must accurately show the correct dose of medicine to be taken. This will ensure staff know the correct dose to give and will minimise errors. 31/03/2009 3 9 13 Where people manage their own medicines risk assessments must be completed. This will ensure the right support is offered. 31/03/2009 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 Care Homes for Older People Page 29 of 31 1 3 Care should be taken to ensure that all the information obtained during the assessment process is considered when developing care plans and assessing risk for people. If changes are made to care plans and risk assessments it should be clear what the changes are and when they were made. This will help staff review how effective any changes are. Staff should ensure that people are adequately supported to maintain their personal hygiene. Nutritional screening should be undertaken for people on admission in accordance with Department of Health guidelines. When staff handwrite instructions for the administration of medicines these should be checked and verified by a second member of staff to reduce the risk of errors. Training in providing activities for older people should be arranged for the care supervisor to help her develop this role. Complaints records should show the outcome of any action taken in response to complaints, so there is a record of whether the complainant was satisfied. The manager should keep staffing levels in the afternoons and evenings under review to ensure that according to the dependency levels of people living there enough staff are on duty to meet their needs. The manager should consider raising her visibility around the home to make sure everyone living there understands her role and feels confident in approaching her. Staff should ensure that all accidents and incidents that occur in the home are fully recorded and reported so the manager can decide if further action is needed to keep people safe. 2 7 3 4 8 8 5 9 6 12 7 16 8 27 9 31 10 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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