Inspection on 19/11/08 for Melrose Residential Home

This inspection was carried out on 19th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Melrose Residential Home 23/04/08

Melrose Residential Home 26/04/07

Melrose Residential Home 11/05/06

Melrose Residential Home 04/01/06

Melrose Residential Home 26/04/05

Melrose Residential Home 12/10/04

Melrose Residential Home 01/06/04

Melrose Residential Home 24/02/04

Similar services:

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Melrose Residential Home 50 Moss Lane Leyland Preston Lancashire PR25 4SH     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: Pat White     Date: 1 9 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 32 Information about the care home Name of care home: Address: Melrose Residential Home 50 Moss Lane Leyland Preston Lancashire PR25 4SH 01772434638 F/P01772434638 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Janet Lesley Turner Type of registration: Number of places registered: Mrs Amina Makda,Miss Shazmeen Makda care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The home is registered in the category Old Age, not falling into any other category (OP) for 25 persons, and one named person in the category of Physical Disability (PD). The total numbers in the home are not to exceed 26 Date of last inspection Brief description of the care home Melrose is a care home providing personal care and accommodation for up to 26 older people. Nursing care is not provided by the home and the district nursing team undertakes any nursing intervention needed. Melrose is privately owned and is situated close to the town centre of Leyland with all the local amenities. The home provides accommodation on three floors in both shared and single rooms. All the former shared rooms have a single occupant. One single room has an en-suite facility. The communal Care Homes for Older People Page 4 of 32 Over 65 25 0 0 1 Brief description of the care home areas are situated on the ground floors and the home has a passenger lift and stair lift. There are garden areas at the front and the back of the house grounds and parking facilities at the front. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owner and staff and the services residents can expect if they choose to live at the home. A copy of the Service User Guide is issued to all residents and their relatives/representatives on admission. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection visit to Melrose care home was carried out on the 19th November 2008. This visit was part of a key inspection to determine an overall assessment on the quality of the services provided by the home. It included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People, and checking the progress made on the matters that needed improving from the previous key (main) inspection in April 2008. At this last main inspection the home was rated as a poor service, and as such had to submit an improvement plan to inform the commission of how the management (owners and acting manager) would improve the service. After the key inspection in April a random visit, including a pharmacist inspectors inspection of medication, was undertaken at the end of July to monitor the improvement plan. This random inspection is also referred to in this report. Care Homes for Older People Page 6 of 32 This key inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents care records and other documents and discussion with the acting manager and other staff. Five residents gave their views about the home. The views of these people are included in this report. Other residents were spoken to but were unable to give their views about the home. Survey questionnaires from the commission were sent to some other residents, and staff, and questionnaires for relatives were left at the home for distribution. At the time of writing this report five residents and one relative had returned completed questionnaires, and their views expressed are also included in the report. However we had not received any completed questionnaires from staff. What the care home does well: What has improved since the last inspection? There had been a number of improvements since the last inspection. The way residents were admitted to the home now included finding out about how much care people needed and what kind of support was needed, before they were offered a place. This is so that people know whether or not the home can look after them. The written information about the care people needed was also improved and more up to date, so that staff had useful guidance on how to look after people. Residents medication was stored more safely than at the previous main inspection, and some procedures had been improved such as the accurate recording of medication coming into the home. This made mistakes less likely and provided a system of checking whether or not residents received the correct medication (see below). There had been some improvement in the leisure activities provided in the home. There was more variety, and residents and staff spoke more positively about this aspect of life in the home. Thos who completed questionnaire surveys said that they were satisfied with the activities provided in the home. The procedures to follow in the event of a suspicion or allegation of abuse had been developed and made clearer and up to date training in this matter was planned. These measures should help to ensure that people were protected. There had been further improvement to the environment. There were some new beds and some bedroom carpets had been replaced. Repairs to appliances were being carried out more promptly which made the staffs jobs easier. The staff training had improved and there was a programme of updating essential training such as moving and handling and first aid. This will help to ensure people are looked after safely. Care Homes for Older People Page 8 of 32 Staff recruitment procedures were more thorough and should help prevent unsuitable people from working in the home. 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. Care Homes for Older People Page 9 of 32 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 10 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedures helped prospective residents and relatives to decide whether or not the home was suitable for meeting their needs, and helped staff understand these needs. Evidence: There was written information about the home (the service user guide) to inform people of the services and facilities at Melrose. However this had still not been reviewed and updated, inspite of a previous recommendation, so the information was out of date and did not give people accurate information about the home. Only one resident and one relative returned completed questionnaires to the commission, but both said that they had enough information to help them make a decision about whether or not the home was a suitable place for them to live. Care Homes for Older People Page 12 of 32 Evidence: Since the last key inspection there was an improvement in the way people were admitted to the home. The viewing of records, and discussions with the acting manager, showed that the acting manager had ensured that the needs of people recently admitted to the home had been assessed. She had visited them where they were living, and obtained information from the social worker in order to help decide whether or not the home could meet their needs. People, including relatives, were able to visit the home to help them make a decision about the suitability of the home. The written assessments contained sufficient detail to assist staff to undersdtand peoples needs on admission. The residents spoken with, and the 2 people who completed a questionnaire, indicated that at the time of our visit to the home, their needs were usually met. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents had written care plans that helped staff understand what care to provide but these were not always up to date with accurate instructions. Medication practices and procedures in general ensured that the right medication was given at the right time medication but some practices could be improved. Evidence: All residents had care plans and those seen had a good level of detail on most important matters, including mental health, continence and pressure area prevention, to assist staff provide the care required. Most of these plans had been reviewed and updated since the last main inspection and the details of the mental health needs of people had improved. However for one resident who had recently been discharged from hospital, and whose care needs had changed considerably, there was no up to date information about the care and supervision needed. Also there was insufficient information about peoples background and interests and hobbies to assist staff provide the most appropriate stimulating activities. Care Homes for Older People Page 14 of 32 Evidence: One resident had the use of bed rails to prevent them falling out of bed, but there was a gap between the rails and the overlay pressure relief mattress. This potentially put the resident at risk from limb entrapment. Also the written risk assessment had identified this risk but did not include any action to be taken to protect the resident. This risk assessment and the risk of falling out of bed had not been reviewed for a number of years, and it was not clear if the bed rails were still needed. Records and talking to the manager showed that residents received the medical care they needed. General Practitioners and district nurses were involved as necessary and there was good liaison with the mental health team. Since the previous main inspection and a random inspection including a pharmacists inspection of medication, medication practices and procedures had improved. The storage of medication was more secure and therefore safer. Accurate records were now being kept of medication coming into the home so there was a clearer audit trail of all medication. Also some of the advice given by the pharmacist inspector regarding record keeping was now being followed. Controlled drugs (CDs) were being stored properly and the CD register showed was accurate and showed that the number of drugs stored in the home was correct according to the number administered. We were also told that all staff administering medication had undertaken appropriate training. However there were still some errors being made. Two residents had not been given an evening medicine just prior to the site visit. Also there were insufficient written instructions for the administration of some medication. This included when required (PRN) medication and thickening substance to prevent choking. There was also insufficient evidence that some medication administration had been verbally altered by the General Practioner. One resident was prescribed 2 types of PRN painkiller but there was insufficient information about how these should be used together according to the GPs verbal instructions. There was therefore a risk that the resident might receive the wrong combination. Also for one resident there were insuffcient instructions about the administration of 2 PRN laxatives in relation to each other and also inadequate instructions for the admionistration of PRN painkillers. Another resident was taking a homely remedy on the advice of a visitor, but this had not been authorised by the GP. At the previous random inspection the pharmacist inspector had strongly advised that the acting manager undertake regular audits of medication to identify errors and areas for development. However we were informed at this site visit that she did not have enough time to do this (see Management and Administration). All residents who were spoken with said that they were well looked after and that the staff treated them well. One said they are so kind. Residents said that staff were attentive and that they usually had the care when needed. Staff were seen treating residents respectfully, patiently and good humouredly. However the hairdresser was Care Homes for Older People Page 15 of 32 Evidence: still using the bedroom of someone who could not give permission, to wash peoples hair even though there were downstairs bathroom facilities. This has been highlighted at previous visits to the home, and the management should give serious consideration to changing this practice. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were adequate activities to suit most peoples interests and most people were satisfied with the level of choice and flexibility in the daily routine. The food served suited most residents tastes and preferences. Evidence: Since the previous inspection there had been some improvement in the provision of social activities and entertainment for people living in the home. Residents and staff confirmed that some new activities had been introduced, such as dominoes, musical entertainment and a TV package to extend viewing options. There had also been a Halloween party. The acting manager was in the process of engaging an activities organiser. One resident was being encouraged to pursue a former occupation of knitting, and to go out more frequently with visitors and staff. Those residents who completed the questionnaire survey also indicated that they were satisfied with the activities in the home. However there was little written information about peoples former hobbies and interests so the planned activities may not be suitable for individual tastes and preferences. This was discussed with the manager and in particular the request of one resident who talked to us. Care Homes for Older People Page 17 of 32 Evidence: Daily routines were sufficiently flexible to suit individuals, and residents said they could get up and go to bed when they wanted and spend time in their rooms. Residents in general were satisfied with the level of choice they had. No visitors were seen at this inspection, but at previous visits relatives had said they were made welcome in the home at any reasonable time and that staff were friendly and approachable. The relatives who completed the questionnaires said that the staff were friendly, communicated well and worked hard. Some residents said that relatives visited frequently and that the staff supported them to go out with them. Residents who were spoken with, and those who completed the questionnaires, said they were satisfied with the meals served, though one person said there was not enough variety. The main hot meal served on the day of the site visit appeared tasty and wholesome. The menus viewed showed a satisfactory variation of traditional dishes. However the food served was not the same as on the menus and this could mislead people. The menus showed a 3 course meal served at lunch time, but in reality only a main course and pudding was served. The cook said that this was because people could not eat 3 courses and that it was the residents choice that there was only 2 courses. The lunch time meal observed was relaxed and unhurried and staff assisted people in a sensitive and patient manner. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The policies and procedures regarding complaints and protection of people from abuse, should help ensure that peoples concerns were taken seriously and that they are protected from abuse. Evidence: The home had a complaints procedure that was accessible to people. Residents spoken with said that they had no complaints but if they had they would speak to relatives or the staff and one person gave an example of having spoke to the acting manager about something she was not happy with. No formal complaints had been made in the home since the last main inspection, and none had been made to the commission. There had been no recent allegations or suspicions of abuse, and the homes policies and procedures to help safeguard people from abuse had been recently developed in accordance with local and national guidelines. They now included the correct information to help guide staff and therefore protect people. Staff training in the protection of vulnerable adults was planned for the near future and this should further help to protect people. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides clean, safe and comfortable accommodation for the residents and their bedrooms suited their needs. However not all parts of the home were well maintained including some appliances. Evidence: A tour of the premises showed that further improvements to the premises had been undertaken since the previous main inspection. These included some decorating, repairs to appliances, and some new beds and carpets. The building work in one half of the house to create another dining room and 3 ensuite bedrooms was complete but the rooms were not furnished. Also there were some other outstanding maintenance jobs such as damaged doors and skirting boards. All areas of the home were comfortable and homely, and the bedrooms (all being used as single rooms) were spacious and personalised with residents own possessions. There were garden areas at the front and back of the house. These had been tidied since the last inspection, but not all areas were yet safe for residents to walk around or developed for them to enjoy. The home is in two parts separated on the ground floor by 5 stairs. The main Care Homes for Older People Page 20 of 32 Evidence: communal space, comprising of a two - part lounge and a through dining room is in one part and some some bedrooms, including the new ones, and the kitchen are in the other part. Staff have to carry food up and down the connecting 5 stairs to and from the kitchen, and residents have to negotiate these stairs to get to the dining room. This presents a potential hazard to staff, and difficulties for some residents, at least one of whom could not use these stairs at the time of the site visit and therefore had to remain in her room. The home was warm and pleasantly heated at the time of the site visit and the hot water temperatures were of a safe and comfortable range. All areas of the residents private and communal areas were clean and fresh at the time of the visit and there were satisfactory laundry procedures. The resident survey questionnaires said that the home was always clean and fresh. However in the kitchen one area needed cleaning. This had been identified at an Environemental Health inspection, and was rectified before the end of the site visit. Also one freezer was not working properly, and if not replaced or repaired could result in contaminated food. Also the oven door was broken and this created an inconvenience for the cook and created a risk of food not being cooked properly. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff training programme was being developed to ensure that staff had the necessary skills and knowledge to look after older people but the number of staff required on duty was not set according to the needs of the residents. Recruitment procedures were sufficiently thorough to help protect residents from unsuitable staff. Evidence: We were informed that the owners had given instructions, a few days before the inspection visit, that the number of care hours during the day must be reduced due to the fall in resident numbers. However staff also informed us that there were 3 residents who needed 2 carers to assist in all aspects of their personal care, one of whom needed considerable supervision. They were concerned that in this situation some residents would not receive the care that they needed as if both carers on duty were attending a resident there would be no cover for the rest of the residents. We were informed that staffing levels were not being set according to the dependency needs of the residents but according to numbers and financial limits. Social services also recently informed us that they were concerned about the staffing levels in the home and in particular whether or not there were sufficient staff to meet the needs of the residents (see beloow). A cook and cleaner were working in the home and this helped to ensure that good standards of food and cleanliness were maintained. Care Homes for Older People Page 22 of 32 Evidence: A high number of care staff had gained National Vocational Qualifications in care. We were informed that 13 out of 16 were qualified to level two, and 10 to level three. Records and discussion with the acting manager showed that other aspects of staff training had improved since the last main inspection. A rolling programme of update training had been introduced in moving and handling, first aid, protection of vulnerable adults and food hygiene. There was a programme of induction for new members of staff. However new members of staff without care qualifications or experience of working in care, did not undertake a detailed enough induction training that was in accordance with government guidance. Therefore they may not have the right knowledge and skills to work independently. Staff spoken with confirmed that the up dated training was taking place and that there was a good staff team who supported one another. As stated earlier no survey questionnaires were received from staff, so a wider staff view has not been assessed. The residents spoken with also praised the staff for their kindness and commitment. Those residents who completed the survey questionnaires said that they usually received care when needed and that staff were usually available. However these were completed before the changes in staffing levels referred to above were implemented so the direct impact on residents of the changes was not clear. The records of two members of staff who had commenced work in the home since the last main inspection showed that recruitment procedures were sufficiently thorough to help ensure that only suitable people worked in the home. All the necessary checks, including the criminal records bureau check and references were carried out before people began work in the home. However for one new member of staff there was no written record of why a previous employer in a care service would not give a reference, so important information about this persons previous relevant work experience was missing. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a competent acting manager, but who is not registered with the commission, and was not given sufficient time and support for the management role. The overall management of the home needs to be improved in the best interests of residents and staff. Evidence: The acting manager had made some improvements in the home since the last main inspection, and according to the requirements and recommendations we made (see below). However we still have concerns about the overall management and running of the home. At the time of our inspection visit there was still no registered manager. The acting manager had been managing Melrose for about a year, and inspite of assurances from the owners in July that a permanent manager would be appointed this was still not finalised. The acting manager was also a senior carer and divided her working week between Care Homes for Older People Page 24 of 32 Evidence: these two roles and did not have sufficient time to manage the home as effectively as is necessary to fully improve and develop the service, such as monitoring medication, developing care plans and policies and procedures, and supervising staff. Social services have also expressed concern to the commission about the lack of permanent manager in the home and the effect on the acting manager and staff in terms of insufficient support and management hours. The commission is addressing this matter specifically with the owners. Staff in discussion said that they felt the acting manager was managing the home as effectively as possible under difficult circumstances of lack of time and insufficient support from the owners. Also in spite of the pressures on her time the acting manager had been able to make some of the necessary improvements required from the last main inspection, such as in recreational activities for the residents and staff training. Since the last main inspection one of the owners had been visiting the home, and had undertaken unannounced monitoring visits under Regulation 26 of the Care Homes Regulations. However reports of these visits did not demonstrate that the owner was dealing with all the previous issues of concern, or supporting the acting manager in a constructive manner. There there was still a lack of communication and clarity from the owners about some important matters concerning the running of the home, such as the future management, resources available, and a lack of understanding regarding the staffing needs of the home. The staff informed us that the acting manager did not have time to undertake one to one supervision or hold regular staff meetings, so overall communication and support within the home was of an ad hoc basis. Since the previous inspection there had been no developments in the homes formal systems to include residents views in the planning and development of the services and facilities in the home. Whilst it was clear from talking to people and from those who completed the questionnaires, that staff listened to residents, there was no evidence that the management of the home developed the services according to these views. The home generally provided a safe environment for residents and staff. All equipment, appliances and installations had been appropriately serviced and maintained. However it was unclear whether or not the fire alarms were being tested frequently enough. The acting manager was advised to contact the fire service about this at the last main inspection and this was still outstanding. Also there were concerns about the fitting of bed rails on one of the beds (see section on Health and Personal Care). Care Homes for Older People Page 25 of 32 Evidence: Since the previous main inspection the acting manager had been notifying the commission of all relevant incidents and accidents, and this enabled the commission to monitor these events. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 All care plans should be updated as required and in particular when care needs change considerably. So that staff have written information about the changes in care needs and so they can provide the right care 31/12/2008 2 8 13 Bed rails and mattresses 31/12/2008 must be fitted correctly so that there are no gaps which could cause limb entrapment. The use of bed rails must be underpinned by an up to date accurate risk assessment that is reviewed and updated. So that residents are not injured 3 9 13 All medication must be given 31/12/2008 as prescribed and must not be omitted without good reason Care Homes for Older People Page 28 of 32 So that residents receive the medication they need to keep them as healthy as possible 4 19 16 All appliances must be in 31/12/2008 good working order including the freezer and the cooker. To prevent contamination of food and to ensure that food is cooked properly 5 27 18 The staffing numbers in the 31/12/2008 home must be set according to the needs and dependency levels in the home and not just according to the numbers of residents. So that there are sufficient staff to give the residents the care they need, when they need it 6 30 18 The Induction training programme for new staff must be in accordance with Governement guidance and sufficiently detailed. So that new staff without the relevant qualifications and experience have sufficient skills and knowledge to look after people. 7 31 8 The registered provider must ensure that there is a permanent manager appointed who is to be registered with the commission 28/03/2009 31/01/2009 Care Homes for Older People Page 29 of 32 So that there is permanent and effective management in the home to develop and maintain services Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and service user guide should be reviewed and updated to ensure it is up to date with developments and changes so that people have accurate information. There should be an assessment of peoples needs based on dependency and support needed, and staffing levels maintained accordingly so that peoples needs are met. There should be sufficient written instructions regarding the adminstration of when required medication and in particular when 2 or more medicines are prescribed together and to be used in combination and including pain relief, laxatives and thickeners. There should be written evidence of the prescribers change of administration instructions so that it is clear what the changes are and who has authorised the change. 2 4 3 9 4 9 The General practitione should be consulted about the use of all homely remedies to ensure that they are compatible with prescribed medication. The acting manager should undertake regular audits of all aspects of medication management to identify errors. The practice of washing residents hair in an occupied bedroom should cease in order to uphold the residents rights to privacy and dignity. There should be sufficient choice of activities to suit individuals tastes and interests. Accurate records should be kept of the food/meals served and should include breakfast and suppers. The menus should be updated and corrected to reflect the meals served. The stairs between the two parts of the home should be made safer and accessible for residents and staff. 5 6 9 10 7 8 12 15 9 19 Care Homes for Older People Page 30 of 32 10 11 20 32 The outside grounds should be developed and made safe so that residents can enjoy being outside. Through effective support the registered provider should ensure that staff morale is improved and that staff feel valued and supported A quality monitoring system should be set up that includes the views of residents in the development of the home There should be a system of formal supervision and support that includes one to one face to face meetings between a manager and care staff The fire service should be consulted about the frequency of the fire alarm testing. 12 13 33 36 14 38 Care Homes for Older People Page 31 of 32 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 © (2008) Commission for Social Care Inspection (CSCI). 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